Transcriber's notes: Seven typographical errors have been corrected: Page 8, "15" changed to "18" (See Fig. 18) Page 208, "5" changed to "7" (See Fig. 7) Page 281, "does" changed to "dose" (Give a big dose of castor oil) Page 306, "he" changed to "be" (which should be covered with a single thickness) Page 348, "iself" changed to "itself" (than by the bite itself) Page 362, "dioxid" changed to "dioxide" (harmless substances as water and carbon dioxide) Page 435, "ecezmatous" changed to "eczematous" (to keep the eczematous skin area moist) [Illustration] THE MOTHERAND HER CHILD BY WILLIAM S. SADLER, M. D. PROFESSOR OF THERAPEUTICS, THE POST-GRADUATE MEDICALSCHOOL OF CHICAGO; DIRECTOR OF THE CHICAGO INSTITUTEOF PHYSIOLOGIC THERAPEUTICS; FELLOW OF THEAMERICAN MEDICAL ASSOCIATION; MEMBER OFTHE CHICAGO MEDICAL SOCIETY; THE ILLINOISSTATE MEDICAL SOCIETY; THEAMERICAN ASSOCIATION FOR THE ADVANCEMENTOF SCIENCE, ETC. AND LENA K. SADLER, M. D. ASSOCIATE DIRECTOR OF THE CHICAGO INSTITUTE OF PHYSIOLOGICTHERAPEUTICS; FELLOW OF THE AMERICAN MEDICALASSOCIATION; MEMBER OF THE CHICAGO MEDICALSOCIETY; THE MEDICAL WOMEN'S CLUB OF CHICAGO;NATIONAL CONGRESS OF MOTHERS ANDPARENT-TEACHER ASSOCIATION; THECHICAGO WOMAN'S CLUB, ETC. _ILLUSTRATED_ [Illustration] TORONTOMcCLELLAND, GOODCHILD & STEWARTCHICAGO: A. C. McCLURG & CO. 1916 Copyright A. C. McClurg & Co. 1916 * * * * * Published August, 1916 * * * * * _Copyrighted in Great Britain_ W. F. HALL PRINTING COMPANY, CHICAGO TO "BILLY" WHO, BECAUSE OF HIS UNCONSCIOUS CONTRIBUTIONS TO ITSPRACTICAL FEATURES, SHOULD BE REGARDED AS ACO-AUTHOR, THIS VOLUME IS AFFECTIONATELYDEDICATED BY HIS PARENTSTHE AUTHORS PREFACE For many years the call for a book on the mother and her child hascome to us from patients, from the public, and now from ourpublishers--and this volume represents our efforts to supply thisdemand. The larger part of the work was originally written by Dr. Lena K. Sadler, with certain chapters by Dr. William S. Sadler, but in therevision and re-arrangement of the manuscript so much work was done byeach on the contributions of the other, that it was deemed best tobring the book out under joint authorship. The book is divided into three principal parts: Part I, dealing withthe experience of pregnancy from the beginning of expectancy to theconvalescence of labor: Part II, dealing with the infant from itsfirst day of life up to the weaning time; Part III, taking up theproblems of the nursery from the weaning to the important period ofadolescence. The advice given in this work is that which we have tried out byexperience--both as parents and physicians--and we pass it on tomothers, fathers, and nurses with the belief that it will be of helpin their efforts at practical and scientific "child culture. " Webelieve, also, that the expectant mother will be aided and encouragedin bearing the burdens which are common to motherhood by the adviceand instruction offered. While we have drawn from our own professional and personal experiencein the preparation of this book, we have also drawn freely from thepresent-day literature dealing with the subjects treated, and desireto acknowledge our indebtedness to the various writers andauthorities. We now jointly send forth the volume on its mission, as a contributiontoward lightening the task and inspiring the efforts of those mothers, nurses, and others who honor us by a perusal of its pages. WILLIAM S. SADLER. LENA K. SADLER. _Chicago_, 1916. CONTENTS * * * * * PART I THE MOTHER CHAPTER PAGE I The Expectant Mother 1 II Story of the Unborn Child 7 III Birthmarks and Prenatal Influence 14 IV The Hygiene of Pregnancy 21 V Complications of Pregnancy 35 VI Toxemia and Its Symptoms 47 VII Preparations for the Natal Day 53 VIII The Day of Labor 63 IX Twilight Sleep and Painless Labor 71 X Sunrise Slumber and Nitrous Oxid 84 XI The Convalescing Mother 93 PART II THE BABY XII Baby's Early Days 103 XIII The Nursery 114 XIV Why Babies Cry 123 XV The Nursing Mother and Her Babe 133 XVI The Bottle-Fed Baby 147 XVII Milk Sanitation 156 XVIII Home Modification of Milk 165 XIX The Feeding Problem 177 XX Baby's Bath and Toilet 190 XXI Baby's Clothing 202 XXII Fresh Air, Outings, and Sleep 213 XXIII Baby Hygiene 222 XXIV Growth and Development 232 PART III THE CHILD XXV The Sick Child 251 XXVI Baby's Sick Room 266 XXVII Digestive Disorders 274 XXVIII Contagious Diseases 285 XXIX Respiratory Diseases 300 XXX The Nervous Child 308 XXXI Nervous Diseases 323 XXXII Skin Troubles 333 XXXIII Deformities and Chronic Disorders 341 XXXIV Accidents and Emergencies 348 XXXV Diet and Nutrition 360 XXXVI Caretakers and Governesses 370 XXXVII The Power of Positive Suggestions 380 XXXVIII Play and Recreation 390 XXXIX The Puny Child 400 XL Teaching Truth 405 Appendix 427 Index 449 ILLUSTRATIONS The mother and her child _Frontispiece_ FIGURE PAGE 1 Steps in early development 10 2 The "expectant" costume 23 3 The photophore 43 4 Taking the blood pressure 48 5 Breast binder 59 6 How to hold the baby 110 7 Making the sleeping blanket 117 8 In the sleeping blanket 118 9 Homemade ice box 149 10 Heating the bottle 151 11 A sanitary dairy 158 12 Articles needed for baby's feeding 167 13 Supporting the baby for the bath 194 14 Developmental changes 240 15 The cooling enema 290 16 X ray showing tuberculosis of the lung 346 17 Father and Mother Corn and Morning Glory 406 PART I THE MOTHER THE MOTHER AND HER CHILD * * * * * PART I THE MOTHER * * * * * CHAPTER I THE EXPECTANT MOTHER There can be no grander, more noble, or higher calling for a healthy, sound-minded woman than to become the mother of children. She may bethe colaborer of the business man, the overworked housewife of thetiller of the soil, the colleague of the professional man, or the wifeof the leisure man of wealth; nevertheless, in every normal woman inevery station of life there lurks the conscious or sub-consciousmaternal instinct. Sooner or later the mother-soul yearns and criesout for the touch of baby fingers, and for that maternal joy thatcomes to a woman when she clasps to her breast the precious form ofher own babe. MOTHERHOOD THE HIGHEST CALLING Motherhood is by far woman's highest and noblest profession. Science, art, and careers dwindle into insignificance when we attempt tocompare them with motherhood. And to attain this high profession, toreach this manifest "goal of destiny, " women are seeking everywhere toobtain the best information, and the highest instruction regarding"mothercraft, " "babyhood, " and "child culture. " In an Indiana town not long ago, at the close of a lecture, a small, intellectual-appearing mother came forward, and, tenderly placing hertiny and emaciated infant in my arms, said: "O Doctor! can you help mefeed my helpless babe? I'm sure it is going to die. Nothing seems tohelp it. My father is the banker in this town. I graduated from highschool and he sent me to Ann Arbor, and there I toiled untiringly forfour years and obtained my degree of B. A. I have gone as far as Icould--spent thousands of dollars of my unselfish father's money--butI find myself totally ignorant of my own child's necessities. I cannoteven provide her food. O Doctor! can't something be done for youngwomen to preparé them for motherhood?" MOTHERCRAFT PREPARATION The time will come when our high and normal schools will provideadequate courses for the preparation of the young woman for herhighest profession, motherhood. This young mother, who had reached thegoal of Bachelor of Arts, found to her sorrow that she was entirelydeficient in her education and training regarding the duties andresponsibilities of a mother. In every school of the higher branchesof education that train young women in their late teens there shouldbe a chair of mothercraft, providing practical lectures on babyhygiene, dress, bathing, and the general care of infants, and givinginstruction in the rudiments of simple bottle-feeding, together withthe caloric values of milk, gruels, and other ingredients which enterinto the preparation of a baby's food. Young women would most enthusiastically enroll for such classes, andas years passed and marriage came and children to the home, imaginethe gratitude that would flood the souls of the young mothers who werefortunate enough to have attended schools where the chairs ofmotherhood prepared them for these new duties and responsibilities. EARLY MEDICAL SUPERVISION Just as soon as it is known that a baby is coming into the home, theexpectant mother should engage the best doctor she can afford. Sheshould make frequent calls at his office and intelligently carry outthe instruction concerning water drinking, exercise, diet, etc. Twenty-four hour specimens of urine should be frequently saved andtaken to the physician for examination. In these days theblood-pressure is closely observed, together with approachingheadaches and other evidences of possible kidney complications. Theearly recognition of these dangers is accompanied by the immediateemployment of appropriate sweating procedures and other measuresdesigned to promote the elimination of body poisons. Thus science isable effectively to stay the progress of the high blood-pressure offormer days, and which was so often followed by eclampsia--uremicpoisoning. In these days of careful urine analysis, expertly administeredanaesthetics, and up-to-date hospital confinements, the averageintelligent woman may enter into pregnancy quite free from the oldtimefears, whose only rewards were grief and cankering care. All fear ofchildbirth and all dread of maternal duties and sacrifices do not inthe least lessen the necessary unpleasantness associated with normallabor. It lies in the choice of every expectant mother to journeythrough the months of pregnancy with dissatisfaction and resentment orwith joy and serenity. "The child will be born and laid in your armsto be fed, cared for, and reared, whether you weep or smile throughthe months of waiting. " THE RESENTFUL MOTHER A little woman came into our office the day of this writing, saying:"Doctor, I'm just as mad as I can be; I don't want to be pregnant, Ijust hate the idea. " As I smiled upon this girl-wife of nineteen, Idrew from my desk a sheet of paper and slowly wrote down these wordsfor the head of a column: "Got a mad on, " and for the head of another, "Got a glad on;" and then we quickly set to work carefully to tabulateall the results that having a "mad on" would bring. We found to herdismay that its harvest would be sadness of the heart, husbandunhappy, work unbearable, while all church duties as well as socialfunctions would be sadly marred. Then, just as carefully, wetabulated the benefits that would follow having a "glad on. " Her facebroke into a smile; she laughed, and as she left the office sheassured me that she would accept Nature's decree, make the best of herlot, and thus wisely align herself with the normal life demands of oldMother Nature. This view of her experience, she came to see, wouldbring the greatest amount of happiness to both herself and husband. She left me, declaring that she was just "wild for a baby;" and thereis still echoing in my ears her parting words: "I'm leaving you, Oh, such a happy girl! and I'm going home to Harold a happy and contentedexpectant mother. " There often enters on the exit of a discontented and resentfulexpectant mother, a woman, very much alone in the world--perhaps abachelor maid or a barren wife, who, as she sits in the office, bitterly weeps and wails over her state of loneliness or sterility;and so we are led to realize that discontentment is the lot of manywomen; and we are sometimes led to regret that ours is not the powerto take from her that hath and give to her that hath not. EARLY SIGNS OF PREGNANCY Among the first questions an expectant mother asks is: "What are earlysigns of pregnancy?" The answer briefly is: 1. Cessation of menstruation. 2. Changes in the breast. 3. Morning sickness. 4. Disturbances in urination. Menstruation may be interrupted by other causes than pregnancy, butthe missing of the second or third periods usually indicatespregnancy. Accompanying the cessation of menstruation, changes in thebreast occur. Sensation in the breasts akin to those which usuallyaccompany menstruation are manifested at this time in connection withthe unusual sensations of stinging, prickling, etc. Fully one-half ofour patients do not suffer with "morning sickness;" however, it is thegeneral consensus of opinion that "morning sickness" is one of theearly signs of pregnancy, and these attacks consist of allgradations--from slight dizziness to the most severe vomiting. It isan unpleasant experience, but in passing through it we may be glad inthe thought that "it too, will pass. " Because of the pressure exerted by the growing uterus upon thebladder, disturbances in urination often appear, but as the uteruscontinues to grow and lifts itself up and away from the bladder thesesymptoms disappear. Chief of the later signs of pregnancy are "quickening" or fetalmovements. The movements are very much like the "fluttering of a youngbirdling. " They usually are felt by the expectant mother between theseventeenth and eighteenth weeks. This sign, together with the notingof the fetal heartbeat at the seventh month, constitute the positivesigns of pregnancy. PROBABLE DATE OF DELIVERY And now our expectant mother desires to know when to expect the littlestranger. From countless observations of childbirth under allconditions and in many countries, the pregnant period is found tocover about thirty-nine weeks, or two hundred and seventy-three days. There are a number of ways or methods of computing this time. Manyphysicians count back three months and add seven days to the first dayof the last menstruation. For instance, if the last menstruation wereDecember 2 to 6, then, to find the probable day of delivery, we countback three months to September 2, and then add seven days. This givesus September 9, as the probable date of delivery. The real date ofdelivery may come any time within the week of which this calculateddate is the center. As a rule, ten days to two weeks preceding the day of delivery, theuterus "settles" down into the pelvis, the waist line becomes morecomfortable, and the breathing is much easier. On the accompanying page, may be found a table for computing theprobable day of labor, prepared in accordance with the plan justdescribed. TABLE FOR CALCULATING THE DATE OF CONFINEMENT =========+=================================================+=======Jan. | 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 |Oct. | 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 |---------+-------------------------------------------------+-------Jan. | 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 |Oct. | 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 | Nov. =========+=================================================+=======Feb. | 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 |Nov. | 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 |---------+-------------------------------------------------+-------Feb. | 17 18 19 20 21 22 23 24 25 26 27 28 |Nov. | 24 25 26 27 28 29 30 1 2 3 4 5 | Dec. =========+=================================================+=======Mar. | 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 |Dec. | 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 |---------+-------------------------------------------------+-------Mar. | 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 |Dec. | 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 | Jan. =========+=================================================+=======April. | 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 |Jan. | 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 |---------+-------------------------------------------------+-------April. | 17 18 19 20 21 22 23 24 25 26 27 28 29 30 |Jan. | 22 23 24 25 26 27 28 29 30 31 1 2 3 4 | Feb. =========+=================================================+=======May. | 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 |Feb. | 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 |---------+-------------------------------------------------+-------May. | 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 |Feb. | 21 22 23 24 25 26 27 28 1 2 3 4 5 6 7 | Mar. =========+=================================================+=======June. | 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 |Mar. | 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 |---------+-------------------------------------------------+-------June. | 17 18 19 20 21 22 23 24 25 26 27 28 29 30 |Mar. | 24 25 26 27 28 29 30 31 1 2 3 4 5 6 | Apr. =========+=================================================+=======July. | 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 |Apr. | 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 |---------+-------------------------------------------------+-------July. | 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 |Apr. | 23 24 25 26 27 28 29 30 1 2 3 4 5 6 7 | May. =========+=================================================+=======Aug. | 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 |May. | 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 |---------+-------------------------------------------------+-------Aug. | 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 |May. | 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 | June. =========+=================================================+=======Sept. | 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 |June. | 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 |---------+-------------------------------------------------+-------Sept. | 17 18 19 20 21 22 23 24 25 26 27 28 29 30 |June. | 24 25 26 27 28 29 30 1 2 3 4 5 6 7 | July. =========+=================================================+=======Oct. | 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 |July. | 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 |---------+-------------------------------------------------+-------Oct. | 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 |July. | 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 | Aug. =========+=================================================+=======Nov. | 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 |Aug. | 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 |---------+-------------------------------------------------+-------Nov. | 17 18 19 20 21 22 23 24 25 26 27 28 29 30 |Aug. | 24 25 26 27 28 29 30 31 1 2 3 4 5 6 | Sept. =========+=================================================+=======Dec. | 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 |Sept. | 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 |---------+-------------------------------------------------+-------Dec. | 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 |Sept. | 23 24 25 26 27 28 29 30 1 2 3 4 5 6 7 | Oct. =========+=================================================+======= Supposing the upper figure in each pair of horizontal lines torepresent the first day of the last menstrual period, the figurebeneath it, with the month designated in the margin, will show theprobable date of confinement. CHAPTER II STORY OF THE UNBORN CHILD To every physician in every community, sooner or later in hisexperience there come thoughtless women making requests that we evenhesitate to write about. Their excuses for the crime which they seekto have the physician join them in committing, range all the way from"I don't want to go to the trouble, " to "Doctor, I've got sevenchildren now, and I can't even educate and dress them properly;" or, maybe, "I nearly lost my life with the last one. " EMBRYOLOGICAL IGNORANCE One little woman came to us the other day from the suburbs, andhonestly, frankly, related this story: "We've been married just six months, I have continued my stenographicwork to add the sixty-five dollars to our monthly income. Doctor, wemust meet our monthly payments on the home, I must continue to work, or we shall utterly fail. I am perfectly willing a baby shall come tous two years from now, but, doctor, I just can't allow this one to goon, you must help me just this once. Why doctor, there can't be muchform or life there, it's only three months now, or will be next week, and you know it's nothing but a mass of jelly. " She had talked with a "confidential friend" in her neighborhood, hadbeen told that she "could do it herself, " but fearing trouble orinfection, had come to the conclusion she had better go to a "clean, reputable physician, " to have the abortion performed. This is not the place to narrate the experiences of the unfortunatevictims of habitual criminal abortion, but we would like to impressupon the reader some realization of the untimely deaths, the awfulsuffering, and the life-long remorse and sorrow of the poor, misguidedwomen who listen to the criminal advice of neighborhood "busybodies. "The infections, the invalidism, the sterility that so often follow inthe wake of these practices, are well known to all medical people. THE STREAM OF LIFE And so after the patient's last statement, "It's nothing but a mass ofjelly, " we began the simple but wonderfully beautiful story of thedevelopment of the "child enmothered. " Just as all vegetables, fruits, nuts, flowers, and grains come from seeds sown into fertile soil, andjust as these seeds receive nourishment from the soil, rain, andsunshine, so all our world of brothers and sisters, of fathers andmothers, came from tiny human seeds, and in their turn receivednourishment from the peculiarly adapted stream of life, which flows inthe maternal veins for the nourishment and upbuilding of the unbornembryo. Every little girl and boy baby that comes into the world, has storedwithin its body, in a wonderfully organized capsule, a part of theancestral stream of life that unceasingly has flowed down through thecenturies from father to son and from mother to daughter. This "germplasm" is a divine gift to be held in trust and carefully guarded fromthe odium of taint, to be handed down to the sons and daughters of thenext generation. Any young man who grasps the thought that hepossesses a portion of the stream of life, that he holds it in sacredtrust for posterity, cannot fail to be impressed with a sense ofsolemn responsibility so to order his life as to be able to transmitthis biologic trust to succeeding generations free from taint anddisease. THE PROCESS OF FERTILIZATION Just as within the body of "Mother Morning Glory" (See Fig. 15) may befound the ovary or seed bed, so there are two wonderfully organizedbodies about the size of large almonds found in the lower part of thefemale abdomen on either side of the uterus, and connected to it bytwo sensitive tubes. There ripens in one of these bodies each month ahuman baby-seed, which finds its way to the uterus through the littlefallopian tube and is apparently lost in the debris of cells and mucuswhich, with the accompanying hemorrhage go to make up the menstrualflow. This continues from puberty to menopause, each glandalternatingly ripening its ovum, only to lose it in the periodicalphenomenon of menstruation, which is seldom interrupted save by thatstill more wonderful phenomenon of conception. At the time of conception, countless numbers of male germ-cells(sperms) are lost--only one out of the multitude of these perfectlyformed sperms made up of the mosaics of hereditary depressors, determiners, and suppressors that so subtly dictate and determine thecharacteristics and qualifications of the on-coming individual--Irepeat, only one of these wonderful sperms finds the waiting ovum(Fig. 1). In this search for the ovum, the sperm propels itselfforward by means of its tail--for the male sperm in general appearancevery much resembles the little pollywog of the rain barrel (Fig. 1). The fateful meeting of the sperm and the ovum takes place usually inthe upper end of one of the fallopian tubes. It is a wonderfuloccasion. The wide-awake, vibrating lifelike sperm plunges head firstand bodily into the ovum. The tail, which has propelled this bundle oflife through the many wanderings of its long and perilous journey, nowno longer needed, drops off and is lost and forgotten. This union ofthe male and female sex cells is called "fertilization. " Thereimmediately follows the most complete blending of the two germcells--one from the father and one from the mother--each with itspeculiar individual, family, racial, and national characteristics. Here the combined determiners determine the color of the eyes, thecharacteristics of the hair, the texture of the skin, its color, thesize of the body, the stability of the nervous system, the size of thebrain, etc. , while the suppressors do a similar work in themodification of this or that family or racial characteristic. THE FIRST WEEKS OF LIFE The fertilized ovum remains in the tube for about one week, when itslowly makes its way down into the uterus, all the while rapidlyundergoing segmentation or division. It does not grow much in sizeduring this first week, but divides and subdivides first, into twoparts, then four, then eight, then sixteen and so on, until we have apeculiar little body made up of many equally divided parts, and knownas the "Mulberry Mass" (Fig. 1). The blending of the sperm and ovumhas been perfect, the division of the original body multitudinous. [Illustration:Sperm and Ovum Cell Division Fetus at Six Weeks Fetus at Three Months Fig. 1. Steps in Early Development] While this division of the united sex cells is progressing, awonderful change is also taking place in the inside lining of theuterus. Instead of the usual thin lining, it has greatly thickened andhas become highly sensitized, and as the ovum enters the uterus fromthe fallopian tube, this sensitized lining catches it and holds it inits folds--actually covers it with itself--holding the precious massmuch as the cocoon, you have so often seen fastened to the side of aplant or leaf, holds its treasure of life. Just as soon as the new uterine home is found the baby heart begins tomake its appearance, as also do many other rudimentary parts. By theend of the third week, our round mass has flattened and curved andelongated, and the nervous system and brain begin to develop, whilethe primitive ears begin to appear. At this time, the alimentary canalpresents itself as one straight tube which is a trifle larger at thehead end. And it is interesting to note that at this early date, eventhe arms and legs are beginning to bud and push out from the body. LATER EMBRYONIC DEVELOPMENT In the fourth and fifth weeks, the lungs and the pancreas may befound, the heart develops, the nervous system has taken on moredefinite form, and several of the larger blood-vessels are appearing. By the eighth week, by the most wonderful and complicated processes ofoverlapping, pushing out, indentation, enfolding, budding, pressing, and curving, the majority of the important structures are formed--theeyes, ears, nose, hands, feet, abdominal organs, and numerous glands. Thus, at the end of two months, almost every structure and organnecessary to life is present in a rudimentary state. AT THE END OF THREE MONTHS By the close of the third month, witness the work of creation! Fromthe blending of the two germ cells there has come forth a beautifullyformed body (Fig. 1). True, it is but three and one half inches inlength, but it is nevertheless a perfect body. About this time, thesex may be determined. The eyes, nose, ears, chin, arms and legs andeven the fingers and toes may all be clearly distinguished. A "jelly mass" at three months? No, by no means! No! Life and form andfeatures are all there. It really has a face, whose features mayeasily be delineated. In all my experience, I have yet to find the woman who wished tocontinue in her wicked and criminal intent after she had listened tothis story of the creative development of the first three months ofher "child enmothered. " During the next four months, which take us to the close of theseventh, rapid growth and farther development take place to theextent, that, should birth occur at that time, life may continue underproper conditions. LAST WEEKS OF PREGNANCY Everything is now nearing completion--only awaiting further growth, development, and strength--except some of the bone development, whichtakes place during the remaining two months. Growth is rapid, strengthis doubled, and as the two hundred and seventy-three days draw to aclose, everything has been completed. It has all taken place accordingto the laws of creation in an infinite way and with clock-likeprecision. With the developmental growth of the product of conception, the uterusor room that had been particularly prepared for the "big reception" ofthe second week, has also grown to great dimensions. It fills almostthe entire abdomen and as a result of the pressure against thediaphragm the breathing is somewhat embarrassed. The door of this "room" has been closed by a special mechanism, while, in the fullness of time, Mother Nature begins the delicate workof opening the door, through whose portals passes out into the worldthe completed babe. The authors feel that this discussion of, and protest against, abortions, _should be_ accompanied by an appropriate consideration ofthe control of pregnancy. We are never going to eliminate the abortioncurse of present-day civilization by merely preaching againstit--warnings and denouncements alone will not suffice to remove thestain. Notwithstanding our feelings and convictions in this respect, we are also well aware of the fact that public sentiment is not nowsufficiently ripe to welcome such a full and frank discussion of thesubject of the prevention of conception as the authors would feelcalled upon to present; we are equally cognizant of the fact thatexisting postal regulations and other Federal laws are of such acharacter (at least capable of such interpretation) as possibly torender even the scientific and dignified consideration of suchsubjects entirely out of question. CHAPTER III BIRTHMARKS AND PRENATAL INFLUENCE In the preceding chapter we learned that when the two germ cells cametogether, there occurred a complete blending of two separate anddistinct hereditary lines, reaching from the present away back intothe dim and distant past. By the union of these two ancestral strainsa new personality is formed, a new individual is created, with its ownpeculiar characteristics. HEREDITARY TRAITS Probably none of the laboriously acquired accomplishments of thepresent generation can be directly--and as such--handed down to ourchildren. What we are to be and what we will do in this world waslargely determined by the laws of heredity by the time we were wellstarted on our development experience _en-utero_ during the third orfourth week of our prenatal existence, as outlined in a formerchapter. It is now generally accepted in scientific circles that acquiredcharacteristics are not transmissible. Someone has aptly stated thistruth by saying that "wooden heads are inherited, but wooden legs arenot. " This does not by any means imply that we do not have power andability to fashion our careers and carve out our own destiny, withinthe possible bounds of our hereditary endowment and environmentalsurroundings. Heredity does determine our "capital stock, " but our ownefforts and acts determine the interest and increase which we mayderive from our natural endowment. From the moment conception takesplace--the very instant when the two sex cells meet and blend--thenand there "the gates of heredity are forever closed. " From that timeon we are dealing with the problems of nutrition, development, education, and environment; therefore, so-called prenatal influencecan have nothing whatever to do with heredity. A father may have acquired great talent as a physician or a surgeon, in fact he may hold the chair of surgery in a medical college, buteach of his children come into the world without the slightestknowledge of the subject, and, as far as direct and immediate heredityis concerned, will have to work just about as hard to master thesubject as will the same average class of children whose parents werenot surgeons. This must not be taken to mean that certain abilitiesand tendencies are not inheritable--for they are; but they areinherited _through_ the parents--and not _from_ them--directly. Thesetransmitted characteristics are largely "stock" traits, and usuallyhave long been present in the "ancestral strain. " MATERNAL IMPRESSIONS A mother may sing and pray all through the nine months of expectancy, or she may weep and scold, or even curse. In neither case can sheinfluence the spiritual or moral tendencies of her child and cause it, through supposed prenatal influence, to be born with criminaltendencies or to grow up a pious lad or become a devout minister. These tendencies and characteristics are all largely determined by the"depressors, " "suppressors, " and "determiners" which were present inthe two microscopic and mosaic germ cells which united to start theembryo at the time of conception. The child is destined to be born, endowed, and equipped with themental, nervous, and physical powers which his line has fallen heir toall through the past ages. Down through the ages education, religion, environment, and other special influences have no doubt played a smallpart in influencing and determining hereditary characteristics; justas environment in the ages past changed the foot of the evolving horsefrom a flat, "cushiony" foot with many toes (much needed in the softbog of his earlier existence) into the "hoof foot" of later days, whenharder soil and necessity for greater fleetness, assisted by some sortof "selection" and "survival, " conspired to give us the foot of ourmodern horse, and this story is all plainly and serially told in thefossil and other remains found in our own hemisphere. It would appearthat many, many generations of education and environment are requiredto influence markedly the established and settled train of heredityregarding any particular element or characteristic in any particularline or lines of hereditary tendencies. EUGENIC SUPERSTITION There is probably more misinformation in the minds of the people onthe subject of "maternal impressions" and "birthmarks" than any otherscientific or medical subject. The popular belief that, if a pregnantwoman should see an ugly sight or pass through some terrifyingexperience, in some mysterious way her unborn child would be "marked, "deformed, or in some way show some blemish at birth, is a time-honoredand ancient belief. Such unscientific and unwarranted teaching has been handed downfrom mother to daughter through the ages, while the poor, misguidedsouls of expectant women have suffered untold remorse, heaped blameupon themselves, lived lives literally cursed with fear anddread--veritable slaves to superstition and bondage--all because ofthe simple fact that a certain percentage of all children born in thisworld have sustained some sort of an injury or "embryologicalaccident" during the first days of fetal existence. For instance, takethe common birthmark of a patch of reddened skin on the face, brow, orneck. As soon as the baby is born, the worried mother asks in anxioustones: "Doctor, is it all right, is it perfect, has it got anybirthmarks?" On being told that the baby has a round, red patch on itsleft brow, the ever-ready statement of the mother comes forth: "Yes, Iknew I'd mark it, I was picking berries one day about three monthsago, and I ate and ate, until I suddenly remembered I might mark mybaby, and before I knew what I was doing, I touched my brow and I justknew I had marked my baby. " Do you know, reader, that that birthmarkwas present fully four months before she passed through thatexperience in the berry patch? And yet so worried and apprehensivehas been the pregnant mother, that, although she can neversuccessfully predict the "birthmarks" and blemishes of her child, nevertheless when these defects are disclosed at birth she isunfailingly able immediately to recall some extraordinary experiencewhich she has carefully stored away in her memory and which, to hermind, most fully explains and accounts for the defect. Is it much wonder that in the very early days of embryonic existence, during the hours of delicate cell division, indentation, outpushing, elongation, and sliding of young cells--is it much wonder, Irepeat--that there occur a few malformations, blemishes, or otheraccidents which persist as "birthmarks?" CAUSES OF BIRTHMARKS There are many factors which may enter into the production ofbirth-blemishes, deformities, monstrosities, etc. These influences areall governed by certain definite laws of cause and effect. Apre-existent systemic disease in the father, or a coexistent disorderin the mother, may be a leading factor. A mechanical injury, such as asudden fall, a blow, or a kick, or certain kinds of prolongedpressure, not to mention restrictions and contractions of the maternalbony structures, may all possibly contribute something to theseprenatal miscarriages of growth and development. Maternal or prenatalembryonic infections could bring about many sorts of birthmarks andmalformations. These defects might also be caused by certain types ofsevere inflammatory disorders in the uterus during the early days ofpregnancy. The same factors that produce the accidents of embryology resulting inmalformations or monstrosities in the human family, are also operativein the case of our lesser brethren of the animal kingdom, formonstrosities and birth-defects are very common among the loweranimals, notwithstanding the fact that the animal mother probably doesnot "believe in birthmarks. " "It is a striking fact that during the nineteenth century, theteratologists, those who have scientifically investigated the causesof monstrosities and fetal morbid states, have almost withoutexception, rejected the theory of maternal impressions. " Scientistsand physicians are coming to recognize the fact that fears and frightsdo not in any way act as causes in the production of monstrosities anddeformities. Let us seek forever to liberate all womankind from thecommon and harassing fear and the definite dread and worry that, because they failed to control themselves at the instant of someterrifying sight or experience, they were directly responsible for themisfortune of their abnormal offspring. It should be remembered that there exists no direct connectionwhatsoever between the nervous system of the unborn child and thenervous system of the mother. The only physiological or embryologicalrelationship is of a nutritional order, and even that is indirect andremote. ROLE OF THE PLACENTA By the end of the third month, the "cocoon" attachment described inchapter two has disappeared; the fetus is slowly pushed away from theuterus which has so snugly held it for more than eleven weeks; whileupon the exact site of its previous attachment the thickened uterinemembrane undergoes a very interesting and important change--definiteblood vessels begin to form--which begin indirectly to form contactwith the maternal vessels, and thus it is that the placenta, or "afterbirth" is formed; and then, by means of the umbilical cord, nourishment from the mother's blood-stream is carried to the growingand rapidly developing child. In exchange for the nourishing stream oflife-giving fluid by which growth and development take place, theembryo gives off its poisonous excretions which are carried back tothe placenta, from which they are absorbed into the veinouscirculation of the mother; so, while the mother does, through theprocess of nutrition, influence growth and development in the embryo, she is wholly unable to produce specific changes and such definitedevelopmental errors as birthmarks and other deformities. Just as truly as it would be impossible so to frighten a setting henas to "mark" or otherwise influence the form or character of thechicks which would ultimately come forth from the eggs in her nest, it is just as truly impossible to frighten the pregnant mother andthereby influence the final developmental product of the human eggwhich is so securely tucked away in its uterine nest; for, whenconception has occurred, the human embryo is just as truly anegg--fashioned and formed--as is the larger and shell-contained embryoof the chick which lies in the nest of the setting hen. And so we are compelled to recognize the fact that there is littlemore danger to the unborn child when the mother is frightened thanwhen the father is scared. The one contributes as much as the other tothe general character of the child, while neither is to blame fordevelopment errors and defects. SUGGESTION AND HEREDITY Certain fears are suggested to children. For twenty years I livedunder the delusion that I was terribly afraid of snakes--more so thanany other human being; for I was told when a mere child that I hadbeen "marked with the fear of snakes, " that just two months before Isaw the peep of day, my esteemed mother had been terrified by a snake. Everywhere I went, I announced to sympathizing and ofttimesmischievous friends, that "I was marked with the fear of snakes andmust never be frightened with them. " It is needless to add in passing, that I was teased and frightened all through my girlhood days. I was averitable slave to the bondage of snake-fear. Everywhere I went Ilooked for my dreaded foe, expecting to sit on one, step on one, or tohave one drop into my lap from the roof. The day of deliverance came after marriage, when in a supreme effortto deliver me from the shackles of fear, the goodman of the housetenderly, but firmly, maneuvered a morning walk so that it halted infront of a large plate-glass window of the Snake Drug Store in SanFrancisco. Just back of this plate glass, and within eighteen inchesof my very nose, were fifty-seven varieties of the reptiles, big andsmall, streaked and checkered, quiet and active. After muchremonstrance and waiting, I came-to--gazed at the markings, beautifulin their exactness--while slowly the change of mind took place. Faithtook the place of fear, calmness subdued panic, and I was wondrouslydelivered from the veritable bondage of a score of years. And so it isthat the mother suffers and then the child suffers, ofttimes a livingdeath, because of the superstition "I'm marked, " while there is everpresent the fear or dread that "something is going to happen, becauseI'm different from all other individuals--because 'I'm marked!'" CHAPTER IV THE HYGIENE OF PREGNANCY As soon as a woman discovers that she is pregnant, she should sit downand quietly think out the plan for the nine months of expectancy. The cessation of the menses may come as a surprise to her, and for awhile she is more or less confused; she must go over the wholesituation and adjust future plans to fit in with this new and allimportant fact. From a large experience with maternity cases, I havereached the conclusion that the larger percentage of pregnancies docome as a surprise, and in many instances a complete change of programmust be painstakingly thought out. This is especially true of thebusiness woman, the professional woman, the busy club woman, or theactive society woman. EARLY PLANNING Let me say to the woman who is pregnant for the first time, theexperiences of the pregnant state should cause you no fear, worry, oranxiety. Giving birth to a baby is a perfectly natural, normalprocedure, and if you are in reasonable health--if your physiciantells you you are a fairly normal woman--then you can dismiss furtherthought of danger and go on your way rejoicing. For thousands of yearsmaternity has been women's exclusive profession and no doubt willcontinue to be many ages hence. By far the most important and the first thing to do is carefully toselect the best physician your means will allow, and place yourselfunder his or her care. Your doctor will help you to plan wisely andintelligently during the waiting time, for physicians have learnedfrom experience that the better care the pregnant woman receives, theeasier will be her labor, and the more speedy and uneventful therecovery. And now, we proceed to take up one by one the particular phases of thehygiene of pregnancy which touch the comfort, convenience, and healthof both the mother and her unborn child. THE CLOTHING At all times and under all circumstances the pregnant woman's clothingshould be comfortable, suitable for the occasion, artistic, andpractical. And to be thus beautifully clothed is to be asinconspicuous as is possible. Of all times, occasions, and conditions, that of pregnancy demands modesty in color, simplicity in style, together with long straight lines (Fig. 2). For the "going out" dress, select soft shades of brown, blue, wine, or dark green. Let the housedresses be simple, easy to launder, without constricting waist bands, of the one-piece type, in every way suitable for the work at hand. Under this outer dress, a princess petticoat should cover a speciallydesigned maternity corset (if any corset at all be worn), to which isattached side hose-supporters. A support for the breasts may be wornif desired, it should be loose enough to allow perfect freedom inbreathing. The union suit may be of linen, silk, or cotton, with the weightsuitable for the season. Stockings and shoes should be of acomfortable type, straight last, low or medium heel and at least aswide as the foot. There are two or three shoes on the market that areparticularly good, whose arches are flexible, heels comfortable, straight last, and whose soles look very much like the lines of thefoot unclothed. This style is particularly good during the maternitydays. Painful feet are a great strain upon the general nervous system. Who of us has not seen women with strained, tense faces hobbling aboutin high-heeled, narrow-toed shoes? And if we followed them we wouldnot only see tenseness and strain in the features of the face, butcould hear outbursts of temper on the least provocation. Aching feetproduce general irritability. If ease of body and calmness of spiritis desired, wear shoes that are comfortable, and the surprising partof it is that many of them are very good looking. [Illustration: Fig. 2. The "Expectant" Costume The long lines, so admirable for maternity wear are portrayed in thishandsome afternoon costume. Tunic waist is made with shoulder yokefrom which fullness hangs in fine plaiting with panel at back, frontand under arms. The set in vest is of black-striped gold cloth trimmedwith gold thread crochet buttons and with tiny waistcoat of blackmoire. Sleeves are of Georgette crepe. Loose adjustable girdle ofblack moire ribbon. Full skirt is attached on elastic to china silkunderbodice. Material Crepe de chine or any other soft, clingingfabric. ] Toward the end of pregnancy ofttimes the feet swell, in which instancelarger shoes should be worn in connection with the bandaging of theankles and legs. During the latter days of expectancy an abdominal supporter may beworn advantageously. Much of the backache and heaviness in the pelvisis entirely relieved by the supporting of the pendulous abdomen with awell-fitted binder. An ordinary piece of linen crash may be fittedproperly by the taking in of darts at the lower front edge; or elasticlinen, or silk binder may be secured; in fact, any binder thatproperly supports the abdomen will answer the purpose. It should be within the means of every pregnant woman to have a neat, artistic out-door costume, for social, club and church occasions (Fig. 2). For no reason but illness should an expectant mother shut herselfup in doors. True men and true women hold the very highest esteem for the maternalstate, and the opinion of all others matters not; so joyfully go forthto the club, social event, concert, or church; and to do this, youmust have a well-designed, artistic dress. The material does notmatter much, but the shade and style are important. DIET There are certain laws which govern the diet at all times; forinstance, the man who digs ditches requires more of a certain elementof food and more food in general, than does the man who digs thoughtsout of his brain. The growing child requires somewhat differentelements of food than does an adult. In other words, "The diet shouldsuit the times, occasions, occupations, etc. " In the case of the expectant mother it should be remembered that thechild gains nine-tenths of its weight after the fifth month ofpregnancy, and it is, therefore, not necessary that a woman shallbegin "eating for two" until after the fifth month. And since it isalso true that the baby doubles its weight during the last eight weeksof pregnancy, it follows that then is the time when special attentionmust be given to the quantity as well as the quality of "mothers'food. " During the first five months, if the urine and blood-pressure arenormal, the "lady in waiting" should follow her usual dietetic tastesand fancies so long as they do not distress or cause indigestion. Because of the additional work of the elimination of the fetal wastes, much water, seven or eight glasses a day, should be taken; while oneof the meals--should there be three--may well consist largely offruit. All of the vegetables may be enjoyed; salads with simpledressings and fruits may be eaten liberally. Of the breads, bran, whole wheat, or graham are far better for the bowels than the finergrain breads, or the hot breads. Something fresh--raw--should be taken every day, such as lettuce, radishes, cabbage salad, and fresh fruits. If the prospective mother is accustomed to the liberal use of meat, providing the blood-pressure and urine are normal, she may be able toindulge in meat once a day. Many physicians believe that the maternalwoman should eat meat rather sparingly--from once a day to once ortwice or three times a week. Of the desserts, gelatine, junket, ice cream, sponge cake, and fruitare far better than the rich pastries, which never fail even in healthto encourage indigestion and heart burn. The fruitades are all good. Candies and other sweets may be eaten in moderation. Alcohol should beavoided. Tea and coffee should be restricted, and in many casesabandoned. For many, two meals and a lunch of fruit or broth arebetter than three full meals. There is a continual and increasedaccumulation of waste matter which must be thrown off by the lungs, kidneys bowels, and skin; so that clogging of one channel ofelimination makes more work for one or more of the other eliminativeorgans. Sometimes the craving for food is excessive, and the desire to nibblebetween meals is quite troublesome. These unusual feelings should becontrolled or ignored. A glass of orangeade will sometimes satisfythis unnatural craving. Save your appetite for meal time--for a goodappetite means good digestion--all things equal. The woman whohabitually eats between meals is the sluggish, constipated individualwho needs to acquire self-control and learn self-mastery. WATER DRINKING Water is the circulating medium of the body, from which the digestivesecretions are formed, and by which the food is assimilated anddistributed to individual cells. And, finally, water is the agent fordissolving and removing waste products from the body through thevarious eliminating organs. We literally live, think, and have ourbeing, as it were, under water. The tiny cell creatures of our bodies, from the humble bile workers of the liver to the exalted thinkingcells of the brain, all carry on their work submerged. Accordingly, the amount of water we drink each day, determines whether the liquidscirculating through our tissues shall be pure, fresh, and life-giving, or stagnant, stale, and death-dealing. Thirst is the expression of the nervous system, constituting a callfor water, the same as hunger represents a call for food. Pure water, free from all foreign substances, is the best liquid with which toquench this thirst. It is just as important to supply abundance of water for the properbathing and cleansing of the internal parts of the body, as it is towash and bathe the external skin frequently. The living tissues arejust as literally soiled and dirtied by their life action and theirpoisonous excretions, as is the skin soiled by its excretions of sweatand poisonous solids. Thus the regular drinking of water is absolutelynecessary to enable the body to enjoy its internal bath, and thisinternal cleansing is just as grateful and refreshing to the cells andtissues, as is the external bath to the nerves which exist in theskin. The total amount of water necessary varies according to the nature ofone's work, the amount of sweating from the skin, the moisture of theatmosphere, the amount of water in the food, etc. We believe theaverage person requires about eight glasses of liquid a day; that is, about two quarts. By the word "glass" we refer to the ordinary glassor goblet, two of which equal one pint. This amount of water shouldbe increased, if anything, throughout pregnancy; while, during thelater months, the amount of water taken each day should be at leastdoubled. In the condemnation of so-called artificial beverages, an exceptionshould be made of the fruit juices. The fresh, unfermented juices ofvarious fruits come very near being pure, distilled water, as theyconsist of only a little fruit sugar and acid, together with smallamounts of flavoring and coloring substances, dissolved in pure water. None of these substances contained in pure fruit juice needs to bedigested. Lemonade not too sweet, and taken in moderate quantities, is certainlya beverage free from objection when used by the average pregnantwoman. Unripe or overripe fruits frequently cause bowel disturbances;as also do the millions of germs which lurk upon the outside offruits, and which find their way into the stomach and bowels whenthese fruits are eaten raw without washing or paring. Otherwise, thejuices of fruits and melons are wholesome food beverages when consumedin moderation. EXERCISE It should be the regular practice of every expectant mother to spend aportion of each day in agreeable, suitable exercise or physical workof some description. This exercise will be far more beneficial if itcan be taken in the open air. The weather and the strength of thepatient must be taken into consideration and the necessarymodifications of the daily exercise should be made. An expectant mother living in the city and enjoying the average healthand strength, should engage in such agreeable exercise as the raisingof flowers, the training of vines, with brisk walks in the fresh air. As much time as possible should be spent in the parks. The rural "mother in waiting, " may do light gardening, raising ofchickens, or pigeons, training of vines, or other outdoor work she mayenjoy. No matter what kind of weather prevails, a daily brisk walk should betaken, out of doors, on the porch or in a room with open windows. Adaily sweat, as well as the daily prayer, is good for the well-beingof the expectant mother. All forms of light housework are commendable. Keep out of crowds. Spend more time in the parks than in thedepartment stores. An occasional evening at the concert or theater isdiversion and harmless provided the ventilation is good. Suchexercises as horseback riding, bicycling, dancing, driving over roughroads, lifting and straining of any kind, and all other forms offatiguing exercise should be avoided. REST Rest and relaxation are quite necessary for men and women even in thebest of health. A kind providence has arranged that we spend a largeportion of our time resting, and sleeping. In addition to unbrokenrest at night it is well for the prospective mother quietly towithdraw from the family circle, when the first signs of fatigue beginto appear, and indulge in a little rest, before she gets into a stateof nervousness--where nerves twitch and she becomes irritable. A mother who has borne six children, who has had little domestic help, and who yet retains her youthful appearance and energy, thinks her present condition due to the fact that while carrying and nursing her babies she never permitted herself to reach that stage of exhaustion where her nerves twitched, her voice shrilled, and she became irritable. She made it a practice to drop her work when these symptoms began to appear, and to seek the sanctuary of a quiet room apart from her family, if only for ten or fifteen minutes. And, most important, from the very start she trained her household to respect her right thus to draw apart. I have told many women whose household duties press hard: "Yourhusband would rather see a cold lunch on the table, or 'go out' fordinner, while his wife rested, smiling and happy, than to have a mostsumptuous meal spread before him and the wife tired, and fretful. "Every woman should make it the rule of her life to stop just this sideof the outburst of words, and lie down long enough, breathing deeply, to calm the spirit. FRESH AIR "With all persons plenty of fresh air, night and day, is indispensableto health, and to none more than the pregnant woman. She should sleepwith the windows open, or out of doors, at all seasons of the year; ofcourse, making due allowance for the severity of the winters in theNorth. It is not only necessary to provide for the adequateventilation of sleeping-rooms, but also for that of the living-roomsof the house. Many persons, who are quite particular to open wide the windows of thebedrooms, forget that the other rooms need it quite as much. All therooms of the house which are occupied should be thoroughly ventilatedby throwing doors and windows open every morning; at night when thefamily is assembled the air must be changed now and then or it willbecome unfit for human lungs. " Men and women are outdoor animals. They were made to live in a garden, not a house. Remember that each person requires one cubic foot offresh air every second. Don't allow the temperature of living-rooms, during the winter season, to go above sixty-eight degrees. If yourhome has no system of ventilation, open wide the windows and doorsseveral times a day and enjoy the blessings of a thorough-goingflushing with fresh air. Oxygen is the vital fire of life. Our food, however well digested andassimilated, is just as useless to the body without oxygen, as coal isto the furnace without air. It is equally important to keep up theproper degree of moisture in the air of the living-rooms. BATHING Bathing is made necessary by the clothes we wear and by our indoorlife. If the skin were daily exposed to sunshine and fresh air, itwould seldom be necessary to bathe. The neglect of regular bathingresults in overworking the liver and kidneys, and debilitates theskin. Regular bathing--ofttimes sweating baths--is very essential tothe hygiene of pregnancy. The neutral bath (97 F. ) is excellent to quiet the nerves and inducesleep. Morning bathing is an exceedingly valuable practice. Ifproperly taken before breakfast or midway between breakfast and lunch, it is found to be refreshing and tonic in nature. The feet should bein warm water, the application of cold should be short and vigorous. Arough mit dipped in cold water, rubbed over the body until the skin ispink, is a splendid tonic. Warm cleansing baths should be taken twice a week at night. There isno good reason for the use of the vaginal douche during pregnancy. THE TEETH Because the mother's system is drained of the lime salts which aid inbuilding up the bones of the child, along with other metabolic changeswhich cause the retention of certain acids which ofttimes affect theteeth, they should be frequently examined and carefully guarded. Severe dental work should be avoided, but all cavities should receivetemporary fillings while the teeth are kept free from deposits. As a preventive to this tendency of the teeth to decay, a simple mouthwash of one of the following may be used after meals: 1. One teaspoon of milk magnesia. 2. One tablespoon of lime water. 3. One-half teaspoon common baking soda. Any one to be dissolved in a glass of water. DIRECTIONS FOR SAVING URINE SPECIMENS Beginning with the second voiding of urine after rising on the morningof the day you are to save the specimen, save all that is passedduring the following twenty-four hours, including the first voiding onthe second morning. Measure carefully the total quantity passed in thetwenty-four hours. Shake thoroughly so that all the sediment will bemixed, and immediately after shaking take out eight ounces orthereabouts for delivery to the physician the same forenoon. Thefollowing items should be noted, and this memoranda should accompanythe specimen: 1. Patient's name. 2. Address. 3. This specimen was taken from a twenty-four hour voiding of urine, which began at .... A. M. .... , and ended at .... A. M. .... 4. The total quantity voided during this twenty-four hours was .... Pints. This specimen should reach the laboratory by ten o'clock the samemorning. It is of utmost importance the specimen should be taken to yourphysician every two weeks, and oftener if conditions indicate it. Takeit yourself at the appointed time. THE BOWELS Owing to the increasing pressure exerted upon the intestines, mostexpectant mothers experience a tendency to sluggish bowels andconstipation. This unpleasant symptom is usually increased during thelater months. In the first place, a definite time must be selected for bowel action. It may ofttimes be necessary, and it is far less harmful, to insert aglycerine suppository into the rectum, than to get into the enemahabit. The injection of a large quantity of water into the lower bowelwill mechanically empty it; but the effects are atonic and depressingas regards future action. Before we take up the advisability of taking laxatives let us considerwhat foods will aid in combating constipation. The following list offoods are laxative in their action and will be found helpful inovercoming the constipation so often associated with pregnancy: 1. All forms of sugar, especially fruit sugar, honey, syrup, and malt. All the concentrated fruit juices. Sweet fruits, such as figs, raisins, prunes, fruit jellies, etc. 2. All sour fruits, and fruit acids: Apples, grapes, gooseberries, grape fruit, currants, plums, and tomatoes. 3. Fruit juices, especially from sour fruits: Grape juice, lemonade, fruit soup, etc. 4. All foods high in fat: Butter, cream, eggs, eggnog, ripe olives, olive oil, nuts--especially pecans, brazil nuts, and pine nuts. 5. Buttermilk and koumiss. 6. All foods rich in cellulose: Wheat flakes, asparagus, cauliflower, spinach, sweet potatoes, green corn and popcorn, graham flour, oatmealfoods, whole-wheat preparations, bran bread, apples, blackberries, cherries, cranberries, melons, oranges, peaches, pineapples, plums, whortleberries, raw cabbage, celery, greens, lettuce, onions, parsnips, turnips, lima beans, and peanuts. White bread should be tabooed, and in its place a well-made bran breadshould be used. Two recipes for bran bread follow, one sweetened andcontaining fruit, the other unsweetened: BRAN BREAD RECIPES 1. Two eggs, beaten separately; three-fourths cup of molasses, plusone round teaspoon of soda; one cup of sour cream; one cup of sultanaseedless raisins; one cup of wheat flour, plus one heaping teaspoonbaking powder; two cups of bran; stir well and bake one hour. 2. One cup of cooking molasses; one teaspoon of soda; one smallteaspoon of salt, one pint of sour milk or buttermilk, one quart ofbran, one pint of flour. Stir well, and bake for one hour in a veryslow oven. It may be baked in loaf, or in gem pans, as preferred. Thebread should be moist and tender, and may be eaten freely, day afterday, and is quite sure to have a salutary effect if used persistently. The drinking of one-half glass of cold water on rising in the morningoften aids in keeping the bowels active. Of the laxative drugs whichmay be used at such a time, cascara sagrada and senna are among theleast harmful. Two recipes of senna preparation follow, and may betried in obstinate cases: 1. _Senna Prunes. _ Place an ounce of senna leaves in a jar and pourover them a quart of boiling water. After allowing them to stand fortwo hours strain, and to the clear liquid add a pound of well-washedprunes. Let them soak over night. In the morning cook until tender inthe same water, sweetening with two tablespoons of brown sugar. Boththe fruit and the sirup are laxative. Begin by eating a half-dozen ofthe prunes with sirup at night, and increase or decrease the amount asmay be needed. 2. _Senna with prunes and figs. _ This recipe does not call forcooking. Take a pound of dried figs and a pound of dried prunes, washwell. Remove the stones from the prunes and if very dry soak for anhour. Then put both fruits through the meat chopper, adding two ouncesof finely powdered senna leaves. Stir into this mixture twotablespoons of molasses to bind it together, the result being a thickpaste. Begin by eating at bedtime an amount equal to the size of anegg, and increase or decrease as may be necessary. Keep the pastetightly covered in a glass jar in a cool place. If the senna isdistasteful a smaller quantity may be used at first. CARE OF THE BREASTS The breasts are usually neglected during the months of pregnancy, andas a result complications occur after the baby comes which cause noend of discomfort to the mother. If, during the pregnancy, the breastsare washed daily with liquid soap and cold water, and rubbedincreasingly until all sensitiveness has disappeared, they may betoughened to the extent that no pain whatsoever is experienced by themother when the babe begins to nurse. During the last month ofpregnancy a solution of tannin upon a piece of cotton may be appliedafter the usual vigorous bathing. If the nipples are retracted theyshould be massaged until visible results are attained. THE MENTAL STATE Keep the mind occupied with normal, useful, and healthy thoughts. Listen to no tales of woe. Stay away from the neighborhood auntiedolefuls. Keep yourself happy and free from all worry, care, andanxiety. "Put no faith in fables of cravings, markings, signs, orsuperstitions. They are all unfounded vagaries of ignorant old womenand will not bear investigation. " Don't take drugs for worry and sleeplessness. Take a bath. The secret of deliverance from worrying is self-control. Minimize yourdifficulties. Cultivate faith and trust. The conditions which favor sound sleep are: Quiet, mental peace, pureblood, good digestion, fresh air (the colder the better), physicalweariness (but not fatigue), mental weariness (but not worry). When tempted to borrow trouble, when harassed by fictitious worries, remember the old man who had passed through many troubles, most ofwhich never happened. Train the mind to think positive thoughts. Replace worry-thought with an opposite thought which will occupy themind and enthuse the soul. Drive out fear-thought by exercisingfaith-thought. Cultivate the art of living with yourself as you are, and with the world as it is. Learn the art of living easily. Associatewith children and learn how to forget the vexing trifles of everydaylife. There is something decidedly wrong with one's nerves when everybody isconstantly "getting on them. " They are either highly diseased orabnormally sensitive. Every woman is a slave to every other thatannoys her. Fear is capable of so disarranging the circulation as to contribute tothe elevation of blood-pressure--which will be more fully consideredin a later chapter. CHAPTER V COMPLICATIONS OF PREGNANCY It is the purpose of this chapter to take up the various complicationswhich may appear in the course of an otherwise normal pregnancy, andoffer advice appropriate for their management. MORNING SICKNESS About one-half of the expectant mothers that come under our care andobservation, experience varying degrees of nausea or "morningsickness. " This troublesome symptom makes its appearance usually aboutthe fourth week of pregnancy and lasts from six to eight weeks. On attempting to rise from the bed, there is an uncomfortably warmfeeling in the stomach followed by a welling up into the throat of awarmish, brackish tasting liquid which causes the patient to hasten torid herself of it; or, as she rides on the train, on the street cars, in a carriage or automobile, she frequently senses the same unpleasantand nauseating symptoms during the second and third months ofpregnancy. Normally, this uncomfortable symptom quite disappears bythe end of the third month. A number of remedies have been suggestedfor it, but that which seems to help one, gives little or no relief toanother; we therefore mention a variety of remedies which may betried. First and most important of all remedies--is to keep the bowels open. Sluggishness of the intestinal tract greatly increases the tendency todizziness and nausea. During the attack, it is advisable not toattempt to brush the teeth, gargle, or even drink cold water. Whileyou are yet lying down, the maid or the goodman of the house shouldbring to you a piece of dry, buttered toast, a lettuce sandwich witha bit of lemon juice, or perhaps a cup of hot milk or hot malted milk. Coffee helps to raise the blood-pressure, and all articles of dietthat tend to raise the blood-pressure are best avoided duringpregnancy. A cup of cocoa may be tried, but, as a rule, women at thistime do not relish anything sweet. Oftentimes a salted pretzel is justthe thing, or a salted wafer will greatly help. Remain in bed fromone-half to one hour and then rise very slowly. There should be plentyof fresh air in the room, as remaining in overheated places is quitelikely to produce a feeling of sickness at the stomach. When the attack comes on during a train ride, open the window andbreathe deeply, this, with the aid of a clove or the tasting of a bitof lemon, will usually give relief. In extreme instances the patientshould lie down flatly on the back, with the eyelids closed. Go to therear of the street car, so that you can get off quickly if necessitydemands; breathe deeply of the air; resort to the use of cloves orlemons; and thus by many and varied methods will the expectant motherbe enabled to continue her journey or finish her shopping errand. Wewould suggest that, as far as possible, walking should be substitutedfor riding. I have never heard of a woman being troubled with nauseawhile walking in the parks, on shady streets, along the country road, or on the beach. Of the medicines prescribed for "morning sickness" and the nausea ofpregnancy, cerium oxalate taken three times a day in doses of fivegrains each, is probably one of the best. The persistent or pernicious vomiting which continues on throughpregnancy will be spoken of later. HEARTBURN Acid eructations are spoken of as "heartburn, " and are occasioned bythe increased activity of the acid making glands of the stomach. Undercertain conditions this acid content of the stomach is regurgitatedback into the throat and even belched up into the mouth. In thiscondition it is well to avoid most acid fruits. Ice cream and otherfrozen desserts are beneficial. The lowered temperature of cold foodsdepresses the activity of the acid glands, as also does the fats ofthe cream, while protein food substances such as white of egg, cheese, and lean meat, help by combining with the excess of acid present inthe stomach. Buttermilk or the prepared lactic acid milk, if takenvery cold, is often helpful, notwithstanding it is an acid substance, in connection with the dietetic management of heartburn. If the acideructations be troublesome between the meals, the taking of calcinedmagnesia (one round teaspoon in a glass of cold water), or, one-halfteaspoon of common baking soda in a glass of water, will affordimmediate and temporary relief. Simply nibbling a little from a blockof magnesia will often give instant relief. These alkalineseffectively neutralize the mischievous acids which cause the so-called"heartburn. " IRRITABILITY OF THE BLADDER The flexing or bending forward of the gravid uterus, by makingpressure on the bladder, sets up more or less irritation andconsequent disturbance of the urinary function. The capacity of thebladder is actually diminished, and this produces frequent urination. There is usually no pain connected with this annoying symptom--thechief discomfort is the frequent getting up at night. Thisinconvenience may be lessened by drinking less water after six P. M. These bladder disturbances are most marked in the earlier months, andgradually disappear as the uterus raises higher up into the abdomen;although this symptom may reappear in the last two weeks, as the headdescends downward on its outward journey. Should the urine at any time become highly colored, take a specimen toyour physician at once. Twenty-four hour specimens of urine should betaken by the patient to her physician every two weeks. Do not sendit--take it. LEUCORRHEA While leucorrhea is an unusual complication of pregnancy, it is oftenvery troublesome and sometimes irritating. Do not take a vaginaldouche unless it has been ordered by your physician, and even thenmake sure that the force of the flow of water is very gentle. The bagof the fountain syringe should be hung only about one foot above thehips. Soap and water used externally, followed by vaseline or zincointment, will usually relieve the accompanying irritation. THREATENED ABORTION In the third chapter attention was called to the formation of theplacenta or "after birth, " on the site of the attachment of the cocoonembryo. At this particular time of the pushing away of the embryo fromthe uterine wall, one of the accidents of pregnancy occurs, in whichthe embryo becomes completely detached and starts to escape from theuterus, accompanied by varying degrees of pain and hemorrhage. Thesymptoms of this threatened abortion are: 1. Heavy menstrual pains. 2. Backache. 3. Hemorrhage. The approach of the calendar date of the third month of pregnancyshould be watched for, and all work of a strenuous nature studiouslyavoided; while at the first signs of the backache or any unusualsymptom, the expectant mother should immediately go to bed and sendfor the physician. One patient who had aborted on four differentoccasions was able to pass this danger period by adhering to a rigidprogram of prevention during her fifth pregnancy. Two weeks before thethird month arrived she discontinued her teaching and went to bed. Sheremained there four weeks, thus running over into the middle of thefollowing month. Gradually, she resumed her duties of teaching, carried her precious bundle of life to full term, and is now the proudand happy mother of a splendid baby girl. Should abortion seem imminent, from one-eighth to one-fourth of agrain of morphine sulphate will greatly reduce all uterinecontractions, and this, with the general quieting effect on the wholesystem, will usually suffice to prevent an abortion. The patientshould quietly remain in bed from three days to one week. If the abortion takes place--if a clot accompanied by hemorrhage ispassed--save everything, lie in bed very quietly and send for yourphysician at once; and when he does arrive, be content if he does notmake an internal examination at once, for if he should there is moreor less danger of infection. And I repeat--throw nothing away--burnnothing up, save everything that passes until your physician hascarefully examined it. SUDDEN ABDOMINAL PAIN Sudden or severe pains in the abdomen should be reported at once toyour physician, while you should immediately go to bed and quietlyremain there until you receive further instruction from your doctorwhen he calls. In the later stages of pregnancy any appearance of blood shouldlikewise be noted and reported without delay. These symptoms may notalways be serious, but they are also associated with gravecomplications, and should, therefore, be given prompt attention. MISCARRIAGE Abortion is a term used to designate the loss of the embryo prior toor at the third month. Miscarriage applies to the expulsion of thefetus or emptying of the uterus after the third month. It is possiblefor a miscarriage to occur anytime during the interim between thefourth and ninth months. After the uneventful passing of the thirdmonth, if an accident threatens, we instruct the mother to remainquietly in bed three to five days at the calendar date comparable witheach menstrual period; and as she approaches the seventh month, weadjure her to be unusually careful and prudent. The causes of miscarriages are many: Disease of the embryo, imperfectfetal development, some constitutional disease of the mother, a faultyposition of the uterus, or it may result from something unusual aboutthe lining of the uterus such as an endometritis--an inflammation ofthe mucus membrane. Expectant mothers who manifest symptoms of a threatened miscarriageshould studiously avoid such exercises as climbing, riding, skating, tennis, golf, dancing, rough carriage or automobile riding, and suchtaxing labor as sweeping, lifting, washing, running the sewingmachine, window cleaning, the hanging of pictures, draperies, etc. CRAVINGS Within reason, a pregnant mother should follow her natural appetiteand satisfy her dietetic longings. Should she desire unusual articlesof food, as far as possible she should have them. The idea has longprevailed that if the mother does not get what her longing soulsupremely desires, that the on-coming baby is going to cry and cryuntil it is given what the mother wanted with all her heart and didnot get. Such an idea is the very quintessence of folly and thepersonification of foolishness and superstition. Many a precious babe has suffered as a victim of this notion of"craving" and "marking. " One mother gave her baby a huge mouthful ofunder-ripe banana because "she knew that was just what he wanted, because, when pregnant, she had craved and craved bananas and for somereason or another she did not get them. " The soft, smooth piece ofbanana slipped down the baby's throat--on into the stomach andintestines--caused intestinal obstruction and finally the end came;and we registered one more victim to the fallacies of fear and thesuperstitious belief in "cravings" and "markings. " Occasionally somecravings are unusual and freakish, for instance, egg shells, leather, candles, chalk, and other abnormal tastes are developed. Of these wehave only to say, "Rise above them, become mistress of the situationand change your longings. " If such abnormal cravings come to you inthe kitchen, don your bonnet and go at once out of doors and take awalk. Don't be foolish just because somebody told you foolish storiesabout these things. CONSTIPATION Bowel hygiene is an important part of the management of pregnancy. Constipation often proves to be very troublesome. In another chapterthis subject is treated at some length. Here, we pause only longenough to say that habit has much to do with this difficulty. Aregular time should be set apart each day for attending to thisimportant matter. HEMORRHOIDS Of all the maladies that the human family falls heir to, hemorrhoidsare among the commonest and, we may add, the most neglected. Any womanwho enters pregnancy, suffering from hemorrhoids, is going to have herfull share of suffering and pain before she has finished with herlabors. Taken early, they may be greatly helped, if not entirelyrelieved, by the daily use of the medicated suppository (SeeAppendix). The bowel movements should never be allowed to become hard, the dietetic advice of another chapter should be carefully followedand the oil enema, as described in the appendix, should be used ifnecessary. For immediate relief, hot witch-hazel compresses may beapplied; or, in the case of badly protruding piles, the patient shouldimmerse the body in a warm bath and by the liberal use of vaselinethey can usually be replaced. The physician should be called and hewill advise any further treatment the case may require. VARICOSE VEINS Varicose veins or the distension of the surface veins of the legs arevery common among women in general and pregnant women in particular. The legs should be elevated whenever the patient sits, while in badcases they should be bandaged while standing. There are many elasticsurgical stockings on the market today that, if put on before risingin the morning, will give much relief and comfort all during the day. Any large medical house or physician's supply house can furnish themaccording to your measurements--which should be taken before gettingout of bed in the morning. These measurements are taken according toinstructions and usually are of the instep, ankle, calf of leg, lengthof ankle to knee, etc. CRAMPS Cramps are sharp, exceedingly painful muscular spasms occurring in themuscles of the calf of the leg, the toes, etc. The expectant motherin the later months of pregnancy awkwardly turns in bed, is suddenlyawakened and without a moment's warning, is seized with a mostexcruciating pain in her leg or toe. The most effectual treatment forthese cramps is quickly to apply a very cold object to the crampingmuscle. Extremes of either heat or cold usually relieve as well as thevigorous grasping or kneading of the muscle. A hot foot bath on goingto bed will often prevent an attack. A long walk in the latter monthsof pregnancy should invariably be followed by a short hot bath or afoot bath. Many attacks may be avoided by this procedure. SWELLINGS All swellings should be taken seriously by the pregnant mother to thisextent, that she save a twenty-four hour specimen of urine and thatshe personally take it to her physician, with a report of her"swellings. " This symptom may or may not indicate kidneycomplications. The blood-pressure together with chemical andmicroscopical analysis of the urine will determine the cause. Slight swelling of the feet is often physiological and is due topressure of the heavily weighted uterus upon the returning veins ofthe legs. The progress of the veinous blood is somewhat impeded, hencethe accumulation of lymph in the tissues of the legs, ankles, andfeet. Never allow yourself to guess as to the cause of swellings, alwaystake urine to the physician and allow him definitely to ascertain thetrue cause. All tight bands of the waist and knee garters must bediscarded at this time. The same general treatment suggested forvaricose veins holds here. GOITRE The enlargement of the thyroid gland--goitre--is physiological duringpregnancy, and is believed to be caused by the throwing into thematernal blood stream of special protein substances derived from thefetus. As just stated, this is more or less physiological, willusually pass away after the babe is born, and, therefore, need givethe mother no particular concern. Tight neck bands should be replacedby low, comfortable ones. The bowels should move freely every day, andwater drinking be increased as well as sweating of the skin encouragedby a short, hot bath, followed by the dry blanket pack, while the headis kept cool by compresses wrung from cold water. In this manner theelimination of these poisons is increased through both the skin andthe kidneys. BACKACHE The backache of the later months of expectancy is very annoying andoften spoils an otherwise restful night's sleep. This is probably alsoa pressure symptom, if the physician's analysis of the urine provesthat the kidneys are not at fault. If you have electric lights in thehome, a very useful contrivance can be made which will give you greatrelief. The light end of an extension cord, five to seven feet inlength, is soldered into the center of the bottom of a bright, pressedtin pail about twelve inches in diameter at the top and nine or teninches deep. With the bail removed, screw in a sixteen or thirty-twocandle power bulb and attach the extension cord to a nearby wall orceiling socket. This arrangement supplies radiant heat and is called aphotophore (See Fig. 3). Apply this twofold remedial agent--light andheat combined--to the painful back (underneath the bed clothing) andour restless mother will go to sleep very quickly. This may safely beused as often and as long as desired. [Illustration: Fig. 3. The Photophore. ] PERNICIOUS VOMITING Persistent, prolonged, and very much aggravated cases of morningsickness are termed pernicious vomiting. The patient emaciates becauseof the lack of ability to keep food long enough to receive anybenefits therefrom. In treating these cases the sufferer should be put to bed in a roomwith many open windows, or, if the weather permit, should be out ofdoors on a comfortable cot. She should remain in bed one hour beforethe meal is served and from one to three hours afterward. The mindshould be diverted from her condition by good reading, friends, orother amusements. The utmost care and tact should be used in thepreparation of her food, and art should be manifested in thedaintiness of the tray, etc. We found one mother was nauseated even atthe sight of her tray and so we planned a call that should bring us toher home at the meal hour. The tray came in with the attendant inunkempt attire, who said, as she placed it carelessly down on amuch-loved book our patient had been reading: "I heard you say youliked vegetable soup so I brought you a big bowl full. " As I gazed atthe tray, I saw a large, thick, gravy bowl running over with the soup. I usually like vegetable soup, but at the sight of that sloppy lookingbowl--well, I thought I should never care for it again. After installing a new maid who had a sense of service and daintiness, and who took real pleasure in the selection of the dishes for thetray, as well as the quality and quantity of food served in them, ourpatient made speedy recovery, went on to full term and became a happymother. There is no doubt that the mind has very much to do with this vexingcomplication of pregnancy. One mother immediately stopped vomitingeverything she ate when told by her husband that "the doctor said hewas coming in the morning to take you away from me to the hospital ifyou didn't stop vomiting. " Everything known should be tried for therelief of these patients and in extreme cases, when the mother's lifeis endangered, pregnancy should be terminated. INSOMNIA The neutral full bath, temperature 97 F. , maintained for twentyminutes to one-half hour, should be taken just on going to bed. Thepatient must not talk--must rest in the bath--absolutely quiet. Thecauses of insomnia should be determined if possible, and propermeasures employed to remove them. They may consist of backache, cramps, frequent urination, pressure of the uterus on the diaphragm orpressure against the sides of the abdomen. The bed should be large, thus giving the patient ample room to roll about. The following procedures may be tried in an effort to relieve thesleeplessness: Rubbing of the spine, alcohol or witch-hazel rubbing of the entirebody, the neutral bath, or the application of the electricphotophore--described a few pages back--may be made to the painfulpart. _Do not resort to drugs_, unless you are directed to do so byyour physician. HEADACHE Headaches should not be allowed to continue unobserved by theattending physician. Measure the daily output of urine, which shouldbe at least three pints or two quarts. In case of daily or frequentheadaches, notify your physician at once and take a twenty-four hourspecimen of urine to him. Headache is an early symptom of retainedpoisons and if early reported to the physician quick relief can begiven the patient and often severe kidney complications be avoided bythe proper administration of early sweating procedures. Water drinkingshould be increased to two quarts (about ten glasses) a day. Less foodand more water are the usual indications in the headaches ofpregnancy. HIGH BLOOD-PRESSURE Blood-pressure is called _high_ when the systolic pressure registersabove 150 to 160 millimeters of mercury. Pressure above 165 should betaken seriously and the patient should keep in close touch with herphysician. Tri-weekly examinations of the urine should be made, whileeliminating baths should be promptly instituted. The subject ofblood-pressure in relation to pregnancy will be fully dealt with inthe next chapter--in connection with toxemia, eclampsia, etc. CHAPTER VI TOXEMIA AND ITS SYMPTOMS At the close of the preceding chapter on the complications ofpregnancy, brief mention was made of blood-pressure as a possiblesource of anxiety. This chapter will be devoted to a furtherdiscussion of the subjects of toxemia, eclampsia, convulsions, andespecially blood-pressure--in connection with other leading symptomsof these serious complications of pregnancy. TOXIC SYMPTOMS In a former chapter we learned that the developing child nearlydoubled its weight in the last two months of pregnancy. As the childgrows, its metabolic waste matter is greatly increased, while allthese poisonous substances must finally be eliminated by the mother. Now, the mother's waste matter is of itself considerably increased;and so, if the kidneys, the liver, and the skin are already over-taxedin their work of normal elimination--if they are already doing theirfull quota of work--we can readily see that the additional wastematter of the unborn child will throw much extra work on the alreadyoverworked eliminative organs, and this results in a condition oftoxemia. Certain symptoms accompany this state of constitutionalpoisoning or auto-intoxication--the chief of which are: 1. Headache. 2. Dizziness. 3. Blurring of the vision. 4. Swelling of the feet and hands, or puffiness of the face. 5. Diminished urine. 6. Vomiting. 7. High blood-pressure. 8. Albumin and casts in the urine. Any one of these symptoms may or may not indicate toxemia; but itshould be reported at once to the attending physician. In the presenceof one or more of these symptoms an expectant mother is always safe, while awaiting the physician's advice, in carrying out the followingprogram: 1. Drink more water or lemonade. 2. Take a mild cathartic. 3. Avoid eating much meat and other highly protein foods. CONVULSIONS OF PREGNANCY This serious complication of the last weeks of pregnancy demandsimmediate attention. They may almost invariably be avoided if theblood-pressure and the urine are studiously watched during the latterpart of the expectant period. If you are unable to get your physician at once, the followingtreatment should be administered immediately. 1. A hot colonic flushing (See Appendix). 2. A hot bath followed by the hot blanket pack (See Appendix). 3. One drop of croton oil on a bit of sugar may be placedon the back of the tongue. 4. Chloroform may be administered, provided a competentnurse or other medical person is present. The appearance of convulsions which have been preceded by one or moreof the symptoms noted under the head of "toxemia, " indicates that thepatient has become so profoundly intoxicated and poisoned by theaccumulating toxins, that the lives of both mother and child arejeopardized by threatened eclampsia. At such a time, the attendingphysician will immediately set about to bring on labor, and thus seekto empty the uterus at the earliest possible moment. CARDINAL SYMPTOMS OF TOXICITY Since toxemia (eclampsia) is one of the complications of pregnancymost to be dreaded, it is fortunate that it almost invariably exhibitsearly danger signals which, if recognized and heeded, would enable thepatient and physician to initiate proper measures to avert dangerand escape the threatened disaster. The presence of this toxic dangeris indicated by the persistent presence of the following threesymptoms: 1. Persistent, dull headache. 2. Presence of casts in the urine. 3. Persistent high blood-pressure, with tendency to increase. Of course, albumin will probably appear in the urine along with thecasts, but it is the continued appearance of the casts that is of moreimportance as a danger signal. Albumin is quite common in the urine ofthe expectant mother, but casts--long continued--suggest trouble. Headache as an indicator of toxemia is of special significance whencoupled with the other two cardinal symptoms of eclampsia--urinarycasts and increasing high blood-pressure. Therefore, the necessity forfrequent urinary tests and blood-pressure examinations during the lastweeks of pregnancy--especially, if the patient has suffered fromheadaches and has been running albumin in the urine. [Illustration: Fig. 4. Taking the Blood Pressure] HIGH BLOOD-PRESSURE Blood-pressure is a term used to indicate the actual pressure of theblood stream against the walls of the blood vessels. Theblood-pressure machine tells us the same story about our circulatorymechanism, that a steam gauge does about a high-pressure boiler (SeeFig. 4). The normal blood-pressure varies according to the age of thepatient. For instance, the normal pressure of a young person, say upto twenty years of age, runs from 100 to 120 millimeters of mercury;and then, as the age advances, the blood-pressure increases in directratio; for every two years additional age the blood-pressure increasesabout one point--one millimeter. The average pregnant woman starts in her pregnancy with ablood-pressure of say, 125 millimeters, but as pressure symptomsincrease, and as constipation manifests itself, and as the circulatingfluids are further burdened with the toxins which are eliminated fromthe child, the blood-pressure normally increases to about 140 mm. , andlater, possibly to 150 mm. If the pressure goes no higher, we are notalarmed, for we have come to recognize a blood-pressure of 140 asabout the normal pressure of the pregnant woman. There are a number of factors which enter into the raising of theblood-pressure. For instance, at any time during the pregnancy, if theeliminative organs of the mother are doing inefficient work, if shefalls a victim to a torpid liver, diseased kidneys, decreased skinelimination, or sluggish bowels, then, with the added and extraexcretions from the child, there is superimposed upon the mother farmore than the normal amount of eliminative work--and then, because ofimproper and incomplete elimination, the blood-pressure isincreasingly raised. ECLAMPSIA PREVENTED This whole subject can best be illustrated by relating a story, theactual experience of Mrs. A. This patient came to the office with ahistory of Bright's disease (albumin and casts in the urine), andchronic appendicitis. While treating her for the kidney condition, preparatory to an operation for the removal of the troublesomeappendix--in the very midst of this treatment--she became pregnant, and great indeed was our dismay. We entertained little hope of gettingboth the mother and child safely through. Frequent examination ofurine was instituted, the albumin did not increase and theblood-pressure remained at normal--about 124 mm. She paid weekly orbi-weekly visits to the office and carefully followed the regimeoutlined. She drank abundantly of water and strictly followed thedietary prescribed. Weeks and months passed uneventful, until weapproached the last six weeks of pregnancy, and then we found to oursurprise one day that the blood-pressure had made a sudden jump up to175 mm. , while the urine revealed the presence of numerous casts andalbumin--in the meantime the albumin had entirely disappeared. Therewere also other urinary findings which showed that the liver was notdoing its share in the work of burning up certain poisons. In her home we began the following program: Every day we had herplaced in a bathtub of hot water, keeping cold cloths upon her brow, face and neck, and then, by increasing the temperature of the bath, weproduced a very profuse perspiration. She was taken out of this bathand wrapped in blankets, thus continuing the sweat. All meat, bakedbeans, and such foods as macaroni and other articles containing a highper cent of protein were largely eliminated from her diet. At timesshe did not even eat bread. Her chief diet was fruit, vegetables, andsimple salads, and yet the albumin and casts continued to increase inthe urine and the blood-pressure climbed up to 190 mm. As we approached the last two weeks of pregnancy, this little womanwas taken to the hospital and systematic daily treatment with sweatingprocedures was begun. Among other things, she had a daily electriclight bath. After each of these baths she was wrapped in blankets andthe sweating continued for some time. Careful estimations of albuminwere made daily and the blood-pressure findings noted three times aday. During the last week of pregnancy she lived on oranges andgrapes. Day by day she was watched until the eventful hour arrived. She went into the delivery room and gave birth to a perfectly normalchild. The albumin and casts quickly cleared up, the blood-pressurelowered, and today the little woman is a fond mother of a beautifulbaby boy. It is hard to estimate what might have taken place had not herelimination been stimulated. The blood-pressure was our guide. Had thealbumin (without casts) appeared in the latter weeks of pregnancywith a blood-pressure of 140 or 150 mm. , we would not have becomeexcited, for the reason that in every normal pregnancy there isoften present a trace of albumin in the latter weeks; but whenthe blood-pressure jumped to 170 or 190, then we knew thattoxemia--eclampsia--convulsions--were imminent. So we have in recentyears, come to look upon the blood-pressure as an exceedinglyimportant factor--as an infallible indicator of approachingtrouble--as a red signal light at the precipice or the point ofdanger; and it not only warns us of the danger, but it tells us abouthow near the boilers are to the bursting point. The glassy eye, theheadache, the full bounding pulse and the blurring of vision, are allsymptoms accompanying this high blood-pressure, so that in theseenlightened days no practitioner can count himself worthy the name, orin any way fit to carry a pregnant woman through the months ofwaiting, unless he sees, appreciates, and understands the value ofblood-pressure findings in pregnancy. CHAPTER VII PREPARATIONS FOR THE NATAL DAY Two months before baby is to arrive, the expectant mother should payparticular attention to the conservation of her strength. The womanwho is compelled to leave her home for the factory, the laundry, theoffice, or other place of employment, should stop work during theselast two or three months. The active club woman should pass theburdens on to others, and the woman of leisure should withdraw fromactive social life with its varied obligations. During the final weeksof pregnancy, the prospective mother needs the same hygienic careregarding fresh air, exercise, diet, and water drinking, as outlinedin a former chapter. THE FINAL WEEKS As the gravid uterus rises higher in the abdomen, increased pressureis exerted on the stomach, the lungs, and upon the nerve centers ofthe back; and it is because of this situation, that the duties andobligations of the prospective mother should be reduced to a minimum, that she may feel at liberty to lie down several times during the dayon the porch or in a well-ventilated room, in the midst of the bestpossible surroundings. Sexual intercourse should be largelydiscontinued during the last months of pregnancy. I sometimes wish the prospective mothers in our dispensary districtsmight have some of the care and the kind treatment which is bestowedupon an ordinary prospective mother horse, which at least enjoys avacation from heavy labor, and whose food is eaten with calm nervesand in the quietness of a clean stall. While the state of the mother'smind does not materially influence the child; nevertheless, the stateof the mother's body, the weary over-worked muscles and nerves ofhot, tired women, bending over cook stoves, laundry tubs, or scrubbingfloors, does materially derange the mother's health and digestion, which in turn, reflexly interferes with the growth and physicaldevelopment of her child. Extra strength is required for the day oflabor, and since the baby doubles its weight during the last twomonths, the mother is living for two, and should, therefore, avoidextreme fatigue, over tiring, and irksome labor during these finalweeks of watchful waiting. SELECTION OF THE HOME It may or may not be within the province of prospective parents torearrange, rebuild, or otherwise change the home. Usually the size ofthe pocketbook, the bank account, or the weekly pay envelope decidesuch things for us. The home may be in the country or suburbs, withits wide expanse of lawns, its hedges of shrubbery, and with itsspacious rooms and porches; or it may be a beautifully equipped, modern apartment on the boulevard of a city, with its sun parlors, large back porches, conveniently located near some well-kept citypark, or it may be one of those smaller but "snug as a bug in a rug"apartments, in another part of the city, where usually there is asunny back porch; or again some of my readers may themselves be, ortheir friends may be, in a darkened basement with broken windows, illyventilated rooms, with no porches, no yards, no bright rays to be seencoming in through windows--and yet into all of these varied homesthere come little babies--sweet, charming little babies, to be caredfor, dressed, fed, and reared. And we must now proceed to the subjectof making the most of what we have--to create out of what we have, asbest we can, that which ought to be. SANITARY PREMISES In both the country and city place, yards and alleys should be cleanedup. Garbage--the great breeding place of flies--should be removed orburned. The manure pile of the stable or alley should also be properlycovered and cared for. In this way breeding places for flies areminimized and millions and billions of unhatched eggs are destroyed. In the large cities, provision is made for the prompt disposal ofgarbage, and laws are beginning to be enforced regarding the coveringand the weekly removal of manure, and thus in many of our large citiesflies are diminishing in numbers each year. Fly campaigns and garbagecampaigns are teaching us all to realize the dangers of infection, contagion, and disease as a result of filth; while through theschools, the children of even our foreign tongued neighbors take homethe spirit of "cleaning up week. " Even in the rural districts we hopefor the dawning of the day when filth, stagnant pools, open manurepiles, and open privies, will be as much feared as scorpions orsmallpox. ENGAGING THE DOCTOR As suggested elsewhere, as soon as the expectant mother is aware thatshe is pregnant, she should engage her physician. And since these aredays of specialists, he may or may not be the regular family doctor. The husband and friends may be consulted, but the final choice shouldbe made by the prospective mother herself. "The faith which casts outfear, the indefinable sense of security which she feels in her chosenphysician, supports her through the hours of confinement. " Twenty-fourhour specimens of urine should be saved and taken to the physiciantwice each month and oftener during later months of pregnancy. Thechosen physician's instructions and suggestions should be carried outand counsel should be sought of him as to the place of confinement. THE PLACE OF CONFINEMENT There are a number of factors that enter into the selection of theplace of confinement. In the first place, if the home be roomy, bathroom convenient, if the required preparation of all necessitiesfor the day of labor can be effected, and it is further possible toprepare a suitable delivery-room at home with ample facilities foremergencies and complications, and you can persuade your physician todo it--then the best place in the world for the mother to be confinedis within the walls of her own home. But such is the case in but onehome out of hundreds, and I regret that time and space will not allowme to describe and portray the many untimely deaths that might havebeen avoided if this or that supply had only been ready at the momentof the unexpected complication of delivery. Why should we needlesslyrisk the lives of prospective mothers, when, in every up-to-datehospital delivery-room, all these life-saving facilities are freelyprovided? Here in the modern hospital, the mothers from small homesand apartments, the mothers who live in stuffy basements, as well asthose from the average home in the average neighborhood, can come withthe assurance of receiving the best possible care and attention. Everywoman who can arrange or afford it, should plan to avail herself ofthe benefits, comforts, quietness, and calm of a well-equippedhospital and the surgical cleanliness and safety of its asepticdelivery-room. Fortunately, the mother of the basement home may have the same clean, sterile dressings used upon her as does the mother of the boulevardmansion. The maternity ward bed at $8. 00 to $10. 00 a week can be justas clean as the bed of the $40. 00 a week room. The methods andprocedures of the delivery-room can be just as good in the case of thevery poor woman as in the case of the magnate's wife. In no way andfor no reason fear the hospital. It is the cleanest, safest, and byfar the cheapest way. The weekly amount paid includes the board of thepatient, the routine care, and all appliances and supplies of everysort that will be used. Under no circumstances should a midwife beengaged. Any reputable physician or any intellectual minister willadvise that. Let your choice be either the hospital or the home; butalways engage a physician, _never_ a midwife. THE NURSE After selecting the place of confinement, the question of the nursemay next be considered. If it is to be the hospital, you need givelittle further thought to the nurse, for your physician will arrangefor the nurse at the time you enter the hospital. She will be a partof the complete service you may enjoy. You will find her on duty asyou, quietly resting in your room, awaken in the sweet satisfactionthat at last it is all over--at last your baby is here. A competent nurse is a necessity, if the confinement takes place inthe home. She may be a visiting nurse, who, for a small fee, will notonly come on the day of labor, but will make what is known as"post-partum calls" each day for ten or twelve days. These are shortcalls, but are long enough to clean up the mother and wash and dressthe babe. She is not supposed to prepare any meals or care for thehome. Then there is the practical nurse--women who have preparedthemselves along these lines of nursing, whose fees range from $12. 00to $18. 00 a week. If your physician recommends one to you, you mayknow she is clean and dependable. The trained nurse, who has graduatedfrom a three years' course of training, is prepared for everyemergency, and will intelligently work with the physician for thepatient's welfare and comfort. Her fees range from $25. 00 to $35. 00 aweek. Both the practical and the trained nurses are human beings, andrequire rest and sleep the same as all other women do. One nurse, after having faithfully remained at her post of duty some sixty hoursreminded the husband and sister of the patient that she must now havefive hours of unbroken rest and they replied in a most surprisedmanner, "Why we are paying you $30. 00 a week, and besides, weunderstood you were a _trained_ nurse. " The physician usually makes arrangement with the family for competentrelief for the nurse. She should have at least one to two hours ofeach day for an airing, and six hours out of the twenty-four forsleep. PREPARATIONS FOR A HOME DELIVERY The supplies should all be in the home and ready, as the seventh monthof pregnancy draws near. In the first place, select the drawer orcloset shelf where the supplies are to remain, untouched, until yourphysician orders them brought out. The supplies requiring specialpreparation and sterilization are: Three pounds of absorbent cotton. One large package of sterile gauze (25 yards). Four rolls of cotton batting. Two yards of stout muslin for abdominal binders. Two old sheets. Twelve old towels or diapers. One yard of strong narrow tape for tying the cord. Three short obstetrical gowns for the patient. Two pairs of extra long white stockings. Four T-binders. Other articles needed by physician, nurse, and patient are: Fifty bichloride of mercury tablets (plainly marked "_poison_"). Four ounces of lysol. Two ounces of powdered boric acid. One half ounce of 20% argyrol. One quart of grain alcohol. One pound jar of surgeon's green soap. One half pound of castile soap. One bottle white vaseline. One drinking tube. One medicine glass. One two-quart fountain syringe. One covered enamel bucket or slop jar. One good sized douche pan. Three agateware bowls, holding two quarts each. Two agateware pitchers, holding two quarts each. Two stiff hand-brushes. One nail file. One pair surgeon's rubber gloves. One and one-half yards rubber sheeting 36 inches wide. Two No. 2 rubber catheters. Two dozen large safety pins. Small package of tooth picks, to be used as applicators. Six breast binders (Fig. 5). Six sheets. Just before confinement send for one ounce of fluid extract of ergotand an original pint bottle of Squibb's Chloroform. THE PREPARATION OF THE SUPPLIES 1. _The sanitary pad_ is used to absorb the lochia after confinement, and needs to be changed many times during the day and night; fullyfive or six dozen will be required. They are usually made from cottonbatting and a generous layer of absorbent cotton. If made entirelyfrom absorbent cotton they mat down into a rope-like condition. Theyare four and one-half to five inches wide and ten inches long. Thesterile cheesecloth is cut large enough to wrap around the cottonfilling and extends at both ends three inches, by which it isfastened to the abdominal binder. With a dozen or fifteen in eachpackage these vulva pads are wrapped loosely in pieces of old sheetsand pinned securely and marked plainly on the outside. 2. _Delivery pads. _ These pads should be thirty-six inches square andabout five inches thick, three or four inches of which may be thecotton batting and the remainder absorbent cotton. Three of these areneeded. Each should be folded, wrapped in a piece of cloth andlikewise marked. 3. _Gauze squares. _ Five dozen gauze squares about four inches in sizemay be cut, wrapped and marked. These are needed for the nipples, baby's eyes, etc. [Illustration: Fig. 5. Breast Binder] 4. _Cotton pledgets. _ These are cotton balls, made as you would alight biscuit with the twist of the cotton to hold it in shape. Theyshould be about the size of the bottom of a teacup. These are thrownin a couple of pillow slips and wrapped and marked. 5. _The Bobbin. _ Cut the bobbin or tape into four nine-inch lengthsand wrap and mark. 6. The _tooth picks_ are left in the original package and do notrequire sterilization. 7. _Sterilization. _ Before steaming and baking, wrap each bundle inanother wrapping of cloth and pin again securely. Mark each packageplainly in large letters or initials. These packages may be sent tothe hospital for sterilization in the autoclave or they may besteamed for one hour in the large wash boiler, by placing them looselyinto a hammock-like arrangement made by suspending a firm piece ofmuslin from one handle of the boiler to the other. The center of thehammock should come to within five inches of the bottom of the boilerwhich contains three inches of boiling water. The cover of the boileris now securely weighed down and the water boils hard for one hour, atthe end of which time they are removed and placed in a warm oven todry out. The outer wrapping may be slightly tinged with brown by thisbaking. After a thorough drying they are allowed to remain in the samewrappings into which they were first placed and put away in a cleandrawer awaiting the "Natal Day. " REQUISITES FOR THE HOSPITAL Each hospital has its own methods and regulations for caring forobstetrical patients and it is well for the expectant mother to visitthe obstetrical section, the delivery-room and the baby's room, thatshe may personally know more about the place where she is to spendfrom ten days to two weeks. Here she may ascertain from thesuperintendent just what she will need to bring for the baby. Many ofthe hospitals furnish all the clothes needed for the baby while in thehospital; in such instances, the hospital also launders them. Otherhospitals require the baby's clothes to be brought in, in which casethe mother looks after the laundry. The mother always takes her toiletarticles, a warm bed jacket with long sleeves, several night dressesand a large loose kimono or wrapper to wear to the roof garden orporch in the wheel chair. Warm bedroom slippers and a scarf for thehead completes the outfit. BABY'S NECESSITIES Baby's basket on the day of confinement should contain: One pound of absorbent cotton. One pint of liquid albolene. One half ounce of argyrol (mentioned in the mother's list). Safety pins of assorted sizes. A powder box containing powder and puff. An old soft blanket in which to receive the child after birth. A soft hair brush. Three old towels. Small package of sterile gauze squares. Scales. Diapers. A silk and wool shirt (size No. 2). An abdominal band to be sewed on with needle and thread. A pair of silk and wool stockings. A flannel skirt. An outing flannel night dress. A woolen wrapper. THE CONFINEMENT ROOM By special preparation, the ordinary bedroom may be fashioned into adelivery-room. Carpets, hangings and upholstered furniture must beremoved. Clean walls, clean floors, and a scrupulously clean bed mustbe maintained throughout the puerperium. Bathroom, and if possible, aporch should be near by. In the wealthy home, a bedroom, bathroom andthe nursery adjoining is ideal; but I find that real life is alwaysfilled with anything but the ideal. The dispensary doctor is compelled to depend upon clean newspapers tocover everything in the room he finds his patient in. The only sterilethings he uses he brings with him, and should he have to spend thenight, the floor is his only bed. A student who was in my service toldme that there was not one article in the entire home, which consistedof but one room, that could be used for the baby. He wrapped his owncoat about it and laid it carefully in a market basket and placed iton the floor at the side of the pallet on which the mother lay and bythe aid of a nearby telephone secured clothes from the dispensary forthe babe. Always select the best room in the house for a home confinement. Ifthe parlor is the one sunny room, take it; remove all draperies, carpet, etc. , and make it as near surgically clean as possible. Whilesunshine is desirable, ample shades must be supplied, as the eyes ofboth mother and babe must be protected. THE BED A three-quarter bed is more desirable than a double bed. If it is low, four-inch blocks should be placed under each leg, the casters havingbeen removed to prevent slipping. The bed should be so placed that itcan be reached from either side by the nurse and physician. Themattress may be reenforced by the placing of a board under it if thereis a tendency to sag in the middle. Over this mattress is securelypinned the strip of rubber sheeting or table oilcloth. A clean sheetcovers mattress and rubber cloth and at the spot where the hips are tolie may be placed the large sterile pad to absorb the escaping fluids. The floor about the bed is protected by newspapers or oilcloth. Goodlighting should always be provided. Much trouble and possibleinfection may be avoided by clean bedding, plenty of clean dressings, boiled water, rubber gloves, and clean hands. CHAPTER VIII THE DAY OF LABOR As the two hundred and seventy-three days come to a close, ourexpectant mother approaches the day of labor with joy and gladness. The long, long waiting days so full of varied experiences, so full ofthe consciousness that she, the waiting mother, is to bring into theworld a being which may have so many possibilities--well, even theanticipated pangs of approaching labor are welcomed as marking theclose of the long vigil. These days have brought many unpleasantsymptoms, they have been days of tears and smiles, of clouds andsunshine. THE TIME OF WAITING The prospective mother has thought many times, "Will my baby evercome?" But nature is very faithful, prompt, and resourceful. Sheushers in this harvest time under great stress and strain, for actuallabor is before us--downright, hard labor--just about the hardest workthat womankind ever experiences--and, as a rule, she needs but littlehelp--good direction as to the proper method of work and theeconomical expenditure of energy. In the case of the average motherthis is about all that is needed, and if these suggestions come from awise and sympathetic physician--one who understands and appreciatesasepsis--she may count herself as fortunately situated for theoncoming ordeal. In the days of our grandmothers it was almost the exception ratherthan the rule to escape "child-bed fever, " "milk leg, " etc. ; but inthese enlightened days of asepsis, rubber gloves, and the variousantiseptics, puerperal infection is the exception, while a normalpuerperium is the rule; and this work of prevention lies in thescrupulous care taken by anyone and everyone concerned in any way withthe events of the day of labor. On this day of labor, the mother, who has gone through the longtedious days of waiting, should see to it that nothing unclean--hands, sponges, forcep, water, cloth--is allowed to touch her. Above allthings do not employ a physician who has earned the reputation ofbeing a "dirty doctor. " Puerperal infection is almost wholly apreventable disease and every patient has a right to insist uponprotection against it. In a former chapter will be found a detailed description of the"delivery bed. " Beside this bed, or near by, are to be found the rackon which are airing the necessary garments for the baby'sreception--the receiving blanket and other requisites for the firstbath--together with numerous other articles essential to safety andcomfort. There should be an easy chair in the room for the mother to rest inbetween her walking excursions during the first stages of labor. Thesterilized pads and necessary articles mentioned in an earlier chapterare, of course, close at hand. FIRST SYMPTOMS OF LABOR Regular, cramp-like pains in the lower portion of the abdomen whichare frequently mistaken for intestinal colic, often beginning in thelower part of the back, and extending to the front and down the thigh, are often the first symptoms of the approaching event. With each crampor pain the abdomen gets very hard and as the pain passes away theabdomen again assumes its normal condition. These regular cramp-likepains are the result of the early dilation of the cervix--the firstopening of the door to the uterine room which has housed our littlecitizen through the developmental stages of embryonic life--and as aresult of this stretching and dilating there soon appears that specialblood-tinged mucus flow commonly known as "the show. " THE PRELIMINARY BATH At this time a very thorough-going colonic flushing should beadministered. The patient takes the "knee-chest" position, or the"lying-down" position, and there should flow into the lower bowelthree pints of soapy water; this should be retained for a few moments;and after its expulsion, a short, plain water injection should begiven. Now follows the preliminary general bath. Just prior to the bath, the pubic hair should be clipped closely, orbetter shaved. Then should follow a thorough soap wash, with patientstanding up in the tub, using plenty of soap, applied with a shampoobrush or rough turkish mit. The rinsing now takes place by either ashower or pail pour. _Do not sit down in the tub. _ This is a rule thatmust not be broken, because of the danger of infection in those caseswhere the bag of waters may have broken early in the labor. A weak antiseptic solution, prepared by putting two small antiseptictablets into one pint and a half of warm water, is now applied to thebody from the breasts to the knee. Put on a freshly laundered gown, clean stockings and wrapper. The head should be cleansed and hairbraided in two braids. THE PROGRESS OF LABOR If all the mothers who read this volume could bear children with thecomfort Mrs. C. Does, I should be happy, indeed. At four o'clock one morning a very much excited father telephoned me, "Hurry, quick, Doctor, it's almost here. " It was well that we didhurry, for the first sign the little mother had was the deluge of thewaters--at this point the husband ran to telephone for the doctor--nomore pains for thirty-eight minutes (just as we entered the door) andthe baby was there. But such is not usually the case, nor will it be, as labor usually progresses along the lines of conscious dilatingpains, occurring at intervals twenty minutes apart at first, laterdrawing nearer together until they are three to five minutes apart. This "first stage of labor" lasts from one to fifteen hours--duringwhich time the tiny door to the uterine room which was originallyabout one-eighth of an inch open--dilates sufficiently to allow thepassage of the head, shoulders and body of the fully developed child. About this time the bag of waters usually bursts, and, as a rule, this marks the beginning of the "second stage of labor. " The amount ofwater passed varies in amount. Should the rupture take place beforethe door is fully open, then labor proceeds with difficulty and thecondition is known as "dry labor. " The head after proper rotation now begins the descent; and here thepains begin to change from the sharp, lancinating, cramp-like painswhich begin in the back and move around to the front, to those of the"bearing down" variety, while at the same time there begins to appearthe bulging at the perineum, which means that the head is about to beborn. At this time great stress is brought to bear upon the perineumand often, in spite of anything that can be done to prevent it, theperineum is more or less lacerated. As soon as the baby is born the "second stage of labor" has passed andwithin thirty to fifty minutes the close of the third stage of laboris marked by the passage of the placenta or "afterbirth. " FALSE LABOR PAINS Sometimes, as long as two weeks before the birth of the child, certainirregular, heavy, cramp-like pains occur in the abdomen and back. Fora half-dozen pains they may show some signs of regularity; but theyusually die down only to start up again at irregular intervals. Theseare known as "false pains. " When the pains begin to take on regularity and gradually grow heavierand it is near the appointed time for the labor, the patient shouldprepare to start for the hospital; or, if it is to be a home delivery, the physician should be called. As noted above, the first subjectivesymptom may be the rupture of the bag of waters, and it is imperativeto prepare at once for the labor. It is far better to spend the day atthe hospital, or even two days waiting, rather than to run the risk ofgiving birth to the child in a taxicab or street car; or, in the eventof a home labor, to have the child born before the doctor arrives. WHAT TO DO IN THE ABSENCE OF A DOCTOR It is often the case that when we need our physician the most, he isbusy with another patient and cannot come, or perhaps an automobileaccident detains the man of the hour. The hospital delivery alwayspossesses this advantage over the home--physicians are always on hand. We deem it wise to relate in detail the method of procedure during therapid birth of a child; that the husband or nurse may give intelligentand clean service. After the patient has been given the enema and has been shaved and thebath has been administered as previously directed, the helper mostvigorously "scrubs up. " There are three distinct phases to the"scrubbing up": First, the three-minute scrubbing of the hands andforearms with a clean brush and green soap; to be followed by, second, the trimming and cleaning of the finger nails, for it is here, underthe nails, that the micro-organism lives and thrives that causeschild-bed fever or septicemia; and, third, the final five-minutescrubbing of the fingers, hands, and forearms. An ordinary towel isnot used to dry the well-cleansed hands, but they are now dipped inalcohol and allowed to dry in the air. And now if the pains are returning every three to five minutes or ifthe bag of waters has broken, the patient should go to bed. She willlie down on her back with the knees drawn up and spread apart. Thepatient, having had the cleansing bath, is now washed with thedisinfectant bath (2 antiseptic tablets to 1½ pints of water), fromthe breasts to the knees. Another member of the family takes the outerwrappings off the sterilized delivery pad and the "clean" helperplaces the sterile delivery pad under the expectant mother, who isdirected to "bear down" when her pains come. She may be supportedduring these pains by pulling on a sheet that has been fastened to thefoot of the bed. The _clean_, helper then sits by her constantly until the baby is bornbut under no circumstances should touch her until after the headappears. Immediately after the birth of the head, the shouldersusually follow with the next pain, which ought to occur within two orthree minutes. Occasionally the face turns blue, in such an instance, the mother is directed to strain vigorously and presses down heavilyon the abdomen with both her hands, this usually hurries mattersmaterially, and the body of the child follows quickly. The baby shouldcry at once. If the child does not show signs of life, quick, briskslapping on the back usually brings relief. During the birth of thehead it is imperative that, in the event of liquid passing at the sametime, no water or blood be sucked into the mouth by the baby. Greatcare must be exercised in this matter. Should the baby remain blue, lay it quickly upon its right side near the mother, and after thepulse of the cord has stopped beating the clean helper ties the cordtwice, two inches from the child and again two inches from this tyingtoward the mother, and then the cord is cut between the two tyingswith scissors that have been boiled twenty minutes. Should there be more difficulty with the breathing of the new bornchild, if slapping it on the back brings no relief, its back (withface well protected) may be dipped first in good warm water, thencold, again in the warm, again in the cold--this seldom fails. Thechild should then be kept very warm, lying on its right side. CARE OF THE MOTHER All this time, a member of the family has been firmly grasping themother's abdomen, and within an hour the afterbirth passes out throughthe birth canal. If the physician has not yet arrived, all dressings, the pad, the afterbirth, must all be saved for his inspection. The inside of the thighs and the region about the vagina is now washedwith bichloride solution, the soiled delivery pad removed, a cleandelivery pad is placed under her; an abdominal binder is applied andtwo sterile vulva pads are placed between the legs, and hot waterbottles are put to her feet, as usually at this stage there is aslight tendency toward chilliness. She should now settle down forrest. Fresh air should be admitted into the room. There may be somehemorrhage, and if it is excessive, grasp the lower abdomen and beginto knead it until you distinctly feel a change in the uterus from thesoft mass to a hard ball about the size of a large grape fruit; thuscontraction has been brought about which causes the hemorrhage todecrease. If the doctor has not yet arrived put the baby to thebreast, and place an ice bag for ten or fifteen minutes on the abdomenjust over the uterus. Should there be lacerations, the doctor willattend to their repair when he comes. One teaspoonful of the fluidextract of ergot is usually given at this time, if possible get intouch with the physician before it is administered. CARE OF THE BABY After the mother is comfortable, your attention is directed to thebaby; the condition of the cord is noted; should it be bleeding, donot disturb the tying, but tie again, more tightly just below theformer tying, and with the long ends of the tape, tie on a sterilegauze sponge or a piece of clean untouched medicated cotton, thusefficiently protecting the severed end of the cord. No furtherdressing is needed until the doctor arrives. Grave disorders have arisen from infection through the freshly cutumbilical cord. Should the doctor be longer delayed, one drop of twenty per centargyrol should be dropped in each of the infant's eyes and separatepieces of cotton should be used for each eye to wipe the surplusmedicine away. This application must not be long neglected, for a very large per centof all the blindness in this world might have been avoided had thismedicine been placed in each eye soon after birth. The warmed albolene is now swabbed over the entire body of the infant(this is done with a piece of cotton), the arm pits, the groins, behind the ears, between the thighs, the bend of the elbow, etc, mustall receive the albolene swabbing. In a few minutes, this is gentlyrubbed off with a piece of gauze or an old soft towel, and the babycomes forth as clean and as smooth as a lily and as sweet as a rose. The garments are now placed on the child--first the band, then shirt, diaper, stockings, flannel skirt, and outing flannel gown--and it isput to rest after the administration of one teaspoonful of cooled, boiled water. In six to eight hours it will be put to the breast. CHAPTER IX TWILIGHT SLEEP AND PAINLESS LABOR In recent years much has appeared in both the popular magazines andthe medical press concerning the so-called "twilight sleep" and othermethods of producing "painless childbirth. " Many of these populararticles in the lay press cannot be regarded in any other light thanas being in bad taste and wholly unfortunate in their method andmanner of presenting the subject; nevertheless, these writings haveserved to arouse such a general public interest in the subject ofobstetric anesthetics, that we deem it advisable to devote twochapters to the brief and concise consideration of the subjects ofpain and anesthetics in relation to the day of labor. THE PAIN OF LABOR First, let us briefly consider the question of pain in connection withchildbirth. Many women--normal, natural, and healthy women--suffer butcomparatively little in giving birth to an average-sized baby duringan average and uncomplicated labor. Like the Indian squaw, they suffera minimum of pain at childbirth--at least this is largely true afterthe birth of the first baby; and so there is little need of discussingany sort of anesthesia for this group of fortunate women; for at most, all that would ever be employed in the nature of an anesthetic in suchcases, would be a trifle of chloroform to take the edge off thesuffering at the height or conclusion of labor. But the vast majority of American mothers do not belong to thisfortunate and normal class of women who suffer so little duringchildbirth; they rather belong to that large and growing class ofwomen who have dressed wrong; who have lived unhealthful and sometimesindolent lives; who are more or less physically and temperamentallyunfitted to pass through the experiences of pregnancy and the trialsof labor. The average American woman shrinks from the thought and prospect ofsuffering pain; she is quite intolerant with the idea of undergoingeven the few brief moments of physical suffering attendant uponchildbirth. She refuses to contemplate the day of labor in any otherlight than that which insures her against all possible pain and otherphysical suffering. And it is just this unnatural and abnormal fear of labor-pains--thisunwomanly dread of the slightest degree of physical suffering--thathas indirectly led up to so much discussion regarding the employmentof "twilight sleep" and other forms of obstetric anesthesia. While the authors recognize the great blessing of anesthesia to thewoman in labor--and almost unfailingly make use of it in someform--nevertheless, we also recognize that it would be a fine form ofmental discipline and mighty good moral gymnastics, if a great manyself-centered and pampered women would "spunk right up" and face theordeal of labor with natural courage and normal fortitude. It would be"the making of them, " it would make new women out of them, it wouldstart them out on the road to real living. At the same time we do notmean to advocate that women should suffer unnecessary pain inchildbirth any more than we allow them to suffer in connection withsurgery. PREPARATION FOR LABOR While so much is being written about "twilight sleep" and "painlesslabor, " it might be well to remind the American mother that much canbe done to lessen the sufferings of the day of labor by one's methodof living prior to the confinement. We believe that child-bearing is a perfectly normal physical functionfor a healthy and normal woman--that it is even essential to hercomplete physical health, mental happiness, and moral well-being. Theoretically, child-bearing ought to be but little more painful thanthe functionating of numerous other vital organs--stomach, heart, bladder, bowels, etc. --and, indeed, it is not in the case of certainsavage tribes and other aboriginal people, such as our own NorthAmerican Indian. But we must face the facts. The average American woman does suffer atchildbirth; and she suffers more than we are disposed to allow her, ormore than she, as a general rule, is willing to suffer. So, while wediscuss appropriate methods of lessening the pain of labor and thepangs of childbirth by the scientific use of anesthetics, let us alsocall attention to certain things which may aid in decreasing theamount of pain which may reasonably be expected to attend childbearing. To assist in bringing about this preparation for decreased pain atchildbirth, mothers should teach their daughters how to develop, strengthen, and preserve their physical, mental, and moral resistance. The young mother should be taught by both her mother and her physicianhow to dress, how to work, and how to eat. Every care should be givento the hygiene of pregnancy and labor. The expectant mother should have plenty of fruits and fruit juices, and if not physically well endowed to give birth to a large babe, sheshould have her diet restricted in meat, bread and milk, as well asthe cereals. Overeating during pregnancy should be carefully guardedagainst, as emphasized in an earlier chapter. Deformities of thepelvis, etc. , should rule out a consideration of pregnancy. While artificial painless childbirth by means of "twilight sleep" andother similar methods all have their place; nevertheless, theseprocedures should not lead to the neglect of those natural methods andpreventive practices which aid in preparing the normal expectantmother for nature's relatively painless labor. When so much anesthesiahas to be used in a normal labor, it cannot but strongly suggest thatboth patient and physician have neglected those common but efficientmethods which contribute indirectly to lessening the pangs of childbearing. WHAT IS TWILIGHT SLEEP? "Twilight sleep" is a recent term which has become associated in thepublic mind with "painless labor. " The reader should understand that"twilight sleep" is not a new method of obstetric anesthesia. Whilethis method of inducing "painless labor" has been brought prominentlybefore the public mind in recent years by much discussion and bynumerous magazine articles--being often presented in such a way assometimes to lead the uninstructed layman to infer that a new methodof obstetric anesthesia had just been discovered--it has, nevertheless, been known and more or less used since 1903. Later knownas the "Freiburg Method, " and as the "Dammerschlaf" of Gauss, andstill later popularized as "twilight sleep, " this "scopolamin-morphin"method of obstetric anesthesia, has gained wide attention and acquiredmany zealous advocates. "Twilight sleep" is, therefore, nothing new--it is simply a revival ofthe old combination of _scopolamin_ and _morphin_ anesthesia. Whilemany different methods of administering "twilight sleep" have beendevised, the following general plan will serve to inform the readersufficiently regarding the technic of this much-talked-of procedure. The scopolamin must always be fresh, although different forms of thedrug are used. It tends quickly to decompose--forming a toxicby-product--and, according to some authorities, this decomposedscopolamin is responsible for many undesirable results which haveattended some cases of "twilight sleep. " Various forms of morphin arealso used, as also is narcophin. TECHNIC OF "TWILIGHT SLEEP" The "twilight-sleep" injections are not started until the patient isin the stage of active labor. The initial injection consists of theproper dose of scopolamin and morphin (or some of their derivatives), while the patient's pupils, pulse, and respiration are carefullynoted, as also are the character of the uterine contractions and thecharacter of the fetal heart action. Usually within an hour, a second dose of scopolamin is given, whilethe application of so-called "memory tests" serves to indicate whetherit is advisable to administer additional injections. Some leadingadvocates of this method claim that the majority of the unfavorableresults attendant upon "twilight sleep" are the direct result offailure to control the dosage of the drug by these "memory tests;" andthey call attention to the large percentage of "painlessness" as proofof probable overdosing. If the patient's memory is clear and she isnot yet under the influence of the drug, a third dose is soon given. If, however, the patient is in a state of amnesia (lack of memory), this third injection is not commonly given until about one hour afterthe second injection. The amount of amnesia present is used as a guidefor repeated injections at intervals of one to one and a half hours. As a rule, the morphin is not repeated. It must be evident that the success of such a method of anesthesiamust depend entirely upon thoroughgoing personal supervision of theindividual patient by a properly trained and experienced physician;and it is for just these reasons that "twilight sleep" is destined toremain largely a hospital procedure for a long time to come. Experience has shown that those cases of "twilight sleep" that are notunder the influence of scopolamin over five or six hours do vastlybetter than those under a longer time. When employed too long beforelabor this method seems to favor inertia and thus tends to increasethe number of forceps deliveries. The number of injections may run from one to a dozen or more, andpatients have come through without accident with fifteen or moredoses, running over a period of twenty-four hours. THE CLAIMS OF "TWILIGHT SLEEP" While "twilight sleep" as a method of anesthesia is not altogethernew, many of the claims made for it by recent advocates are more orless new; and, to enable the reader clearly to comprehend both theadvantages and disadvantages of this method, both the favorable andunfavorable facts and contentions will be summarized in thisconnection. The favorable claims made for "twilight sleep" are: 1. That eighty to ninety per cent of all women who use this method canbe carried through a practically painless labor. 2. That there is practically no danger to the mother (some degree ofdanger to the child is admitted by most of its champions) other thanthose commonly attendant on the older and better known methods ingeneral use. 3. That "twilight sleep, " being almost exclusively a hospitalprocedure, would result in more women going to the hospital for theirconfinement--if it were used more; and would, therefore, tend to bringabout more careful supervision and individual care on the part of theattending obstetrician. 4. That by lessening the dread of labor and the fear of painfulchildbirth, there will probably occur an increase in the birth rate ofthe so-called "higher classes of society"--the social circles whichnow show the lowest birth rates. 5. That it is of special value in the cases of certain neurotic womenand those of low vital resistance; especially those patients sufferingfrom certain forms of heart, respiratory, kidney, and other organicdiseases. 6. Some authorities maintain that "twilight sleep" is of value even inthreatened eclampsia, although they admit it tends to produce a risein blood-pressure. 7. It is supposed to shorten the first stage of labor--by facilitatingthe dilation of the cervix--owing to the painless stretching; althoughthe majority of its special advocates admit that it lengthens thesecond stage of labor, during which the patient must be very closelywatched. 8. That even in those cases where the sense of pain is not entirelydestroyed, the patient seems to possess little or no subsequent memoryof any physical suffering or other disagreeable sensations. 9. That the method is of special value in sensitive, high-strung, nervous women of the "higher classes, " who so habitually shun therigors of child bearing--especially in the instance of their firstchild. 10. That the action of scopolamin is chiefly upon the central nervoussystem--the cerebrum--that it diminishes the perception of painwithout apparently decreasing the contractile power of the uterus;labor may, therefore, proceed with little or no interruption, whilethe patient is quite oblivious to the accompanying pains. 11. That the physical and nervous exhaustion is quite entirelyeliminated--especially in the case of the first labor--that patientswho have had this method of anesthesia appear refreshed and quitethemselves even the first day after labor. 12. That there is decidedly less "trauma" (appreciable injury) to thenervous system and therefore less "shock;" and that all this saving ofnervous strain tends greatly to hasten convalescence. 13. And, finally, that "twilight sleep" does not interfere with thecarrying out of any other therapeutic measures which may be deemednecessary for a successful termination of the labor. DANGERS OF TWILIGHT SLEEP While we are recounting the real and supposed advantages of "twilightsleep"--especially in certain selected cases--it will be wise to pauselong enough to give the same careful consideration to the known andreputed dangers and drawbacks which are thought to attend this methodof anesthesia in connection with labor cases. We desire to state that these expressions, both for and against"twilight sleep, " are not merely representative of our own experienceand attitude; but that they also represent, as far as we are able tojudge at the time of this writing, the consensus of opinion on thepart of the most reliable and experienced observers and practitionerswho have used and studied this method in both this country and Europe. The dangers and difficulties of "twilight sleep" may be summarized asfollows: 1. That this method tends to weaken the mental resistance of manywomen; to lessen their natural courage and to decrease thatcommendable fortitude which is such a valuable feature of thecharacter endowment of the normal woman. 2. That "twilight sleep" is essentially a hospital method and is, therefore, inaccessible to the vast majority of women belonging tothe middle and lower classes of society, as well as to those women wholive in rural communities. 3. That in fifteen or twenty per cent, the method fails to produce thedesired results--at least, when administered in amounts which aredeemed safe. 4. That this method does decrease the baby's chances of living; thatthe second stage of labor is definitely prolonged; that from ten tofifteen per cent of the babies are sufficiently under the influence ofthe anesthesia when born as to be unable to breathe or cry withoutartificial stimulus. 5. That it is a method requiring special training and experience; thatit will be many years before the average practitioner will becomeproficient in its use; and that the older methods are probably farsafer for the average physician. 6. That the method requires more care in its administration than canbe expected outside of the hospital in order to avoid the dangers offetal asphyxiation--which danger has led not a few obstetricians toabandon it. 7. That a satisfactory technic is almost impossible of development;that every patient must be individualized; that the chief dangers areconnected with the over dosage of morphin; that the method is notadaptable to the general practice of the average doctor. 8. That by prolonging the second stage of labor and by sometimesgiving too much morphin, the number of forceps deliveries is greatlyincreased, with their attendant and increased dangers to both motherand child. 9. That the prospects of passing through labor which may be renderedpainless by artificial methods, tends to produce an attitude ofcarelessness and indifference towards those natural methods of livingand other hygienic practices which so greatly contribute to naturallypainless confinements. 10. That this method as sometimes practiced greatly increases thedangers of a general anesthetic, if such should be found necessarylater on during the labor. 11. That "twilight sleep" is contra-indicated (should not be used) inthe following conditions: primary inertia (abnormally delayed and slowlabor); expected short labor--especially in women who have alreadyborne children; when the fetal head is known to be large and themother's pelvis small; placenta praevia (abnormal placentalattachment); accidental hemorrhage; absent or doubtful fetal heartbeat; when labor is already far advanced; and in threatenedconvulsions and eclampsia. CONCLUSIONS REGARDING TWILIGHT SLEEP Having presented the evidence both for and against "twilight sleep, "it may be of assistance to the lay reader to have placed before herthe personal conclusions and working opinions of the authors. We, therefore, undertake to summarize our present attitude and outline ourpractice as follows: 1. "Twilight sleep" as a method of obstetric anesthesia in certainselected cases and in well-equipped hospitals, and in the hands ofcareful and experienced practitioners, has demonstrated that it is ascientific reality--and has probably come to stay--at least untilbetter and safer methods of affecting a relatively painlessconfinement are discovered; although we are compelled to state that itis not the panacea the lay press has led many of our patients tobelieve. (That we believe a much better and safer method has beendevised, the next chapter will fully disclose. ) 2. We do not expect this method ever to become general in its use; wedo not look for a chain of special "twilight hospitals" to stretchacross the continent and then to overrun the country. We expect muchof the recent forced enthusiasm to die down, while scopolamin-morphinanesthesia takes it proper place among other scientific methods ofalleviating the pangs of labor. 3. We know that standard and fresh solutions--as already noted--areabsolutely essential for the success of this method. 4. We are certain that no routine method or technic can be developed. Each patient must be individualized. The method does not consist ininjecting scopolamin every so often. The patient's mental and physicalcondition--as also that of the unborn child--must control theadministration of "twilight sleep. " 5. The patient must be in a quiet and partially darkened room. Shemust not be disturbed; while the physician, or a competent trainednurse, must be in constant attendance. 6. While this method of treatment is best carried out in thewell-appointed hospital, there is no real reason why it cannot befairly well carried out in a well-regulated private home, provided thenecessary preparations have been made, a trained nurse is present, andprovided, further, that the physician is willing to remain in the homewith the patient the length of time required properly to supervise thetreatment. 7. Even when the treatment is not instituted early in labor, it can, in certain selected and appropriate cases, be utilized even in thesecond stage of labor--thus saving these special cases muchunnecessary pain; in fact, some authorities regard it as a valuableadjunct in the management of "borderland contractions" as it allowsthe patient a full test of labor. 8. In our opinion, this method has little effect on the first stage oflabor if properly administered; but it does undoubtedly prolong andtend to complicate the second stage; in fact, we are coming to lookupon "twilight sleep" as being more distinctly a first stageprocedure; that it bears the same relation to the first stage of laborthat chloroform bears to the second stage--relieving the pain but notstopping the progress of labor. 9. That when safe amounts of the drug are used the pain is greatlylessened in all cases--the subsequent memory of pain is absent in themajority of the patients--but the labor is not always entirelypainless as is popularly supposed. 10. We do not believe that this method when properly administeredincreases the number of forceps deliveries--at least not in the caseof high forceps operations. It undoubtedly does cover up the symptomsof a threatened rupture of the uterus, and thus increases danger fromthat source; nevertheless it may be safely stated that this methoddoes not in any way greatly interfere with any other measures whichmight be found necessary to institute in order to bring about asuccessful termination of the labor. 11. The baby's heart beat must be carefully and constantly watched;sudden slowing means that the treatment must be discontinued and thechild delivered as soon as possible; even then, difficulty may beexperienced in getting the baby's breathing started after it is born. In the vast majority of cases where the baby does not cry or breatheat birth, the usual methods employed in such cases serve quickly toestablish normal respiration, and the baby seems to be but little theworse for the experience. 12. While altogether too much has been claimed for "twilight sleep" atthe same time many false fears have also been suggested, among whichmay be mentioned the fear of the mother losing her mind after thetreatment; the undue fear of asphyxiation on the part of the baby; thefear of post-partum hemorrhage; and the fear that it will lessen themilk supply. We cannot deny that the child's dangers are oftenincreased; but in other respects, this method (in properly selectedcases) presents little more to worry us than the older methods ofanesthesia. 13. We are inclined to the belief that this method has but littleinfluence on the course of convalescence following labor. Certainnervous and highly excitable women certainly seem to do better, as aresult of experiencing less pain and nervous shock; while other casesdo not turn out so well. It certainly does not retard repair andrecovery during the puerperium. 14. This method seems to have its greatest field of usefulness inthose cases of highly intelligent but excessively neurotic women whohave an abnormal dread of pain and child bearing; or women who havesuffered unusually at the time of a previous confinement--perhaps inthe case of the first baby--or from other complications; women such asthese, and other special cases, are the ones to benefit most from theemployment of "twilight sleep. " 15. This method as has already been intimated, is most useful in thecase of the first baby, or in the case of women who have established arecord of tedious and painful labors. It has no place in normal andshort labors; although it may be used to great advantage in certaincases during the first stage of labor--being carefully and lightlyadministered--while chloroform or gas is utilized at the end of thesecond stage just as has been our custom for a generation. 16. As noted under the special claims made for this method, it is (asalso is nitrous oxid) the ideal procedure in cases of heart, respiratory, kidney, and other organic difficulties, the details ofwhich have already been noted, and their repetition here is notnecessary. 17. It must be remembered that scopolamin and morphin are more or lessuncertain in their action; scopolamin is variable in its results, often producing such marked nervous excitement in the patient asgreatly to interfere with the carrying out of an aseptic technic;while morphin has been shunned by obstetricians for a wholegeneration, because of its well-known bad effects on the unborn childas well as its interference with muscular activity on the part of themother. In Germany, it is said, that a great many damage suits againstprominent physicians have resulted because of the alleged ill effectswhich have followed the use of "twilight sleep. " 18. In presenting these facts and opinions regarding "twilight sleep, "the reader should bear in mind that we are not only endeavoring tostate our own views and experience, but also to give the reader justas clear and fair an idea of what other and experienced physiciansthink of the method, both favorably and unfavorably; and we will drawthese conclusions to a close by citing the opinion of one or two whohave had considerable experience with the method and who, in summingup their observations, say: The disadvantages of the method are entirely with the accoucheur and not to the mother or child. _It requires his presence at the bedside from the time the treatment is undertaken until the completion of labor_, not so much because of any danger, but to keep the patient evenly under anesthesia on a line midway between consciousness and unconsciousness, for if she is allowed to go above that line in several instances she will have several so-called "isles of memory, " and will be able to draw a picture of her labor in her mind and thus lose the benefit of the treatment. These methods of anesthesia are very important and have merit. They should be used when properly indicated. No one should limit himself to a routine method. Each case should be individualized and the form of anesthesia best suited to the case in hand should be employed. For instance, in dealing with a primipara--one who is full of fear, who cannot stand pain, who is of an hysterical nature--morphin-scopolamin anesthesia is best suited in that particular case, because these drugs have a selective action when it comes to allay fear and produce amnesia. On the other hand, in a multipara who has had three or four children, whose soft parts are relaxed and who has short labors, the anesthetic of choice would be a few whiffs of chloroform as the head passes over the perineum. It is ridiculous to try to give such women the "twilight sleep. " Furthermore, take the cases you see for the first time at the end of the first stage of labor, or during the second stage; these cases are best treated with the nitrous oxid and oxygen method. You have to individualize your cases. The prospective mother now consults the obstetrician early to find out if her particular case is suitable for the "twilight sleep. " She has been informed that certain examinations--urine, blood pressure, etc. --are necessary. She knows that these examinations have to be made at regular intervals. In other words, we get the patients early and we can give them good prenatal care. This chapter has been devoted to "twilight sleep;" the followingchapter will consider "nitrous oxid" and other methods of anesthesiain connection with labor, and should be read along with the foregoingdiscussion in order to obtain an intelligent view of the whole subjectof "painless labor. " CHAPTER X SUNRISE SLUMBER AND NITROUS OXID Since the public has already been told so much about obstetricanesthesia, we deem it best to go into the whole subject thoroughly, so that the expectant mothers who read this book will be able to forman intelligent opinion regarding the question, and thus be in aposition to give hearty cooperation to the decision of their physicianto employ, or not to employ, any special form of anesthesia oranalgesia in their particular case. In order to give the reader acomplete understanding of "painless labor, " it will be necessary togive attention to that newer and more safe method of obstetricanesthesia called "sunrise slumber. " This method of anesthesiaconsists in the employment of nitrous oxid or "laughing gas, " and willbe fully considered in this chapter. OBSTETRIC FEAR In this connection we desire to reiterate and further emphasize somestatements made in the preceding chapter concerning the unnatural fearand abnormal dread of childbirth. We feel that it is very important in connection with this new movementin obstetrics to reduce the woman's pain and suffering to the lowestpossible minimum, that the trials of labor should not be overdrawn andthe pangs of confinement overestimated. We must not educate the normalwoman to look upon labor as a terrible ordeal--something like a majorsurgical operation--which, since it cannot be escaped, must be enduredwith the aid of a deep anesthesia. The facts are that a very small per cent of healthy women suffer anyconsiderable degree of severe pain--at least not after the firstchild. We often observe that judicious mental suggestion on the partof the physician or nurse in the form of encouraging words andsupporting assurances tends to exert a marked influence in controllingnervousness and subduing the sufferings of the earlier labor pains. We must not allow the efforts of medical science to lessen thesufferings of child-bearing, to rob womankind of their natural andcommendable courage, endurance, and self-reliance. We do not mean to perpetuate the old superstition that pain andsuffering are the necessary and inevitable accompaniments ofchild-bearing--that the pangs of labor are a divine sentencepronounced upon womankind--and that, therefore, nothing should be doneto lessen the sufferings of confinement. Severe and unnatural pain isnot at all necessary to childbirth, and there exists no reason underthe sun why women should suffer and endure it, any more than theyshould suffer the horrors of a very painful surgical operation withoutan anesthetic. In this connection, it should be recalled thatanalgesic drugs have been introduced into obstetric practice onlyduring the last fifty years, while such methods of relieving pain havebeen used in general surgery for a much longer period. It is now onlysixty-nine years since Simpson first employed anesthetic inobstetrics, while six years afterwards Queen Victoria gave her seal ofapproval to the use of chloroform in labor cases. Thirty years ago, in speaking of the expectant mothers, Lusk warnedus: As the nervous organization loses in the power of resistance as the result of higher civilization and of artificial refinement, it becomes imperatively necessary for the physician to guard her from the dangers of excessive and too prolonged suffering. NITROUS OXID--"LAUGHING GAS" Nitrous oxid, or "laughing gas, " was first used in labor cases in 1880by a Russian physician. During the last twenty-five years it has beenused off and on by numerous practitioners in connection withconfinement, but not until the last few years has this method ofrelieving labor pain come into prominent notice. While the "laughing gas" method of obstetric anesthesia did not gainnotoriety and publicity from being exploited in magazines and otherlay publications, it did get its initial boost in a very unique andunusual manner. A gentleman who manufactured and sold a "laughing gas"and oxygen mixing machine for the use of dentists, insisted that thismethod of anesthesia should be used in the case of his daughter, whowas about to be confined. This patient was kept under this nitrousoxid anesthetic for six hours--came out fine--no accidents or otherundesirable complications affecting either mother or child, and thusanother and safe method of reducing the sufferings of childbirth hasbeen fully demonstrated and confirmed, although it had previously beenknown and used in labor cases to some extent. Starting from this particular case in 1913, many obstetricians beganexperimental work with "gas" in labor cases; and, at the time of thiswriting, it has come to occupy a permanent place in the management oflabor, alongside of chloroform, ether, and "twilight sleep. " ANALGESIA VS. ANESTHESIA The reader should understand the difference between analgesia andanesthesia. Anesthesia refers to the condition in which the patient ismore or less unconscious--wholly or partially oblivious to what isgoing on, and, of course, entirely insensible to all pain. Analgesiais a term applied to the loss of pain sensation. The patient may notbe wholly or even partially unconscious--merely under the influence ofsome agent which dulls, deadens, or otherwise destroys the realizationof pain. This is the condition aimed at by the proper administrationof any form of "twilight sleep, " whether by the scopolamin-morphinmethod, or by the nitrous oxid ("sunrise slumber") method. Any method of treatment which can more or less destroy the pain oflabor without in any way interfering with its progress, and which inno way complicates its course or leaves behind any bad effects oneither mother or child, must certainly be hailed with joy by both thepatient and the physician. While chloroform has served these purposesfairly well, there have been numerous drawbacks and certain dangers;and it was the knowledge of these limitations in the use of bothchloroform and ether, that has led to further experimentation and thedevelopment of these newer methods of producing satisfactoryanalgesia--freedom from pain--without bringing about such a state ofprofound anesthesia as accompanies the administration of the oldermethods. It should be borne in mind that in using "sunrise slumber" (nitrousoxid) for labor pains, the gas is so administered that the patient isjust kept on the "borderline"--in a typical "twilight" state--and notin the condition of deep anesthesia which is developed when nitrousoxid is employed by physicians and dentists as an anesthetic for majorand minor surgical operations. Analgesia is the first stage of anesthesia--the "twilight zone" ofapproaching unconsciousness--in which the sense of pain is greatlydulled or entirely lost, while even that which is experienced is notremembered. It seems to the authors that "gas" is the ideal drug forproducing this condition whenever it is necessary, as nitrous oxid isthe most volatile of anaesthetics, acts most quickly, and its effectspass away most rapidly, while its administration is under the mostperfect control--it may be administered with any desired proportion ofoxygen--and may be discontinued on a moment's notice. It ispractically free from danger even when continued as an analgesic forseveral hours. Nitrous oxid never causes any serious disturbance inthe unborn child, as chloroform sometimes does when used tooliberally. EFFECTS OF NITROUS OXID It will not be necessary to compare the favorable and unfavorableclaims for nitrous oxid as we did the contentions for and against"twilight sleep. " Whatever service "laughing gas" or "sunrise slumber"can render the cause of obstetrics we can accept, knowing full wellthat, in competent hands, it can do little or no harm; and this weknow from the facts herewith recited and from the further fact that wehave gained a wide experience with this agent in the practice of bothdentistry and surgery. In a general way, the influence of "sunriseslumber" on mother and child may be summarized as follows: 1. It can accomplish its purpose--can quite satisfactorily relieve themother of severe pain--when employed as an analgesic. It is notnecessary to administer the gas to the point of anesthesia except atthe height of suffering at the end of the second stage of labor, whenthe head of the child is passing through the birth canal. 2. This method can be stopped at any moment--the patient ran bebrought out from under its influence entirely and almostinstantaneously. It is not like a hypodermic injection of a drug whichmay exert a varying and unknown influence upon the patient, and which, when once given, cannot be recalled. 3. It is a method which may be used in the patient's home just assafely as in a hospital; the only drawback being the inconvenience oftransporting the gas-containing cylinders back and forth. This is evennow partially overcome by the improved combination gas and oxygen formof apparatus which has been devised. 4. The administration of nitrous oxid analgesia or anesthesia does notinterfere with or lessen the uterine contractions or expulsive effortson the part of the mother--at least not to any appreciable extent. 5. Just as soon as a severe uterine contraction--attended by itssevere pain--begins to subside, the gas inhaler is immediatelyremoved, and in a few seconds the patient is again conscious. It isnot necessary to keep the patient continuously under the influence ofthe drug, as in the case of the scopolamin-morphin method of "twilightsleep. " 6. This method ("sunrise slumber") is certainly far more safe inordinary and unskilled hands than the "twilight sleep" procedure. Thepatient is more safe with this method in the hands of the averagedoctor or trained nurse. 7. It has been our experience that nitrous oxid in the smaller, interrupted and analgesic doses, actually tends to stimulate theuterine pains and contractions, while at the same time rendering thepatient quite oblivious to their presence. When properly administered, the freedom from pain is perfect. 8. Under the influence of "gas, " patients often appear to "bear down"with increased energy. It certainly does not lessen their cooperationin this respect. 9. We have not observed, nor have we learned of, any cases of inertia(weak and delayed contractions), post partum hemorrhage, or shock, asa result of "laughing gas" or "sunrise slumber" analgesia. 10. This method lends itself to perfect control--it may be decreased, increased, or discontinued, at will; it may be given light now andheavy at another time; while, at the height of labor, it may be pushedto the point of complete anesthesia, if desired. 11. We have found "sunrise slumber" (nitrous oxid) analgesia to be theideal obstetric anaesthetic, and have adopted it quite to theexclusion of both chloroform and "twilight sleep. " We find that thisform of analgesia has all the advantages of "twilight sleep" withoutany of its dangers or disadvantages. 12. A possible objection to the nitrous-oxid method is the cost, especially in the private home. The average cost in the hospitalswhere we are using this method runs about $2. 00 for the first hour and$1. 50 for each hour thereafter. This is the cost when using largetanks of gas, and is, of course, somewhat increased when the smallertanks are used in the patient's home. METHOD OF ADMINISTRATION Since it was thought best to give the reader some idea of the technicfor the administration of "twilight sleep, " it may not be amiss toexplain how "sunrise slumber" is usually employed in labor cases. Thetechnic is very simple. The administration of the gas is generallybegun about the time the patient begins seriously to complain of theseverity of the second stage pains; although, of course, the gas canbe given during the first stage pains if desired. In the vast majorityof cases, however, we think it is best to encourage the patient toendure these earlier and lighter pains without resorting to analgesicprocedures. The form of apparatus used is the same as that employed by dentistsand contains both nitrous oxid and oxygen cylinders. A small nasalinhaler is best, although the ordinary mouthpiece will do very well. The gasbag attached to the tank should be kept under low pressure and, as a pain begins, the patient is told to breathe quietly, keeping themouth closed. As a rule this sort of light inhalation serves toproduce the desired analgesic effect. It is not necessary to put thepatient deeply under in order to relieve the pain. It is our custom to begin "sunrise slumber" as soon as the uterinecontractions become painful. The earlier the gas is started, the moreoxygen should be used. Two or three inhalations will suffice to takethe "edge" off the earlier and lighter pains. When the pains growheavier we use less oxygen and permit three or four deep inhalationsjust before a bearing-down pain. At the first suggestion of acontraction, the patient must begin to inhale the gas; while after thepatient has pulled hard on the traction strops--just as thecontraction pain is passing--she is given an inhalation containing alarger percentage of oxygen. At the beginning of a pain, pure nitrous oxid is administered, and thepatient is instructed to breathe deeply and rapidly through the nose. The gasbags should be about half filled. The mixture of gas and oxygenmust be determined by the severity of the pains and individualbehavior of the patient. Four to six inhalations of the gas are sufficient to produce therequired analgesia in the average case. Following the first few deepinspirations through the nose, the patient can be instructed tobreathe through the mouth, while the gas is well diluted with oxygenand continued until the end of the pain. In this way a satisfactoryanalgesia is maintained throughout the "pain" with a minimum of "gas. "The proportion of oxygen used will run from nothing up to ten percent. This procedure is repeated with the occurrence of each pain. The use of the "mask" is just as effective as a nasal inhaler, butwastes more gas and so is more costly. When the head is passing the perineum the gas should be pushed to thepoint of anesthesia, while the patient's color will suggest the amountof oxygen to be used as well as serve to control the administration ofthe nitrous oxid. CHLOROFORM AND ETHER For many years chloroform and ether have been used to alleviate thepains of women in labor. Valuable as these agents are when deepanesthesia is required for the carrying out of operative procedures, they have not proved satisfactory as analgesic agents. If administeredin small quantities at the commencement of a strong uterinecontraction, the patient does not usually inhale sufficient to abolishpain. She is then apt to be irritated and is certain to insist onbeing given a larger quantity. If a sufficient amount be administeredto satisfy the woman, the continued repetition gradually inhibits thepower both of the uterus and of the accessory muscles, so that laboris unnecessarily prolonged, and, possibly, the life of the fetusendangered. Physicians have, therefore, been accustomed to employthese drugs very sparingly, restricting their use to the very end ofthe second stage, during the painful passage of the head through thevulva. The results of the administration at this time are alsouncertain. If delivery be rapid the woman may not be able to inhalesufficient to abolish her consciousness of pain. If it be slow she maytake too much and weaken the muscular powers, thereby prolonging laborand, often, necessitating forceps delivery. It is not surprising, therefore, that the medical profession has long been hoping that amore satisfactory method of relieving the pain of labor would befound. CONCLUSIONS In summing up our conclusions regarding analgesia and anesthesia inlabor cases, the authors would state their present position asfollows: 1. That anesthetics or analgesics are a necessary accompaniment ofconfinement in this day and age; that the average labor case demandssome sort of pain-relieving agent at some time during its progress;but that intelligent efforts should be put forth to limit andotherwise control their use. While we recognize the necessity foravoiding needless suffering, at the same time we must also avoidturning our women into spineless weaklings and timid babies. 2. That we should seek to develop, strengthen, and train our girls fora normal and natural maternity; that we should study to attainsomething of the naturalness and the painlessness of the labors ofIndian tribes; and, even if we partially fail in this effort, we shallat least leave our women with ennobled characters and strengthenedwills. 3. That the scopolamin-morphin method of inducing "twilight sleep" hasits place--in the hands of experts--and in the hospital; and that inmany cases it probably represents the best method of obstetricanesthesia which can be employed. 4. That as a general rule and in general practice, the safest and bestmethod of inducing the "twilight" state of freedom from severe pain, is by the use of nitrous oxid or "laughing gas"--the "sunrise slumber"method. It has been our practice to start all general etheranesthetics with "gas" for a number of years, while we have been doingan increasing number of both minor and major operations with "gas"alone. 5. That we still employ general ether or chloroform anesthesia inCesarean sections and other major obstetric operations, althoughseveral operators are beginning to use "gas" in even these heavycases. 6. That the intelligent and careful use of pituitary extract incertain cases of labor serves greatly to shorten the second stage;that it is of great value in certain "slow cases, " and serves greatlyto reduce the use of low forceps. We have treated the subject of obstetric anesthesia in this fullmanner, because of the fact that so much has appeared in the publicpress on these subjects, and, further, because we desired that ourreaders should have placed before them the facts on all sides of thequestion just as fully as a work of this scope would permit. CHAPTER XI THE CONVALESCING MOTHER Popularly spoken of as the "lying-in period, " and medically known asthe puerperium, this time of convalescence immediately followingchildbirth is usually occupied by two important things: therestoration of the pelvic organs to their normal condition beforepregnancy, and the starting of that wonderfully adaptative mechanismconcerned with the production of the varying and daily changing foodsupply of the offspring. The uterus, now more than fifteen times its normal size and weight, begins gradually to contract and assume its normal weight of about twoounces; and it requires anywhere from four to eight weeks toaccomplish this involution. In view of all this it is obvious thatthere can be no fixed time to "get up. " It may be at the end of twoweeks, or it may not be until the close of four or five weeks, in thecase of the mother who cannot nurse her child; for the nursing of thebreast greatly facilitates the shrinking of the uterus. Extensivelacerations may hinder the involution as well as other accidents ofchildbirth, so it must be left with the physician to decide in eachindividual case when the mother may enter into the activities of lifeand assume the responsibilities of the care of the baby and themanagement of her home. THE NURSE During this period of the puerperium a member of the family, aneighbor, a visiting nurse, a practical nurse, or a trained nurse, looks after the mother and gives to the babe its first care; whoeverit may be, certain laws of cleanliness must be carried out ifinfection is to be guarded against. If there are daily or semi-dailycalls made by the physician, a member of the family may be trained tocare for the mother with proper cleanliness and asepsis; but it is farbetter for the mother, if possible, to secure the services of atrained nurse, or the visiting nurse, in which instance she will calleach day, wash and dress the baby, clean up the mother and care forthe breasts. She is not supposed to clean the room, make the bed orprepare the food. If a trained nurse can be in charge, theconvalescing time is usually shortened as the responsibilities aretaken from the mother, her mind freed from care and it is her's toimprove, rest, and wait for the restoration of the pelvic organs, whenshe may again go forth among her family. The nurse may have to sleep in the same room; but, if it be possible, she should occupy an adjoining room, she should have a regular timeeach day for an hour's walk in the fresh air, she should be servedregular meals, and be allowed some time out of the twenty-four hoursfor unbroken slumber. In return she will intelligently cooperate withthe physician in bringing about the restoration of body and upbuildingof the mother's nerves. REST AND EXERCISE From a monetary standpoint there can be nothing so wasteful orextravagantly expensive in the home as to allow the mother to dragabout from day to day and week to week with chronic weakness orinvalidism because she did not have proper care during her already tooshort puerperium, or because she got up too soon. Having a baby is a perfectly normal, physiological procedure. It isalso, usually, downright hard work; and, beside the hard laboriouswork, there is not only a wearied and severely shocked nervous systemto be restored, but there is also a certain amount of uterineshrinkage which must take place--and this requires from four to eightweeks; and so our mother must be allowed weeks or even a month or twoto rest, to enjoy a certain amount of well-directed exercise, to havean abundance of fresh air, to be wheeled or lifted out of doors ifpossible into the sunshine, that she may be the better prepared forthe additional duties and responsibilities the little new comerentails. Sunshine and fresh air are wonderful health restorers as isalso a well-directed cold water friction bath administered near theclose of the second week of a normal puerperium. During the secondweek a few carefully selected exercises such as the following are notonly beneficial, but tend to increase circulation and thus to promotethe secretion of milk and the shrinking of the uterus. 1. Head raising, body straight and stiffened. 2. Arm raising, well extended. 3. Leg stretching, with knees stretched and toe extended. 4. Massage, administered by the nurse. A splendid tonic circulatory bath may be administered at the close ofthe second week (in normal puerperium), known as the "cold mittenfriction, " which is administered as follows: The patient is wrapped ina warm blanket, hot water bottle at feet, and each part of thebody--first one arm then the other; the chest, the legs, one at atime--is briskly rubbed with a coarse mit dipped in ice water. As onepart is dried it is warmly covered, while the next part is taken, andso on until the entire body has been treated. The body is now allaglow, the blood tingling through the veins, and the patient refreshedby this wide-a-wake bath. Properly given, the cold-mitten frictionbath is one of the most enjoyable treatments known and under ordinaryconditions, if intelligently administered, may be given as early asthe eighth day. AFTER PAINS After the birth of the first baby the uterus usually is in a state ofconstant contraction, hence there are no "after pains;" but after thebirth of the second or third child, the uterine muscle has lost someof the tone of earlier days--there is a tendency toward relaxation--sothat when the uterine muscle does make renewed efforts at contraction, these "after pains" are produced. They usually disappear by the thirdday. Nothing should be done for them, indeed they should be welcomed, for their presence means good involution (contraction) of the uterus. THE TEMPERATURE Careful notations of the temperature should be made during the firstweek. A temperature chart should be accurately kept and if thetemperature should rise above 100° the physician should be notified atonce. The third day temperature is watched with expectancy, for if anaccidental infection occurred at the time of labor, it is usuallyannounced by a chill and sudden rise of temperature on the third day. This may be as good a place as any to mention the commonly met nightsweating. This is due to a marked accentuation of the function of theskin. It is not at all unusual for a sleeping mother in the earlypuerperium to wake up in a sweat with night gown very nearly drenched. The gown should be changed underneath the bedding, while alcohol isrubbed over the moistened skin surface. These sweats will disappear as soon as the mother begins to regain herstrength. A vinegar rub administered on going to bed may often preventthese sweats. THE TOILET OF THE VULVA Immediately after the birth of the baby and the expulsion of theafterbirth, the thighs and vulva are cleansed as follows: Into a basinof warm, boiled water are dropped four small antiseptic tablets ofbichlorid of mercury; this gives a proper antiseptic wash. Into thissolution are placed four pieces of sterile cotton Two of these areused, one at a time, without being returned to the solution to washeach inside of the thigh, the remaining two to cleanse the vulva. Without drying the vulva, two sterile pads are applied and pinned tothe binder. These pads are changed every hour during the first day ortwo because of the profuse lochial flow. After each urination and bowel movement, a lysol solution (prepared byputting one teaspoonful of lysol in a quart of sterile water) ispoured from a clean pitcher over the vulva into the bed pan, and freshpads applied. This toilet continues until the close of the second weekor longer, if there is a lochial flow. These sterile pads not only absorb the lochia but also, among ignorantor thoughtless mothers, prevent contamination by the patient's hands. URINATION The patient should be encouraged to urinate during the first few hoursafter labor; catheterization should not take place until every efforthas been made to bring about normal urination; or, until there is awell marked tumor above the bony arch of the pelvis in the lower partof the abdomen. It is far less harmful to the patient for her to situp on the jar placed on the edge of the bed, than to undergo the riskof inflammation of the bladder which so often follows catheterization. THE LOCHIA The first few days the lochia is very red because of the large amountof blood which it contains. After the third or fourth day it is palerand after the tenth it assumes a whitish or yellowish color. Duringthe three changes it should always smell like fresh blood. Any foul, putrifying odor should be promptly reported to the physician. If on getting up at the close of the second week the lochia shouldresume its red color, the patient should return to bed and notify herphysician. THE ABDOMINAL BINDER After the tenth day, the abdominal binder may be pinned as tightly asthe patient desires, but prior to the tenth day many physiciansbelieve the exceedingly tight binder causes misplacements of theenlarged, softened, and boggy uterus. It should be pinned snugly; butnot drawn as tight as possible with the idea of keeping the uterusfrom relaxing, for at best, it does not do it; while tightconstriction may produce a serious turning or flexion of the uterus. The breast binder is applied during the first twenty-four hours tosupport the filling breasts, loosely at first, and as they increase insize, as the glands become engorged, the binder is drawn more tightly. A sterile piece of gauze is placed over the nipples. THE BOWELS On the morning of the second day a cathartic is usually given--say oneounce of castor oil or one-half bottle of citrate of magnesia. Thebowels should move at least once during each twenty-four hours; ifthey are obstinate, a simple laxative may be nightly administered. Certain constipation biscuits, sterilized dry bran, or agar-agar maybe eaten with the breakfast cereal. Prunes and figs should be usedabundantly. Bran bread should be substituted for white bread. Theenema habit is a bad one and should not be encouraged; however, theenema is probably less harmful than the laxative-drug habit. Mineraloil is useful as a mild laxative, and does not produce any bad afterresults. CARE OF THE NIPPLES Fissures of the nipples should be reported to the physician at once. There are many good remedies which the physician may suggest; in hisabsence, Balsam Peru may be advantageously applied. Boracic acidsolution should be applied before and after each nursing from the veryfirst day; in this way much nipple trouble may be prevented throughcleanliness and care. The nipples should be kept thoroughly drybetween nursings Nipple shields should be used where fissures persist. THE DIET For the first three days a liquid and soft diet is followed such ashot or cold milk, gruels, soups, thin cereals, eggnog (withoutwhiskey), eggs, cocoa, dry toast, dipped toast, or cream toast. Thereshould be three meals with a glass of hot milk at five in the morning(if awake) and late at night; nothing between meals except plenty ofgood cold water. After the third day, if temperature is normal, asemi-solid diet may be taken, such as baked, mashed, or creamedpotatoes, soups thickened with rice, barley or flour, vegetables(peas, corn, asparagus, celery, spinach, etc. ); eggs, light meats, stale breads, toast, bland or subacid fruits (sweet apples, prunes, figs, dates, pears, etc. ); macaroni, browned rice (parched beforesteaming), etc. ; ice cream, custards, and rice puddings for dessertsafter the seventh day. Three good meals a day, at eight and one andsix, with a couple of glasses of hot milk or cocoa or an eggnog atfive A. M. , to be repeated at 9 or 10 P. M. , with plenty of cold waterbetween the meals, will abundantly supply the necessary milk for thegrowing babe. Tea and coffee are not of any special value inencouraging a flow of milk. The constant coaxing of the mother with "Do drink this, " and "You mustdrink this, or you won't have any milk, " not only saddens her butseriously upsets digestion and thus indirectly interferes with normallactation. GETTING UP Everybody should stay at home and away from the mother and her newborn child until after the seventh day, and then, if our patient isnormal, visitors may call, but should not stay longer than fiveminutes. The convalescing mother will improve faster without theneighborhood gossip, or the tales of woe so often carried bywell-meaning, but woefully ignorant acquaintances. When the hard ball-like mass can no longer be felt in the lowerabdomen, when the lochia has passed through the three changes alreadymentioned, and the flow is whitish or yellowish, scanty and odorless, the patient may sit up in a chair increasingly each day. Suchconditions are usually found anywhere from the tenth to the fifteenthday. The patient first sits up a little in a chair--she has alreadybeen exercising some in bed--and this enables her to sit up with easefor a half-hour the first day, increasing one-half hour each dayduring the week following. At the end of three weeks, she may be takendown stairs providing there is ample help to carry her back up stairs. After another week (at the close of the fourth), if the lochia isentirely white or yellow, with no blood, she may begin carefully to goabout the house. There should be no lifting, shoving, pulling, wringing, sweeping, washing, ironing, or other heavy exercise for atleast another two weeks, better four weeks. Any variance from thisprogram usually means backache, lassitude, diminished milk supply, andfrequently a general invalidism for weeks or months--sometimes years. COMPLICATIONS _Cystitis_, or painful urination, is avoided by tardy "getting up;"quietly, slowly moving about; abundant water drinking; and theavoidance of catheterization. _Hemorrhage. _ Notify the physician if it occurs at any time. Thetreatment is heavy kneading of the abdomen until the uterus againbecomes like a hard ball. Cold compresses over the lower abdomen maysometimes help. _Infection_ is manifested by chilly sensations or a distinct chillfollowed by fever, usually on the third day. Take a cathartic; notifythe physician at once and follow his directions. _Mastitis_, inflammation or caking of the breasts. Very hotfomentations wrung out of boiling water, alternating with ice-coldcompress, should be applied to the breast for an hour or more, threeor four times a day. Cathartics should be administered, andeliminative measures instituted such as the hot-blanket pack. _Pneumonia. _ Keeping the arms and chest well protected by along-sleeved coat of warm texture, should help in preventing thisserious complication. Pneumonia complicating labor is usually theresult of carelessness and exposure. PART II THE BABY PART II THE BABY CHAPTER XII BABY'S EARLY DAYS Happy is the mother and fortunate is the home that possesses theintelligent services of a trained attendant during the early days ofthe baby's career. A century or more ago skilled nurses were unheardof, and both mothers and babies seemed to thrive on the unskilled butfaithful and sympathetic care given by the willing neighbor who"thought I'd just run over and help out. " Who of us cannot rememberthe days when mother was "gone to a neighbor's" to give this samewilling but unskilled care at the time of "confinement. " MODERN METHODS And why are we so concerned today about asepsis, sterilization, etc. , when a generation ago they were not? We used to live more slowly thanwe do now. Then it took the entire day to do the marketing for theweek, now we take a receiver from the hook and a telephone wiretransmits the verbal message. Our days are literally congested withevents that were almost impossibilities a century ago. The ease andleisure of former days are unknown and unheard of today. Theartificial way in which we live exerts more or less of a strain uponthe present generation; the average woman's nervous system is keyed upto a high pitch; her general vital resistance is running at a low ebb;while child-bearing brings a certain added stress and strain thatrequires much planning to avoid and overcome. For many days and ofttimes weeks the mother is unfit--physicallyunable--properly to care for her child, and so whether it be thetrained assistant in constant attendance or the visiting nurse in herdaily calls, or the kind, willing, but unskilled neighbor--each helpermust acquaint herself, in varying degrees, with the physical, nervous, and mental needs of the child, as well as take into account andanticipate the numerous habits and wants of the new born babe, such asurination, bowel movement, pulse, respiration, temperature, etc. THE HEAD At birth, the head is remarkably large as compared to the rest of thebody, for, surprising as it may seem, the distance from the crown tothe chin is equal to the length of the baby's trunk; and, too, ifbirth has been prolonged this large head has also been pressed orsqueezed somewhat out of shape. This state of affairs, however, needgive no cause for either alarm or anxiety, for the head will shapeitself to the beautiful rotundity of the normal baby's head within afew days. The general shape of the baby's head, as seen from above is oval. Justback of the forehead is formed a diamond-shaped soft spot known as theanterior fontanelle which should measure a little more than one inchfrom side to side. On a line just posterior to this soft spot and tothe back of the head, is found another soft spot somewhat smaller thanthe one in front. Gradual closure of these openings in the bonesoccurs, until at the end of six or eight months, the posteriorfontanelle is entirely closed; while eighteen months are required forthe closure of the anterior fontanelle. These "soft spots" should not be depressed neither should they bulge. The head is usually covered with a growth of soft, silky hair whichwill soon drop out, to be replaced, however, by a crop of coarser hairin due season. The scalp should always be perfectly smooth. Any rashor crusts or accumulation of any kind on the scalp is due touncleanliness and neglect, and should be carefully removed by thethorough application of vaseline followed by a soap wash. The vaselineshould be applied daily until all signs of the accumulation areentirely removed. The eyes of all babies are generally varying tintsof blue, but usually change to a lighter or darker hue by the seventhor eighth week. The whitish fur which often is seen on the baby'stongue is the result of a dry condition of the mouth which disappearsas soon as the saliva becomes more abundant. CHEST, ABDOMEN, AND LEGS The baby's chest, as compared to the size of the head and abdomen, appears at a disadvantage, while the arms are comparatively short andthe legs particularly so, since they measure about the same as thelength of the trunk. They naturally "bow in" at birth so that thesoles of the feet turn decidedly toward each other. All these apparentdeformities, as a rule, right themselves without any help or attentionwhatsoever. PULSE AND RESPIRATION The pulse may be watched at the anterior fontanelle or soft spot ontop of the head while the child quietly sleeps and should record, atvarying ages, as follows: At birth 130 to 150 First month 120 to 140 One to six months about 130 Six months to one year about 120 One to two years 110 to 120 Two to four years 90 to 110 The above table is correct for the inactive normal child. Muscularactivity, such as crying and sucking, increases the pulse rate from 10to 20 beats per minute. The respiration of the baby often gives us no small amount of realconcern at the first. The baby may be limp and breathless for some fewmoments at birth, and this condition calls for quick action on thepart of the nurse and doctor. The utmost care to avoid the "sucking in" of any liquid or bloodduring its birth must be exercised, for this often seriouslyinterferes with the breathing. Sometimes this condition is notrelieved until a soft rubber catheter is placed in the throat and themucus is removed by quick suction. When you are reasonably sure thatthere is no more mucus in the throat, then sudden blowing into thebaby's lungs (its lips closely in touch with the lips of the nurse orphysician) often starts respiration. Slapping it on the back alsohelps, while the quick dip into first hot then cold water seldom failsto give relief. A quiet-sleeping infant breathes as shown below at varying ages. Anincrease of six to ten breaths per minute may be allowed for the timeit is awake or otherwise active. At birth and for the first two or three weeks 30 to 50 During the rest of the first year 25 to 35 One to two years about 28 Two to four years about 25 THE WEIGHT The normal weight of the average baby is seven to seven and one-halfpounds. Its length may range anywhere from sixteen to twenty-twoinches. There is an initial loss of weight during the first few days; however, after the milk has been established the child should make a weeklygain of four to eight ounces until it is six months old, after whichtime the usual gain is from two to four ounces per week. If the weight has been doubled at six months and the weight at oneyear is three times the birth weight, the child is said to have gainedevenly and normally. THE SKIN At birth the skin of the baby is red and very soft owing to thepresence of a coating of fine down. A blue-tinged skin may beoccasioned by unnecessary exposure or it may be due to an opening inthe middle partition of the heart which should close at birth. As soonas the baby is born, it should be placed on its right side while thecord is being tied, as this position facilitates closure of thisembryonic heart opening. With the provision for a little additionalheat the blue color should disappear, if it is not due to this heartcondition. At the close of the first week the red color of the skinchanges to a yellow tint due to the presence of a small amount of bilein the blood. This sort of jaundice is very common and is in no wiseevidence of disease. The "down" falls off with the peeling of theskin which takes place during the second week; by the end of whichtime, the skin is smooth and assumes that delightful "baby" characterso much admired. THE CORD DRESSING The cut end of the tied umbilical cord is swabbed and squeezed with asterile sponge saturated with pure alcohol. It is then wrapped in asterile dressing made as follows: Four or five thicknesses of sterilecheese cloth are cut into a four-inch square with a small hole cut inthe center and one side cut to this center. This is slipped about thestump of the cord and wrapped around and about in such a manner asentirely to cover the stump of the cord. The wool binder is thenapplied and sewed on, thus avoiding both pressure and the prick ofpins. If it remains dry this dressing is not disturbed until theseventh or eighth day, when the cord ordinarily drops off. Should itbecome moistened the dressing is removed and the second dressing isapplied exactly like the first. THE EYES The closed eyes of the newly born child are generally covered withmucus which should be carefully wiped off with a piece of sterilecotton dipped in boracic acid solution, in a manner not to disturb theclosed lid. A separate piece of cotton is used for each eye and theswabbing is done from the nose outward. The physician or nurse dropsinto each opened eye two drops of twenty per cent argyrol, the surplusmedicine being carefully wiped off with a separate piece of cotton foreach eye. The baby should now be placed in a darkened corner of theroom, protected from the cold. The eyes are washed daily by dropping saturated solution of boracicacid into each eye with a medicine dropper. Separate pieces of gauzeor cotton are used for each eye. THE FIRST OIL BATH As soon as the cord and the eyes have received the proper attentionand the mother has been made comfortable, the baby is given itsinitial bath of oil. This oil may be lard, olive oil, sweet oil, orliquid vaseline. The oil should be warmed and the baby should be wellcovered with a warm blanket and placed on a table which is coveredwith a thick pad or pillow. The temperature of the room should be atleast eighty degrees Fahrenheit. Quickly, thoroughly, and carefullythe entire body is swabbed with the warmed oil--the head, neck, behindthe ears, under the arms, the groin, the folds of the elbow andknee--no part of the body is left untouched, save the cord with itsdressing. This oil is then all gently rubbed off with an old softlinen towel. THE FIRST CLOTHING After the oil bath, the silk and wool shirt (size No. 2), the diaperand stockings are quickly put on to avoid the least danger ofchilling. The band having been applied at the time of the dressing ofthe cord, our baby is now ready for the flannel skirt. This shouldhang from the shoulders by a yoke of material adapted to the season, cotton yoke without sleeves if a summer baby, and a woolen yoke withwoolen sleeves if a winter baby. The outing-flannel night dresscompletes the outfit and should be the only style of dress worn forthe first two weeks. Loosely wrapped in a warm shawl, the baby isabout ready for its first nap, save for a drink of cooled, boiledwater. This cooled, boiled, unsweetened water should be given in increasingamounts every two hours until the child is two or three years of age. It is usually given the child in a nursing bottle. In this way it istaken comfortably, slowly, can be kept clean and warm, and should thebabe be robbed of its natural food and transferred to the bottle as asubstitute for mother's milk, it will already be acquainted with thebottle and thus one-half of a hard battle has already been fought andwon. BABY'S FIRST NAP The baby's bed should be separate and apart from the mother's. It maybe a well-padded box, a dresser drawer, a clothes basket, or a largemarket basket. A folded comfortable slipped in a pillow slip makes agood mattress. A most ideal bed may be made out of a clothes basket;the mattress or pad should come up to within two or three inches ofthe top, so the baby may breathe good fresh air and not the stale airthat is always found in a deeply made bed. Into this individual bedthe baby is placed as soon as it is dressed; and a good sleep of fourto six hours usually follows. Frequent observations of the cord dressing should be made asoccasionally hemorrhage does take place, much to the detriment of thebabe. If bleeding is at any time discovered the cord is retied justbelow the original tying. By the time baby has finished a six- oreight-hour nap the mother is wondrously refreshed and is ready toreceive it to her breast. PUTTING TO THE BREAST During the first two days the baby draws from the breasts little morethan a sweetened watery fluid known as the colostrum; but its intakeis essential to the child in that it acts as a good laxative whichcauses the emptying of the alimentary tract of the dark, tarryappearing stools known as the meconium. On the third day this form ofstool disappears and there follows a soft, yellow stool two or threetimes a day. The child should be put to the breast regularly every four hours; twothings being thus encouraged: an abundant supply of milk on the thirdday and the early shrinking of the uterus. More than once a mother hasmissed the blessed privilege of suckling her child because somethoughtless person told her "why trouble yourself with nursing thebaby every four hours, there's nothing there, wait until the thirdday;" and so when the third day came, there was little more than amere suggestion of a scanty flow of milk, which steadily grew less andless. THE URINE The urine of the very young child should be clear, free from odor andshould not stain the diaper, nor should it irritate the skin of thebabe. Often urination does not take place for several hours, sometimesnot at all during the first twenty-four hours. If the infant does notshow signs of distress, there is no cause for alarm; the urine shouldpass, however, within thirty hours. As a rule there are usuallybetween ten and twenty wet diapers during each twenty-four hours. Thefollowing table shows about the amounts of urine at different ages: Birth to two years 8 to 12 ounces Two to five years 15 to 25 ounces Five to ten years 25 to 35 ounces GENITALS OF THE MALE CHILD The foreskin of the male child is often long, tight, and adherent, andis often the direct cause of irritability, nervousness, crying, andtoo frequent urination. It should be closely examined by bothphysician and nurse and when the foreskin does not readily slip backover the acorn-like head of the organ, circumcision is advised earlyin the second week. This simple operation will start the child out onhis career with at least one moral handicap removed and one desirablepossibility established--that of being able to keep himself clean. POST-OPERATIVE CARE OF CIRCUMCISION The dressings that are loosely applied at the time of the operationshould remain untouched (especially those next to the skin), unlessotherwise directed by the physician, until the seventh or eighth daywhen the babe is placed in a warm soap bath, at which time thedressings all come off together. Clean sterile gauze is so placed asentirely to protect the inflamed skin from the diaper at all timesbefore this bath, and these same dressings should be continued for atleast another week. Sterile vaseline (from a tube) should be appliedtwice a day after the original dressings are removed in the bath atthe end of the first week. There should be little or no bleedingfollowing the operation, neither should the penis swell markedly; ifeither complication should occur, the physician should be promptlynotified. CARE OF THE FEMALE GENITALS The girl baby is often neglected in respect to the proper care of thegenitals. The lips of the vulva should be separated and thorough butcareful cleaning should be the daily routine. The foreskin or coveringof the clitoris should not be adherent; while the presence of mucus, pus, or blood in the vulva should be at once reported to thephysician; in his absence, the application of twenty per cent argyrolshould be made daily. [Illustration: Fig. 6. How to Hold the Baby] HANDLING THE BABY Let us thoroughly come to understand the very first day the littleone's life, that it was not sent to us because the family neededsomething to play with; it is not a ball to toss up, neither is it avariety show. It is a tiny individual, and your responsibilities asparents and caretakers are very great. The child was sent to be fed, clothed, kept warm, dry, and otherwise cared for by you, until such atime as it will become able to care for itself. Remember, what we sow, that shall we also reap. If we sow indulgence we shall reap anger, selfishness, irritability, "unbecomingness"--the spoiled child. At twoor three days the baby learns that when it opens its mouth and emits aholler, someone immediately comes. If we do it on the second and thirdday, why should we object to run, bow, and indulge on the onehundredth and second day? Handle the baby as little as possible. Turn occasionally from side toside, feed it, change it, keep it warm, and let it alone; crying isabsolutely essential to the development of good strong lungs. A babyshould cry vigorously several times each day. If the baby is to behandled, support the back carefully (Fig. 6). THE EARLY BATHS During the first week the baby is oiled daily over his entire body, with the exception that the cord dressing remains untouched. The face, hands, and buttocks are washed in warm water. After the third week thebathroom is thoroughly warmed and the small tub is filled with waterat temperature of 100 F. The baby having been stripped and wrapped ina warm turkish towel, is placed on a table protected by a pillow, while the caretaker stands by and vaselines the creases of the neck, armpits, folds of the elbows, knees, thighs, wrists, and genitals; andthen, with her own hands, she applies soap suds all over thebody--every portion of which is more quickly and readily reached--thanby the use of a wash cloth. And now, with the bath at 100 F. , with afolded towel on the bottom of the small tub, the soapy child is placedinto the water and after a thorough rinsing is lifted out again to awarm fresh towel on the table and the careful drying is quickly begun. After the bath all the folds and creases are given a light dustingwith a good talcum. During hot weather the bath should be given daily, soap being usedtwice a week. On the other days there should be the simple dipping ofthe child into the tub. During the cold weather the full bath is givenbut twice a week, while on the other days a sponge bath or an oil rubmay be administered. A weak, delicate child should not be exposed to the daily full bath, but rather the semi-weekly sponge bath and the daily oil rub should beadministered. We have found the late afternoon hour to be better thanthe early morning hour for baby's bath. It requires too much vitalresistance to react to an early morning bath, especially when thehouse is cool. REGARDING SOAP The use of soap is very much abused with young babies. I recall onemother who came into the office with her poor little baby which wasconstantly crying and fretting because of a greatly inflamed body--alla result of the too frequent use of soap. I said, "I am afraid you donot keep your baby clean. " "O Doctor!" she replied, "I wash him withsoap every time I change him; I am sure he is clean. " And come to findout, the poor little fellow's tender skin had been subjected to soapseveral times a day. We ordered the use of all soap discontinued, vaseline and talcum powder to be used instead, and the child's skingot well in a very short time. CARE OF THE UMBILICUS Tight bands should not be placed about the babe. If the umbilicusprotrudes, do not endeavor to hold it in by a tight band, but consultyour physician about the use of a bit of folded cotton and adhesiveplaster, and then allow the child the freedom of the knitted bands, with skirts suspended from yokes. The day of tight bands and pinningblankets with their additional and traditional windings is over. Afterthe complete healing of the cord, the need for a snug binder to holdthe dressings in place is over. Should the baby cry violently, theumbilicus should be protected in the manner described above--the foldof cotton and the adhesive plaster. The diaper, stockings, shirt, skirt, and dress with an additionalwrapper for cold days completes the outfit at this age. BIRTH REGISTRATION "One of the most important services to render the newborn baby is tohave his birth promptly and properly registered. " In most states the attending physician or midwife is required by lawto report the birth to the proper authority, who will see that thechild's name, the date of his birth, and other particulars are made amatter of public record. Birth registration may be of the greatestimportance when the child is older, and parents should make sure thisduty is not neglected. A public health official some time ago epitomized some of the uses ofbirth registration as follows: There is hardly a relation in life from the cradle to the grave in which such a record may not prove to be of the greatest value. For example, in the matter of descent; in the relations of wards and guardians; in the disabilities of minors; in the administration of estates; the settlement of insurance and pensions; the requirements of foreign countries in matters of residence, marriage, and legacies; in marriage in our own country; in voting and in jury and militia service; in the right to admission and practice in the professions and many public offices; in the enforcement of laws relating to education and to child labor, as well as to various matters in the criminal code; the irresponsibility of children under ten for crime or misdemeanor; the determination of the age of consent, etc. , etc. CHAPTER XIII THE NURSERY We wish it were possible for every mother who reads this book to havea special baby's room or nursery. Some of our readers have a separatenursery-room for the little folks, and so we will devote a portion ofthis chapter to the description of what seems to us a modelarrangement for such a room; but, realizing that ninety-five per centof our readers can only devote a corner of their own bedroom to theoncoming citizen, we have also carefully sought to meet their needsand help them to take what they have and make it just as near like theideal nursery as possible. THE SEPARATE NURSERY The nursery should be a quiet room with a south or southwesterlyexposure. The bathroom should adjoin or at least be near. Ascreened-in porch is very desirable. Draperies that cannot be washed, and upholstered furniture, do notbelong in the baby's room. A hardwood floor is better than a carpet ormatting; while a few light-weight rugs, easily cleaned, are advisable. Enameled walls are easily washed and are, therefore, preferable towall paper or other dressings. The windows should be well screened, for by far the greatest dangersto which the baby is exposed, are flies and mosquitoes--carriers offilth and disease. Flies, mosquitoes, cockroaches, bed bugs, cats, dogs, lice, and mice are all disease carriers and must therefore bekept out of baby's room. NURSERY EQUIPMENT At each window should be found dark shades, and if curtains aredesired they should be of an easily washable material, such as mull, swiss, lawn, voile, or scrim. The hardwood floor may be covered wherenecessary with easily handled rugs which should be aired daily. Theother necessary articles of furniture are a crib of enameled ironwhose bedding will be described elsewhere in this chapter, a chest forbaby's clothes and other necessary supplies, a screen or two, a lowtable and a low rocker, a small clothes rack on which to air theclothes at night, a pair of scales, and a medicine chest placed highon the wall. If the room will conveniently admit it, a couch will add greatly tothe mother's comfort; and, if possible, it should be of leatherupholstery; otherwise, it should possess a washable cover, for allarticles that promote the accumulation of dust are not to be allowedin the nursery. In these early weeks and months baby will not benefitfrom pictures or other wall decorations, and so let him have cleanwalls that are easily washed and quickly dusted. The necessities for baby's personal care are: Talcum powder. Castile soap. Soft wash cloths. Soft linen towels. Bottle of plain vaseline. Boracic acid, oz. IV (Saturated Solution). Olive oil. Sterile cotton balls in covered glass jar. Safety pins of different sizes. Hot water bag with flannel cover. Baby scales. Drying frames for shirt and stockings. BABY'S BED Since the days of Solomon, accidents have occurred where mother andbabe have occupied the same bed. Not only is there the ever-presentdanger of smothering the babe, but there are also many other reasonswhy a baby should have its own bed. The constant tendency to nurse ittoo often and the possibility of the bed clothing shutting off thefresh air supply, are in and of themselves sufficient reasons forhaving a separate bed for baby. The first bed is usually a basinet--a wicker basket with highsides--with or without a hood. A suitable washable lining and outsidedrape present a neat as well as sanitary appearance. The mattress ofthe basinet is usually a folded clean comfort slipped into a pillowslip; this is to be preferred to a feather pillow, as it is cooler andin every way better for the babe. Drapes about the head of the basinet are not only often in the way, shutting out air, etc. , but they also gather dust and are unsanitary. Screens are movable--they may be used or put away at will--and are, therefore, very convenient about the nursery. The basinet may be dispensed with entirely if the sides of theenameled crib are lined to cut off draughts and the babe is properlysupported by pillows. After the baby is four to six months of age itis transferred to the crib. The basinet has an advantage over the cribduring those early weeks in that its high sides protect the babe fromdraughts, and the comforts and blankets can be more easily tuckedabout the little fellow to keep him warm. The sides should not extendmore than four inches above the lying position of the child. THE CRIB The enameled iron crib should be provided with a woven-wire mattress, over which is placed a mattress; hair is best as a filling for themattress, wool next, and cotton last. Over the mattress should beplaced a rubber sheet, and over all a folded sheet. A pillow of hair or down is not to be discarded; for recentinvestigation has shown that the pillow favors nasal drainage, whilelying flat encourages the retaining of mucus in the nose and nasalchambers--the sinuses. The pillow slip should be of linen texture. During the winter a folded soft blanket over the rubber sheetincreases both softness and warmth. No top sheet is used during thefirst months, particularly if the first months are the winter months. The baby is wrapped loosely in a light weight clean blanket or shawl, and other blankets--as many as the season demands are tucked about thechild. These blankets should be aired daily, and the one next to thebaby changed, aired, or washed very often. [Illustration: Fig. 7. Making the Sleeping Blanket] THE SLEEPING BLANKET To prevent baby from becoming uncovered the sleeping blanket has beendevised. The blanket is folded and stitched in such a way ascompletely to envelop the sleeping babe, and at the same time affordthe utmost freedom (Fig. 7). The babe may turn as often as he desires, but cannot possibly uncover himself. Bed clothes fasteners are alsoused--an elastic tape being securely fastened to the head posts andthen by means of clamps or safety pins attachment is made to theblankets on either side. The elasticity allows considerable freedom tothe child in turning (See Fig. 8). NURSERY HEATING AND VENTILATION The subject of ventilation has been so fully discussed by the authorsin another work that we refer the reader to _The Science of Living, orthe Art of Keeping Well_. For the first two or three weeks the nursery temperature should bemaintained at seventy degrees Fahrenheit by day and from sixty degreesto sixty-five degrees by night. In the third week the day temperatureshould be sixty-eight degrees Fahrenheit measured by a thermometerhanging three feet from the floor. After three months the nighttemperature may go as low as fifty-five degrees Fahrenheit, and afterthe first year it may go as low as forty-five degrees. The heating of the nursery is usually controlled by the generalheating plant, and no matter what system of heating is maintained, humidifiers must be used, the necessity for which is doubled when thesystem is that of the hot-air furnace. These shallow pans of water with large wick evaporating surfaces willevaporate from three to four quarts during the twenty-four hours. Thehumidity should be fifty throughout the seasons of artificial heating. Many colds may be entirely avoided by the use of humidifiers orevaporators. The open grate is one of the very best means of nurseryheating. Gas and oil heaters should not be depended upon for nurseryheat. Only in an emergency should they be used at all, and theelectric heater is by far the best device for such occasions. [Illustration: Fig. 8. In the Sleeping Blanket] BABY'S CORNER IN MOTHER'S ROOM It is probably a conservative estimate to say that ninety-five percent of all the babies occupy a corner of mother's and father'sbedroom for the first two or three years. And believing this estimateto be correct, it is advisable to give the matter some consideration. To begin with, a lot of the non-essentials, ruffles and fluffles ofthe average bedroom, must go. The good father's chiffonier may have tobe put in the bath room; heavy floor coverings must be discarded, tobe replaced by one or two small, light-weight rugs; wall decorationsand the usual bric-a-brac of dressers, tables, etc. , should becarefully packed away. In fact, there should be nothing in the roomsave the parents' bed, dresser (several drawers of which must bedevoted to baby's necessities), table, low rocker, a stool, baby's bedand a good big generous screen, made out of a large clothes horseenameled white and filled with washable swiss. Window draperies must be taken down and packed away, while they arereplaced with simple muslin which can go to the laundry twice a month. If it be within the means of the family purse, it is well to renovatethe walls just prior to the advent of the little stranger. And now the baby's bed is placed in the corner most protected fromdraughts and the glare of the sunlight. If it can be so arranged thatbaby looks away from the light, and not at it, we are guarding it fromdefective vision in the future. CRIB SUBSTITUTES Many a beautiful artistic creation so much admired in this world isfound to be, on closer inspection, a very ordinary thing which hasreceived an artistic touch; and so, many convenient, sanitary, andbeautiful cribs are fashioned from market baskets fastened to tops ofsmall tables whose legs are sawed off a bit; from soap boxes fastenedto a frame, and from clothes baskets. A can of white enamel, a paintbrush and the deft hand of a merry, cheery-hearted expectant mothercan work almost miracles. Remember, please, that all draperies must bewashable and attached with thumb tacks so as to admit of easy andfrequent visits to the laundry. A medium-sized clothes basket will take care of our baby for four orfive months. The same general plan for the mattress and bedding isfollowed as before described. EXTRA HEAT TO THE CRIB If necessary--and it usually is, especially during the wintermonths--a hot-water bottle may be placed underneath the bedding on topof the mattress. This insures a steady, mild, uniform warmth and itnot only saves the baby from the danger of being burned, but it alsoobviates the temporary overheating of the child which usually occurswhen the bottle is placed inside the bed, next to the baby. If the bedis properly made--the blankets coming from under the babe up andover--there is little or no need for extra heat for well babies afterthe first month. LIGHTING BABY'S ROOM If electric lighting is not an equipment of the home neither gas oroil lamps should be allowed to burn in the room for long periods. Foremergency night lighting a well-protected wax candle should be used. However, don't go to sleep and allow a candle to burn unprotected asdid one tired, exhausted mother. The father, suddenly aroused from hissleep, saw a large flame caused by the overturning of a wax candleinto a box of candles, while the lace drapery of the basinet waswithin a few inches of the flame and the baby just beyond. Grabbing apillow he smothered the flames and saved baby and all. FRESH AIR Plenty of fresh air and lots of sunshine should enter baby's room. Thelarge screen amply shields from draughts, and when thus protectedthere need be no unnecessary concern about cool fresh air, especiallyafter two or three months, as it is invigorating and prevents"catching cold. " Warm, stuffy air is devitalizing and even during theearly weeks when the fresh air must be warm, an electric fan should beadvantageously placed so that many times each day the warm fresh airmay be put in motion without creating a harmful draught. Warm stuffy air makes babies liable to catch cold when taken out intothe open. Throw open the windows several times each day and completely changethe air of baby's room. In the absence of the large screen, a woodenboard five or six inches high is fitted into the opening made byraising the lower window sash. Then as the upper sash is lowered theimpure air readily escapes while fresh air is admitted. THE BATH EQUIPMENT Make early preparations for bathing the baby in the easiest possiblemanner; in fact, the young mother should seek to attend to all herduties--the family, the home, and the baby--in the easiest way. Forthe administration of a bath during the early months, a table isneeded, protected by oilcloth on which is placed a roomy bathtub witha folded turkish towel on the bottom for baby to sit on. In additionto the tub, have: An enameled pitcher for extra supply of warm water. A small cup for boracic acid solution. Castile soap. A soft wash cloth. Several warmed soft towels. A bath thermometer. A medicine dropper for washing baby's eyes. Talcum powder. Oil or vaseline. Sterile cotton. Tooth picks. A needle and thread for sewing on the band. All of the clean clothing needed. See that the bathtub is clean and enamel unbroken, and if it has beenused by another babe, freshen it with a coat of special enamel soldfor that purpose. BATH TEMPERATURES During the first eight weeks Temperature 100 F. From two to six months Temperature 98 F. From six to twenty-four months Temperature 90--97 F. A bath at ninety-eight degrees is a neutral bath, and after the babyis six months and over, the bath may be given at this temperature, andat the close quickly cooled to ninety degrees. NURSERY CLEANLINESS The nursery should furnish the baby's first protection from contagious diseases. It must be a veritable haven of safety. Therefore, no house work of any kind should be done in the room, such as washing or drying the baby's clothes. The floors and the furniture should be wiped daily with damp cloths. A dry cloth or feather duster should never be used to scatter dust around the room. All bedding and rugs should receive their daily shaking and airing outof doors, remembering that particles of dust are veritable airshipsfor the transportation of germs. In every way possible avoid raising adust. So much of the lint which commonly comes from blankets may beavoided with the daily shaking out of doors. Soiled diapers should not accumulate in a corner or on the radiator;their removal should be immediate, and if they must await a moreopportune time, soak them in a receptacle filled with cold water. Eventhose diapers slightly wetted should never be merely dried and usedagain, but should be properly washed and dried. No washing soda shouldbe used in the cleansing of diapers--just an ordinary white soap, agood boil, and plenty of rinse water, with drying in the sun ifpossible. They require no ironing. Hands that come in contact withsoiled or wet diapers must be thoroughly cleansed before caring forthe baby or preparing his food. As before mentioned, and it will bear repetition often, all windowsand doors must be well screened, for flies and mosquitoes are dreadedfoes in any community and in babyland in particular. All used bottlesand nipples as well as used cups, pitchers, bits of used cotton, should be removed at once. The washcloth is a splendid harbinger ofgerms. There should be one for the face, and one for the body andbath, and both should receive tri-weekly boiling. Bath towels shouldnot be used more than twice, better only once. The technic of bathing, together with the location, furnishings, andcleanliness of the baby's sick room, will be taken up in laterchapters. CHAPTER XIV WHY BABIES CRY It is surprising how soon even a young and inexperienced mother willlearn to distinguish between the _pain_ cry and the _plain_ cry of herbaby; for most crying can easily be traced to some physical discomfortwhich can be relieved, or to some phase of spoiling and indulgencewhich can be stopped. NORMAL HEALTHY CRYING The young baby can neither walk, talk nor engage in gymnastics, exceptto indulge in those splendid physical exercises connected with a goodhearty cry. To be good and healthy, an aggregate of an hour a dayshould be spent in loud and lusty crying. He should be allowed tokick, throw his arms in the air and get red in the face; for suchgymnastics expand the lungs, increase general circulation and promotethe general well-being of the normal child. As the child grows olderand is able to engage in muscular efforts of various sorts, these"crying exercises" should naturally decrease in frequency andseverity. When baby cries, see that the abdominal band is properlyapplied, that rupture need not be feared. THE BIRTH CRY The sound most welcomed by both doctor and nurse is the cry of thenewly born child, for it shows that the inactive lungs have opened upand the baby has begun to use them, for all the time baby was livingin the uterine room he did not breathe once, the lungs having been ina constant state of collapse; and not until now, the very moment theair comes in contact with his skin, do the lungs begin to functionateas he emits his first lusty holler. ABNORMAL CRYING The cry is said to be abnormal when it continues too long or occurstoo often. It may be strong and continuous, quieting down when he isapproached or taken up; or it may be a worrying, fretful cry, a lowmoan or a feeble whine. And now as we take up the several cries, theirdescription, cause, and treatment, we desire to say to the youngmother: Do not yourself begin to fret and worry about deciding justwhich class your baby's cry belongs to; for help, knowledge, andwisdom come to every anxious mother who desires to learn and who iswilling to be taught by observation and experience. THE HUNGER CRY The continuous, fretful cry, accompanied by vigorous sucking of thefists, both of which stop when hunger has been satisfied, is withoutquestion the hunger cry. If this cry is constant with regular feedings, then the quantity ofthe food must be increased, or the quality improved. The tired, fretful hunger cry must not be neglected; the cause must be removed, for it points to malnutrition. THE CRY OF THIRST One day when lecturing at an Iowa chautauqua, I remained in thebeautiful park for the noonday meal. It was a warm day and the tablesin the well-screened dining tent were filled with mothers who, likemyself, preferred the cool shade of the park to the hot ride throughthe city to the home or hotel dinner. At my table a baby was pitifullycrying. The mother had offered the little child seated in a smalluncomfortable go-cart, milk, bread, and a piece of cake--all of whichwere ruthlessly pushed aside. My little son, then only four and ahalf, said "Mamma, maybe the baby's thirsty, " and up he jumped, hurried to the mother's side with his glass of water, saying, "Ihaven't touched it, maybe the baby's thirsty. " The mother brushed theboy aside, saying, "No, I never give the baby water. " In spite of themother's remonstrance, the baby cried on and on, and finally on"trying" the water, the child drank fully one-half the glass and thecrying was hushed. Babies should be given water regularly--many times every day--frombirth, in varying amounts from two teaspoons to one-half cup, according to the age of the child. The water should be boiled for thefirst few months, and longer if there is any suspicion of impurities. Milk to the nursing infant is like beefsteak and potatoes to theadult; and many times the milk bottle or the breast is just asnauseating to the thirsty babe, as meat would be to the very thirstyadult whose hunger has previously been fully satisfied. THE FRETFUL CRY The babe who is wet, soiled, too hot, or is wrapped too tightly, orwho has on a tight, uncomfortable belly band, or whose clothing isfull of wrinkles, has only one way to tell us of his discomfort, andthat is to cry. It is a fretful cry and should command an immediateinvestigation as to the possible cause. It takes but a moment todiscover a wet diaper; to run the hand up the back under the clothes;to sprinkle with talcum if perspiring; to straighten out the wrinkledclothing; to find the unfastened pin that pricks; or to loosen thetight band. Acquire the art of learning to perform these simple taskseasily, and any or all of these services should be rendered withouttaking the child from its bed. Let the child early learn to rest happily and quietly in his own bed. The pillow or mattress may be turned or perhaps the mattress be raisednearer the edge of the basinet. One poor youngster instantly stoppedhis fretful cry when his mattress was raised four or five inches so hecould get the air, at the same time taking him out of his hot room toa cooler room with raised windows. Babies like cold air. They cry whenthe air is hot, or even warm and close. Every day--rain or shine, windor sleet--babies should nap out of doors on the porch, in awell-sheltered corner. A screen or a blanket protects from the wind, sleet, or rain; and if the baby's finger tips are warm, you can restassured the feet and body are warm. Scores of babies will sleep out onthe porch, on the protected fire escape, or in a room with openedwindows, from one bottle or feeding to another; being aroused at theend of the three or four hour interval just enough to nurse, whenback they go to their delightful, warm nest in the cool, fresh air tosleep for another period. Babies should never sleep in a room withclosed windows. One of the incidents that surprised me most in my early work withdispensary babies was the utter misconception of the purpose of thebelly band. Invariably it was put on so tightly that I could not slipa finger between it and the babe. It is not a surgical instrument, neither is it a truss. These tight belly bands are a source of muchfretting and crying. THE PAIN CRY The little pinched look about the face, the drawing up of the legs, the jerking of the head, arms, or legs, associated with a strong, sharp, unceasing or intermittent cry, demands immediate attention Ourfirst work should be to go about quietly, painstakingly, andsystematically to locate the cause of this "cry of pain. " There are often some accompanying symptoms to the cry of pain whichdemand skilled medical advice and attention, such as the arching ofthe body backward, the drawing of the head strongly to one side, theinability to use one side of the body, or the presence of fever. Theremay be an earache, an abdominal complication, or a sore throat, anyone of which will be detected by the skilled doctor. Earache frequently occurs in young babies who have been taken out ofdoors without proper protection to the ears; or, it may be associatedwith a cold in the head, which is not detected until the mischief hasalready been done, while the resulting running ear tells the tale ofwoeful suffering. Earache must always be thought of as a possiblecause when the cry of pain accompanies a cold in the head, and ifmedical aid is secured early, the abscess may be aborted and thedeafness of later years entirely avoided. There is only one homeremedy for earache, and that is the application of external heat, either by a hot-water bottle or hot-salt bag. Medical advice should besought before anything whatsoever is dropped into the baby's ear. In this connection should be mentioned the wild cry at night which sooften accompanies tuberculosis of the bone. A careful X-Rayexamination will reveal the disease, and proper medical measuresshould be instituted at once. Other fretful night crying will bementioned further on. HABIT CRYING By the frequent repetition of actions, habits are formed. When thebaby is two or three days old, he is so new to us and we have waitedfor him so long, and it is such a great big world that he has comeinto, that we jump, dance, and scramble to attend to his every needand adequately to provide for his every want. At this very early, tender age whenever he opens his mouth to cry or even murmur--somefond auntie or some overly indulgent caretaker flies to his side as ifshe had been shot out of a gun, grabs him up and ootsey tootsey's himabout as she endeavors to entertain and quiet him. The next time andthe next time and the succeeding time he whimpers--like a flashsomeone dashes to the side of the basket, and baby soon learns thatwhen he opens his mouth and yells, somebody comes. In less than a weekthe mischief has been done and baby is badly spoiled. No other factorenters so largely into the sure "spoiled" harvest as picking a newbaby up every time he cries. Often in the early days some indulgentparent will say, "Oh, don't turn out the light, something might happento the dear little thing"--and old Mother Nature sees to it that aconstant repetition of "leaving the light on" brings its sure harvestof "he just won't go to sleep without the light. " And then, "justonce" he had the pacifier--perhaps to prevent his crying disturbingsome sick member of the family--and so we go on and on. If a thing isbad, it is bad, and a supposedly good excuse will not lessen the evilwhen the habit has been thus started and acquired. The rocking of babies to sleep may be a beautiful portrayal of motherlove, but we all pity the child who has to be rocked to sleep as muchas we do the mother who sits and rocks, wanting, Oh, so much! to dosome work or go for a walk--but she must wait till baby goes tosleep. THE TEMPER CRY And so now we come to the temper cry--that lusty, strong outburst ofthe cry of disappointment when he finds that all of a sudden peoplehave stopped jumping and dancing for his every whim. The baby is notto blame. We began something we could not keep up, and he--theinnocent recipient of all our indulgences--is in no sense at fault. Itis most cruel to encourage these habits of petty indulgence, whichmust cause so much future disappointment and suffering on the part ofthe little fellow as he begins to grow up. Nobody is particularly attracted to the spoiled baby. After theover-indulgent parent and caretaker have completed their thoughtlesswork, they themselves are ashamed of it and not infrequently begin tocriticise the product of their own making--the formation of theseunpleasant bad habits. More than anything else, the spoiled childneeds a new environment, new parents, and a new life. THE SPOILED BABY Seek to find out if possible--and it usually is possible--just what heis crying for. It may be for the pacifier, for the light, or to berocked, jolted, carried, taken up and rocked at night, or a host ofother trifles; and if he is immediately hushed on getting his soul'sdesire--then we know he is "spoiled. " The unfortunate thing about it all is that the one who has indulgedand spoiled the baby usually does not possess the requisite nerve, grit, and will power to carry out the necessary program for baby'scure. And the pity of it all is that overindulgence in babyhood sooften means wrecked nerves and shattered happiness in later life. So, fond, indulgent parents, do your offspring the very great kindness tofight it out with them while they are young, even if it takes allsummer, and thus spare them neurasthenia, hysteria, and a host ofother evils in later life. This sort of "spoiled baby crying" can be stopped only through sterndiscipline--simply let the baby "cry it out. " The first lesson mayrequire anywhere from thirty minutes to an hour and thirty minutes. The second lesson requires a much shorter time, and, in normal babieswith a balanced nervous system, a third or fourth lesson is notusually required. THE CRY OF SERIOUS ILLNESS The cry of the severely sick child is the saddest cry of all. The lowwail or moan strikes terror to the saddened mother-heart. It is oftenmoaned out when the child is ill with "summer complaint" or otherintestinal disturbances. Instant help must be secured, and, if medicalhelp is not obtainable, remember, with but one or two exceptions, youare safe in carefully washing out the bowels, in applying externalheat and giving warmed, boiled water to drink. Another cry which demands immediate attention, and the faithfulcarrying out of the doctor's orders, is the hoarse, "throaty" cryindicative of croup or bronchitis. THE COLICKY CRY Perhaps the greatest cause of the most crying during infancy, next tothat of over-indulgence, is ordinary colic which-- ... Manifests itself in every degree of disturbance from mere peevishness and fretfulness to severe and intensely painful attacks in which restlessness passes into grunting, writhing, and kicking; the forehead becomes puckered and the face has an agonized expression; the baby tends to scream violently and draws his thighs up against his belly, which will usually be found to be hard and more or less distended. A colicky baby completely upsets the household and greatly disturbsthe mother, who requires both quiet and rest that she may the betterproduce the life-sustaining stream so much needed for the upbuildingand development of the growing child. COLIC IN THE BREAST-FED While colic is so often seen in the bottle-fed babe, it often occursin the breast-fed child, and is usually traceable to some error in themother's diet or to some other maternal nutritional disturbance. Onemother who was sure she had eaten nothing outside the diet suggestionsshe had received, was requested to bring to the office a freshvoiding of her own urine which was found to be highly acid. Theadministration of an alkaline such as simple baking soda or calcinedmagnesia to the mother, corrected this acidity, and the colic in thebaby entirely disappeared. I recall the case of one mother who ate herdinner in the middle of the day, with a light meal in the evening andthereby stopped the colic in her babe. Another source of colic in the breast-fed baby is the unclean nipple. The nipples should be washed with soap and water and rinsed in boracicacid solution before each nursing. If the mother worries greatly, orthoughtlessly "gets very angry" just before the nursing hour, there isa substance known as "epinephrin" secreted by the glands located justabove the kidneys which is thrown into the blood stream and whichraises the blood pressure of the mother and often produces not onlycolic in the babe, but many times throws him into severe convulsions. COLIC IN BOTTLE-FED BABIES There are many opportunities for colic in the bottle-fed baby; forinstance, dirty bottles, dirty nipples, careless cleansing of utensilsused in the preparation of baby's food, improper mixtures, too muchflour, the wrong kind of sugar, too much cream or too littlewater--all these things help to produce wind under pressure in theintestine, which is commonly known as colic. Underfeeding oroverfeeding, too rapid feeding or too frequent feeding also contributetheir mite in producing colic. As a rule, the bottle-fed child is fed too often. In the new born, theinterval between feeds should be three hours from the start; after sixmonths the interval may be lengthened to four hours. COLIC AND CHILLINESS Hiccough--a spasm of the diaphragm--often accompanies colic, and, inthe case of infants, is usually due to the swallowing of air orover-filling the stomach; gentle massage, external heat, and a fewsips of very warm water usually corrects the condition. The chilling of the skin very often produces a temporary intestinalcongestion with colic as the result. Cold feet, wet diapers, andloitering at bath are all very likely to produce colic; and when it isthus caused by chilling, quickly prepare a bath at 100 F. , and afterimmersing the child for five minutes, wrap up well in warm blankets. THE TREATMENT OF COLIC Those of my mother readers who have electric lights in their home, will find the photophore to be a source of great comfort andconvenience; for this simple contrivance is usually able to banishcolic in a few moments. The photophore is simply radiant heat--heatplus light (See Fig. 3)--and as this heat is applied to legs andbuttocks of the crying child the diaper is warmed, the abdomenrelaxes, gas is expelled, intestinal contractions relieved, and thebaby is soon fast asleep. Occasionally with the aid of the photophore, and even without it, thewarm two-ounce enema containing a level teaspoon of baking soda and alevel teaspoon of salt to a pint of water when allowed to flow intothe bowel, will soon bring down both gas and feces to the great reliefof the baby. Warm water to drink is also very helpful. Putting thefeet in very warm water is also quieting to the crying colicky babe. It is often necessary in cases of repeated and persistent colic, togive a full dose of castor oil to clear out the bowel tract. Do notjolt or bounce the baby, do not carry him about, and don't walk thefloor with him. Heat him up inside and outside, warm his clothing and his bedding, andthus bring about relief without sowing seeds for future trouble--thesorrow of a spoiled child. One very quiet little baby was one day brought to the dispensary whosemother said: "Doctor, I didn't bring him 'cause he's sick, but 'causehe looks so pale; he's as quiet as a mouse; he never cries any moresince I got to giving him medicine. " On examination of the baby and oninquiring about the medicine, we found that the baby was dead drunkall the time. Some "neighbor friend" had told the tired out mother, "Give him a teaspoon of whiskey at each feeding and that'll fix himall right. " If a few more states go dry maybe it will not be so easyfor the ignorant mother to dope and drug her helpless baby. And neither is paregoric to be administered wholesale for colic. Itcontains an opiate, and should not be given without definite ordersfrom a physician. And so as a parting word on "Why Babies Cry, " we askeach mother to run over the following summary of the chapter, and thusseek to find out why her baby cries. BABY CRIES BECAUSE: He is hungry. He is thirsty. He has been given a dirty bottle. His mother has failed properly to cleanse the nipples. His food is not prepared right. His food is too cold. His bowels are constipated. His band is too tight. His clothes are wrinkled. His diaper is wet. He is too hot. He wants fresh air. He is too cold. He is in pain. He is very sick. His throat is sore. His ear aches. He has been rocked, carried, or bounced. He has been given a pacifier. He has had too much excitement. His mother has eaten the wrong food. CHAPTER XV THE NURSING MOTHER AND HER BABE Happy is the mother, and thrice blessed is the babe when he is able toenjoy the supreme benefits of maternal nursing. The benefits to thechild are far reaching; he stands a better chance of escaping manyinfantile diseases; the whole outlook for health--and even lifeitself--is greatly improved in the case of the nursing babe, ascompared with the prospect of the bottle-fed child. Maternal nursinglays the foundation for sturdy manhood and womanhood. Out of every one hundred bottle-fed babies, an average of thirty dieduring the first year, while of the breast-fed babies, only aboutseven out of every one hundred die the first year. At the same time, nursing the babe delivers the mother from all the work and anxietyconnected with the preparation of the artificial food, the dangers andrisks of unclean milk, and the ever-present fear of disease attendantupon this unnatural feeding. The mother who nurses her child can lookforward to a year of joy and happiness; whereas, if the babe isweaned, she is compelled to view this first year with many fears andforebodings. Mother's milk contains every element necessary for thegrowth and development of the child, and contains them in just theproportions required to adapt it as the ideal food for that particularchild. A dirty baby, properly fed, will thrive. A baby deprived of fresh air, but wisely fed, will survive and even develop into a strong healthy man or woman. But the baby raised according to the latest and most approved rules of sanitation and hygiene, if improperly fed, will languish and die. HYGIENE OF NURSING MOTHERS _Outings and Exercise. _ It is most highly important that the nursingmother should be able thoroughly to digest her food; otherwise theflow of milk is likely to contain irritants that will disturb thebaby's digestion, even to the point of making him really sick. Inorder to avoid these complications, exercise and outings areabsolutely essential for the mother. A vigorous walk, gardening, lighthousework or other light athletics, greatly facilitate digestion andincrease the bodily circulation, as well as promote deep breathing, all of which are of paramount importance to a good appetite and gooddigestion. _The Bowels. _ The bowels should move regularly and normally once ortwice during the twenty-four hours. Unfortunately, this is not usuallythe case: and in this connection we would refer our reader to thechapter on "The Hygiene of Pregnancy, " particularly those sectionsrelative to the care of the bowels, recipes for bran bread, lists oflaxative foods and other suggestions pertaining to the hygiene of thenursing mother. _Sleep. _ Nothing less than eight hours sleep will suffice for thenursing mother, and during the day she should take at least one napwith the baby. _Care of the Skin. _ Salt-rub baths are very beneficial taken once aweek. The daily cold-friction rub described elsewhere, will tone upthe system and increase digestion and improve the general well being. The soap wash may be taken once a week. The thorough cleansing of thebreasts, and the frequent changing of the undergarments, will help tokeep the baby happy; for oftentimes it is the odor of perspiration aswell as the smell of soiled clothing that spoils the appetite of thebaby, causing it to refuse food. _Recreation. _ Pleasant diversion is very essential for the mother, andshould be indulged in at least once a week. The bedtime hours, however, should not be interfered with and the recreation should beselected with a view to amuse, refresh and create a harmless diversionfor the mother's mind. Under no circumstances should the mother settledown to the thought: "No, I can't go out any more. I can't leave mybaby. " You should get away from the baby a short time each day, andgo out among your former friends and acquaintances. Many a wreckedhome--a shattered domestic heaven--dates its beginnings back to thedays when the over-anxious young mother turned her back on her husbandand looked only into the face of her (their) child. Nothing shouldcome in between the filial friendship of husband and wife, not eventheir child. So, dear mother, if you can, go out occasionally, awayfrom the baby, and enjoy the association of your husband and keep intouch not only with his interests, but with the outside world. Youwill come back refreshed and wonderfully repaid, and the face of theadored infant will appear more beautiful than ever. DIET OF THE NURSING MOTHER The general suggestions on diet which we made to the expectant motherare also valuable for the nursing mother. The food should beappetizing, nutritious, and of a laxative nature. Three meals shouldbe eaten: one at seven A. M. , one at one P. M. And one aboutsix-thirty at night, with the heaviest meal usually at one P. M. Asthe mother usually wakens at five o'clock, or possibly earlier, sheshould be given a glass of milk, cocoa, or eggnog. If she awakens atsix, nothing should be taken until the breakfast, which should consistof a good nourishing meal, such as baked potatoes with white sauce, poached eggs, cereal, milk or cocoa, prunes, figs, or a baked sweetapple, with bread and butter, etc. From that hour until one P. M. Only water is taken, and severalglasses are urged during this interval. With nothing between meals butwater and a little outdoor exercise, a good appetite is created forthe one P. M. Meal which should abundantly supply and satisfy thehungry mother; and then again, nothing is to be taken between dinnerand supper but water. And after the supper hour, a walk out into thecool night air should be enjoyed with the husband and on going to bedabout ten P. M. , an eggnog or glass of milk may be taken. At the closeof the other meals a cup of oatmeal gruel or milk or any othernourishing liquid may be enjoyed. The eating of food or the drinking of nourishing drinks between themeals not only interferes with digestion and disturbs the mother, butit also upsets the baby; and it is often the reason why the appetiteof the mother is so deranged at the meal time, her spirits depressed, and her milk diminished. Plenty of good nourishing food, taken threetimes a day with an abundance of water drinking between the meals, together with a free happy frame of mind occasioned by the recreationbefore mentioned, usually produces good milk and plenty of it. A napbetween meals will probably produce more milk than eating betweenmeals. OBJECTIONABLE FOODS All foods that cause indigestion in the mother or babe should beavoided. Some mothers continue to eat tomatoes, peaches, sour salads, acidfruits, and it appears in no way to interfere with baby's comfort; butthey are the exception rather than the rule. Usually tomatoes, acidsalad dressings, and mixed desserts must be avoided. Each mother is alaw unto herself. Certainly none of our readers will selfishlycontinue any food she feels will make her baby cry. All acid fruits, rich desserts, certain coarse vegetables, concoctions of alldescriptions such as rarebit, condiments, highly seasoned sauce, etc. , should be avoided. Acid fruitades, such as lemonade, limeade and orangeade, can be takenby a small per cent of nursing mothers; and, since fruit acids areneutralized and alkalized in the process of digestion andassimilation, and since they are the very fruit-drinks we prescribefor patients suffering with an increased acidity, it would appear thatthey were in every way wholesome for the mother--if they in no wayinterfere with the baby. Practically, they do as a rule disturb thebaby's digestion and should be avoided by those mothers who have foundthis to be the case. CAKED BREASTS During the first week of lactation the milk tubes of the breasts veryoften become blocked and the breasts become engored with milk, thiscondition being known as "caked breasts. " At this particular time ofthe baby's life, he takes little more than an ounce of milk at a feed;so, beside the incoming engorgement of milk, an additional burden isthrown upon the milk tubes of the breasts in that they are notentirely emptied each nursing time by the young infant. When thebreasts threaten to "cake, " immediate steps must be taken to relievethe condition--to empty the breasts--and this is usually accomplishedin the following manner: with hands well lubricated with sweet oil orolive oil the nurse begins gentle manipulation of the breasts towardthe nipple in circular strokes, with the result that the milk soonbegins to ooze out. This massage should be continued until relief isobtained; or the breast pump may be applied. Hard nodules should notbe allowed to form or to remain in the breasts. Hot compresses (wrungfrom boiling water by means of a "potato ricer") may be applied to thecaked breast which is protected from the immediate heat by onethickness of a dry blanket flannel. These hot compresses should beremoved every three minutes until three have been applied, then an icewater compress is quickly applied, to be followed by more hot ones andthen a cold; and so on, until as many as four sets each have beenadministered. Gentle massage may again be administered and it will be found thatthey empty now with greater ease because of the preceding heat. Afterthe breasts have been emptied, and thoroughly washed with soap sudsand carefully dried, they should be thickly covered with cottonbatting and firmly compressed against the chest wall by a snug-fittedbreast binder, which serves the double purpose of relieving pain bynot allowing the breasts to sag downward, at the same time preventingan over-abundant secretion of milk by diminishing the blood supply tothe glands of the breast. In case the persistent manipulation of thebreast and the use of the breast pump do not relieve the condition, and if the repeated effort day after day seems to avail nothing; then, as a rule, we must look for a breast abscess to follow if the breastsare not immediately "dried up. " In all such cases of engorgement, theattending physician should be notified at once. SORE NIPPLES The nipple must be kept _dry_ between nursings, which should belimited to twenty minutes. Regularity should be maintained. Thenipples should never be touched or handled by hands that have not beenscrubbed with soap and a nail brush. During the early nursing daysthey are wet much of the time and are subject to much stress andstrain in the "pulling effort" of the baby, as a result of which theybecome very tender, chapped, cracked, and often bleed. Allowing thebaby to go to sleep with the nipple in his mouth also exposes thenipple to unnecessary moisture which increases the possibility ofpainful cracking. The pain occasioned by nursing at this time is trulyindescribable, and is most often the cause of absolute refusal on thepart of the mother to nurse her babe--with the result that it is puton the bottle. Again, the fear and dread of being hurt so often tendsto diminish the flow of milk. It is entirely possible so to preparethe nipple for this exposure, during the last months of pregnancy, that all this discomfort and pain may be entirely avoided (Seechapter, "The Hygiene of Pregnancy"). Before the mother is put to rest after the birth of the baby thebreasts are prepared as follows: A thorough cleansing with soap andwater is followed by a careful disinfection with alcohol which leavesthe nipple perfectly dry. A soft sterile pad is then applied and heldin place by a breast binder. Before and after each nursing the nippleand surrounding area is swabbed with boracic acid (saturated solution)and carefully dried by applying a clean, dry, sterile pad. Painful cracks and fissures are nearly always due to lack of the caredescribed above, and are almost wholly preventable. When the firstcrack appears and nursing becomes painful, the baby's mouth should nottouch the nipple again until healing has taken place. A thoroughcleansing with boiled water should be made and then the sterile nippleshield should be applied through which baby will get abundantsatisfaction, while the mother is spared the pain, and the nipple hasan opportunity to get well. In the case of sore and cracked nipples, thorough cleansing withboiled water and boracic acid solution follows each nursing seance;and, after careful drying, balsam peru--equal parts withglycerine--may be applied with a tiny piece of sterile gauze orcotton; a sterile cotton pad is then applied to each breast which isheld in place by a breast binder. The nipple shield, when employed, is boiled after each nursing andwashed in boracic acid solution just before each nursing. Thestrictest cleanliness must be observed, and then we hope to bringrelief and comfort to the mother, and effect the saving of nature'sbest food for the baby. CONSTITUENTS OF MOTHER'S MILK Mother's milk--that wonderfully adaptable, ever-changing food, soaccurately and scientifically suited to the hourly and daily needs ofthe growing child--is composed of five different parts, totally unlikein every particular, and each part exactly suited to the needs whichit supplies. The cream of the milk, as well as the lactose or sugar, builds up the fatty tissues of the body as well as helps provide theenergy for crying, nursing, kicking, etc. The proteins (the curd ofthe milk) are exceedingly important; they are especially devoted tobuilding up the cells and tissues of the body of the growing child. The salts form a very small part of the baby's food, but an importantone, for they are needed chiefly for the bones and the blood. Thefats, sugars, proteins, and salts, taken together, form the solids ofmother's milk, and are held in solution in the proportion of thirteenparts of solids to eighty-seven parts of water; which so holds thesesolids in solution that the baby can digest and assimilate thesenecessary food elements. The mother's milk increases in strength dayby day and month by month as the baby grows, and is the only perfectinfant food on earth. THE TIME OF THE FIRST FEEDING Soon after the birth of the baby the wearied mother seeks rest--sheusually falls into a quiet, restful slumber; the baby likewise goes tosleep and usually does not awaken for several hours. After six oreight hours the child is put to the breast and he begins to nurse atonce, without any special help. This first nursing should bediscontinued after four or five minutes, while he is put to the otherbreast for the same length of time. If there is difficulty in sucking, a bit of milk may be made to oozeout on the clean nipple, while the baby's lips are pressed to it, after which the nurse gently presses and rubs the breasts toward thenipple. After the nursing, the nipples should be elongated, ifnecessary, by rubbing, shaping, or breast pump. The baby gets but little nourishment during the first two days, butthat which he does get is essential; for the colostrum--the firstmilk--is highly laxative in nature and serves the important purpose ofcleaning out the intestinal tract of that first tarry, fecal residue, the meconium. This early sucking of the child accomplishes anotherpurpose besides the obtaining of this important laxative--it alsoreflexly increases the contractibility of the muscles of the womb, which is an exceedingly important service just at this time. Should the mother or caretaker feel that baby will starve before themilk comes, or that it is necessary to provide "sweetened water;" letus assure them that nothing is needed except what nature provides. Nature makes the babe intensely hungry during these first two days, sothat he will suck well, and if he is fed sweetened water, gruel, oranything else, he will not suck forcefully; and so nature's plan forsecuring extra or increased uterine contractions and the stimulationof the breast glands will be seriously interfered with. WATER DRINKING As soon as the new born babe is washed and dressed he is given twoteaspoons of warmed, boiled water; and this practice is continuedevery two hours during the day, until as much as two to four ounces ofunsweetened water is taken by the tiny babe during the twenty-fourhours. Inanition fever--the fever that sometimes follows a failure togive water to the new born infant--is thus avoided. The bottle fromwhich the water is given should be scalded out each time, the nippleboiled, and just before the "water nursing" the nipple should beswabbed with boracic acid solution. REGULARITY IN FEEDING From earliest infancy the baby should be nursed by the "clock, " andnot by the "squawk. " Until he reaches his sixth-month birthday, he isfed with unerring regularity every three hours during the day. Asleepor awake he is put to the breast, while during the night he is allowedto sleep as long over the three-hour period as he will. Babies areusually nursed at night: during the early weeks, at nine o'clock inthe evening, at midnight, and at six o'clock in the morning. Afterfour months all nursing after ten P. M. May be omitted. The baby is ordinarily allowed to remain at the breast for abouttwenty minutes. He may often be satisfied with one breast if the milkis plentiful; if not, he is given both breasts; and may we add thefollowing injunction? insist that nothing shall go into your baby'smouth but your own breast milk and warm or cool-boiled water; nosugar, whiskey, paregoric, or soothing syrup should be given, nomatter how he cries. Never give a baby food merely to pacify him or tostop his crying; it will damage him in the end. More than likely he isthirsty, and milk to him is what bread and meat are to you, neither ofwhich you want when you are thirsty. POSITION OF MOTHER DURING THE NURSING A perfectly comfortable position during nursing for both mother andbabe is necessary for satisfactory results. During the lying-in periodthe mother should rest well over on her side with her arm up and herhand under her head, the other hand supports the breast and assists inkeeping the nipple in the baby's mouth, as well as preventing thebreast from in any way interfering with baby's breathing. A rolledpillow is placed at the mother's back for support. After the mother leaves the bed, she will find a low chair mostconvenient when nursing the baby, and if an ordinary chair be used, she will find that a footstool adds greatly to her comfort. Onceduring the forenoon and once during the afternoon the nursing motherwill find it a wonderful source of rest and relaxation if she removesall tight clothing, dons a comfortable wrapper, and lies down on thebed to nurse her babe; and as the babe naps after the feed, shelikewise should doze and allow mother nature to restore, refresh, andfit her for restful and happy motherhood. Worry, grief, fatigue, household cares, loss of sleep, socialdebauches, emotional sprawls--all debilitate the mother, and usuallydecrease the flow of milk. NURSING WHEN ANGRY AND OVERHEATED Overheating, irritability, and sudden anger, almost invariably tend toraise the blood-pressure, which means the entry into the blood streamof an increased amount of epinephrin, which disturbs the baby greatly, often throwing him into convulsions or other sudden, acute illness. Menstruation often interferes with the nursing mother, the milkbecoming weaker at this time; however, if the infant continues to gainand the mother feels comparatively well, no attention need be paid tothis fact. Another pregnancy demands a drying up of the breast at once, as thetax is too great on the mother. THE STOOLS The stools of the breast-fed baby do not require as much attention asthose of the bottle-fed child. In cases of constipation, after fourmonths, from one teaspoon up to one-half cup of unsweetened prunejuice may be given one hour before the afternoon feed. In instances of colic with signs of fermentation in the stool, themother may take several doses (under her physician's orders) of commonbaking soda; or, if she is constipated, calcined magnesia will usuallyright the condition. Nature's mother milk is so beautifully adapted tothe baby's needs that it is the rule for baby to have perfectly normalstools. SYMPTOMS OF SUCCESSFUL NURSING A happy baby is a satisfied baby. He lies quietly in a sleepy, relaxedcondition if he has enough to eat, provided he is otherwisecomfortable and dry. He awakens at the end of two hours and perhapscries; but plain, unsweetened, warm, boiled water quenches histhirst, and he lies content for another hour, when he is regularlynursed. He gains on an average of about one ounce a day. EARMARKS OF UNSUCCESSFUL NURSING Constant discomfort, vomiting, fretful crying, passing and belching ofgas, colicky pain, disturbed sleep, greenish stools with mucus, areamong the more prominent earmarks of unsuccessful nursing. Thesesymptoms appearing in a pale, flabby, listless, indifferent or crossbaby, with steady loss of weight continued over a period of three orfour weeks, point to "nursing trouble;" which, if not corrected, willlead to that much dreaded infantile condition--malnutrition. Bolting of food or overeating results in vomiting and gas, and thusinterferes with normal nursing, as also may tongue-tie. A condition inthe mouth, medically known as "stomatitis, " and commonly known as"thrush, " often gives rise to a fretful cry when nursing is attempted. In the first place, the baby cannot "hold on" to the nipple; while, inthe second place, it hurts his inflamed mouth when he makes an effortto nurse. Long continued nursing covering three-fourths of an hour or more, seizing of the nipple for a moment and then discarding it, apparentlyin utter disgust, are the earmarks of very scanty milk supply andshould receive immediate attention. AIDS TO THE MILK SUPPLY Believing that many more mothers than do so should nurse their babies, we have carefully tabulated a number of aids to the milk supply, whichwe hope will be most earnestly tried before the baby is taken from thebreast--for so many, many more bottle-fed babies die during the firstyear than the breast fed. The dangers of infection, the worry of thefood preparation, the uncertainty of results, all call for a mostuntiring effort on the part of every doctor, nurse, and mother, intheir endeavors to secure maternal nursing. The following is a summaryof "aids to the milk supply:" 1. Regular periodical sucking of the breasts from the day of baby'sbirth. 2. Systematic applications of alternate hot and cold compresses, followed by massage to the breasts. 3. Three good nourishing meals each day, eaten with merriment andgladness of heart. 4. A glass of "cream gruel, " milk, cocoa, or eggnog at the close ofeach meal, with a glass just before retiring. 5. Three outings each day in the open air. 6. Nurse the baby regularly and then turn its care over to another, you seek the out of doors and engage in walking, rowing, riding andother pleasurable exercise. 7. Take a daily nap. 8. You can bank on fretting and stewing over the hot cook stove todecrease your milk. It seldom fails to spoil it. 9. Regular body bathing, with cold friction rubs to the skin. 10. A happy, carefree mental state. Nothing dries up milk so rapidlyas worry, grief, or nagging. 11. The administration, preferably in the early days, of desiccatedbovine placenta; although it may be given at any time during theperiod of nursing. WHEN THE BABY SHOULD NOT BE NURSED As much as we desire maternal nursing for the babe, there do occurinstances and conditions which demand a change to artificial feeding, such as the following: 1. A new pregnancy. 2. Mothers with uncontrollable tempers. 3. Cases of breast abscess. 4. Prolonged illness of the mother with high fever. 5. Wasting diseases such as tuberculosis, Bright's disease, heart disease, etc. 6. Maternal syphilis. 7. When maternal milk utterly fails, or is wholly inadequate. When a maternal anesthetic is to be administered, or in case ofinflammation of the breast or during a very short illness not coveringmore than two or three days, then the breast pump may be usedregularly every three hours to both breasts; the baby may beartificially fed and then returned to the breast after the effects ofthe anesthetic has worn off or the temperature has been normal fortwenty-four hours. There may also appear definite indications in certain children whichmake it imperative that the nursing child should early be weaned. These manifestations of disordered nutrition and failing healthadmonish us to put the baby on properly modified milk, or to transferit to a wet nurse. These conditions are: 1. Progressive loss in weight. 2. A bad diarrhea of long standing; one which does not yield to theusual remedies, at least not as long as the baby continues to feedfrom the breast. These diarrheas are especially serious whenaccompanied by a steady loss in weight. 3. Excessive vomiting accompanied by progressive loss in weight. THE WET NURSE Because of the rarity of good, healthy wet nurses, it is always betterto attempt to feed the baby with scientifically modified milk (notproprietary foods), good, clean, cow's milk properly modified to suitthe weight and age of the child. We put weight first, for we preparefood for so many pounds of baby rather than for the number of monthsold he is. If modified food has failed and the best specialist within your reachorders a wet nurse; she must have the following qualifications: 1. She must be free from tuberculosis and syphilis. 2. She should be between twenty and thirty years of age. 3. She should abstain from all stimulants. 4. She should be amiable, temperate, and should sense her responsibility. If an unmarried mother of her first child is engaged as a wet nurse, she should not be "stuffed" or allowed to overeat, which is commonlythe result of moving her from her lower life into more comfortablesurroundings, or given ale or beer to increase her milk. She shouldcontinue her normal eating, take light exercise, which does not meanthe scrubbing of floors or doing the family washing, and live underthe same hygienic regime outlined for the nursing mother. Should shebe the mother of the second or third illegitimate child, then she isquite likely to be mentally deficient and she should not be engaged. Her own babe will have to be fed artificially as very few mothers canendure the strain of two suckling children. The baby's own mother should keep general supervision and not turn herbabe entirely over to the care of the wet nurse. Remember always thatno one in the wide world will ever take the same mother interest inyour offspring that can spring from your own mother heart. CHAPTER XVI THE BOTTLE-FED BABY In taking up the subject of the bottle-fed baby, we must repeat thatthe only perfect baby food on earth is the milk that comes from thebreast of a healthy mother. But sudden illness, accident, chronic maladies, or possibly the deathof the mother, often throw the helpless babes out into a world of manysorts and kinds of artificial foods--foods that are prepared bymodifying cow's, ass', or goat's milk; foods arranged by the additionto the milk of various specially prepared cereals, albumens or maltedpreparations, otherwise known as "proprietary foods. " We shallendeavor, then, in this chapter and in that on "the feeding problem, "to lay down certain general suggestions to both the nurse and themother, which may assist them in their effort to select the food whichwill more nearly simulate nature's wondrous mother-food, and whichwill, at the same time, be best suited to some one particular baby. THE HOURLY SCHEDULE The normal baby, from birth to six months, should receive properlyprepared nourishment every three hours, beginning the day usually atsix A. M. , the last feeding being at nine P. M. During the early weeksan additional bottle is given at midnight, but this is usuallydiscarded at four months, at which time the last feeding should begiven at about ten instead of at nine at night. Should the baby continue to awaken during the night before six in themorning, unless he is under weight, a bottle of warm, boiled, unsweetened water should be given. QUANTITY OF FOOD The quantity of food to be given is always determined by the size ofthe baby's stomach, which, of course, depends somewhat upon the age ofthe child; for instance, the stomach of the average baby one week oldholds about one ounce, while at the age of three months the stomachholds five ounces; so it would not only be folly to give two ounces atone week and seven ounces at three months, but it would also be verydetrimental to the babe, causing severe symptoms due to theoverloading of the stomach. Careful study of the size of the stomach at different ages in infancy, together with the quantity of milk drawn from the breast by a nursingbaby, has led to the following conclusions regarding the capacity ofthe baby's stomach: AGE QUANTITY 1--4 weeks 1--2 ounces 4 weeks--3 months 2½--4 ounces 3 months--6 months 4--6 ounces 6 months--1 year 6--8 ounces REFRIGERATOR NECESSITY It is highly important that the day's feedings be kept in a coldplace, free from the odors of other foods as well as free from dust, flies, and filth. In order that this may be accomplished, thewell-protected bottles, each containing its baby-meal, are placed in acovered pail containing ice and water. This covered receptacle is nowput in an ice box; and, in order that our most economical reader--onewho may feel that she cannot afford to keep up the daily expense ofthe family refrigerator--may herself prepare a simple homerefrigerator, the following directions are given (Fig. 9). HOMEMADE ICE BOX Procure a wooden box about eighteen inches square and sixteen oreighteen inches deep and put four inches of sawdust into the bottom;now fill in the space between a ten-quart pail, which is set in themiddle of the box with more sawdust. A cover for the box is now linedwith two or three inches of newspaper, well tacked on, and isfastened to the box by hinges. We are now ready for the inside pail ofice, into which is carefully placed the well-protected bottles ofmilk, all of which is then set into the ten-quart pail in the box. Five cents worth of ice each day will keep baby's food cool, clean, and provide protection against the undue growth of germs. [Illustration: Fig. 9. Homemade Ice Box] PREPARING THE BOTTLE At each feeding hour, one of baby's bottled meals is taken from theice box and carefully dipped in and out of a deep cup of hot water. Avery convenient receptacle is a deep, quart aluminum cup, which may bereadily carried about. The hot water in the cup should amply cover themilk in the bottle (Fig. 10). To test the warmth allow a few drops to fall on the inner side of thearm, where it should feel quite warm, never hot. A baby's clean woolenstocking is now drawn over the bottle, which keeps it warm during thefeeding. No matter how great the danger of offending a fondgrandparent or a much adored friend never allow anyone to put thenipple in her mouth to make the test for warmth of baby's food. There are many contrivances, both electrical and alcoholic, forheating baby's bottle, many of which are both convenient andinexpensive. POSITION DURING FEEDING And now we realize that we are about to advise against thetime-honored injunction which has been handed down from "Grandma This"and "Mother That" to all young mothers who have lived in theirneighborhoods: "My dear young mother, if you can't nurse your preciousinfant, you can at least 'mother it' at the nursing time by holding itin your arms and gently rocking it to and fro as you hold the bottleto its lips. " This so-called "mothering" has resulted inregurgitation, belching, and numerous other troubles, as well as theformation of the "rocking habit. " A young mother came running into my office one day saying: "Doctor, itwon't work, the food's all wrong; my baby is not going to live, forhe throws up his food nearly all the time. " We arranged to be presentwhen the next feeding time came and watched the proceedings. A dearold friend had told her "she must 'mother' her baby at the nursingtime, " and so she had held the child in a semi-upright position as sheendeavored to hold the bottle as near her own breast as was possible. The hole in the nipple was a bit large, which occasioned thesubsequent bolting of the food, and then to continue the "mothering"she swayed him to and fro, all of which was interrupted suddenly bythe vomiting of a deluge of milk. [Illustration: Fig. 10. Heating the Bottle] I drew the shade in an adjoining room, opened the windows, and into acomfortable carriage-bed I placed the baby on his side. Seating myselfbeside him I held the warm, bottled meal as he nursed. Several times Itook it from his mouth, or so tipped it that "bolting" was impossible. Gradually, carefully, and slowly, I took the empty bottle away fromthe sleepy babe, and as I closed the door the mother said in anxiousamazement: "He won't forget I'm his mother if I don't hold him whilehe nurses?" You smile as I smiled at this girl-mother's thought; but, nevertheless there are many like her--anxious, well-meaning, butignorant. The infant stomach is little more than a tube, easily emptied if thebaby's position is not carefully guarded after nursing. No bouncing, jolting, patting, rocking, or throwing should take place either justbefore, during, or immediately after meals. TIME ALLOWANCE FOR ONE FEEDING From twelve to twenty minutes is long enough time to spend at a bottlemeal. The nipple hole may have to be made larger, or a new nipple witha smaller hole may have to be purchased. When new, you should be ableto just see a glimmer of light through the hole, and if the infant istoo weak to nurse hard, or the hole too small, it may be made largerby a heated hatpin run from the inside of the nipple out; great caremust be taken, else you will do it too well. If the nipple hole is toolarge, bolting is the sure result; while too small a hole results incrying and anger on the part of the hungry child, because he has towork too hard to get his meal. AFTER THE FEED We have seen some mothers, in their anxiety to prevent the sucking inof air from the emptied bottle, rush in and jerk the nipple from thegoing-to-sleep babe so forcibly that all thoughts of sleep vanishedand a crying spell was initiated. The tactful mother is the quiet onewho slowly, quietly, draws the empty bottle with its "much lovednipple" from the lips. If you observe that the babe is going to sleep, with an occasional superficial draw at the nipple, wait a moment; hewill drop it himself, and you can pick it up as you quietly leave theroom. In all instances, whether it be indoors or out of doors, arrangethe babe in a comfortable sleeping position, remembering that nursingis warm exercise and the babe gets uncomfortably sweaty ifoverbundled, especially about the head and neck. No one shouldunnecessarily touch the babe immediately after feeding; even hisdiaper may be changed without awakening him while he is thus lyingquietly in his bed. INTERVALS BETWEEN MEALS The three-hour interval is reckoned from the beginning of the meal, and not from its close. More than two hours is spent in the stomachdigestion, and any food or sweetened water which may enter betweenmeals only tends to cause indigestion and other disturbances. And thatthis important organ may have a bit of rest, we fix the interval atthree hours, which in our experience and that of many otherphysicians, has yielded good results. As a rule we have noregurgitation and no sour babies on the three-hour schedule. Sickbabies, very weak babies, and their feeding time, will be discussed ina later chapter. ADDITIONAL FOODS At six months, and often as early as four, in cases of constipation, unsweetened, well-strained prune juice may be given, beginning withone-half teaspoon one hour before the afternoon feed and increasing itdaily until two tablespoons are taken. At six months, both orangejuice and vegetable broths are given, whose vegetable salts add a veryimportant food element to the baby's diet--an element which ourgrandmothers thought could only be obtained through the time-honored"bacon rind" of by-gone days. Orange juice is also unsweetened and well strained, and isadministered in increasing amounts, beginning with one-half teaspoonone hour before the afternoon feeding, until the juice of a wholeorange is greedily enjoyed by the time of the first birthday. Thevegetable juices are obtained from cut-up spinach, carrots, tomatoes, and potatoes, strained, with a flavor of salt and onion--really abouillon--and is given just before the bottle at the six P. M. Feeding. They are also begun in teaspoon amounts. FOOD FOR THE TRAVELING BABE Baby travel should be reduced to a sheer necessity; never should thebabe be subjected to the exposure of disease germs, the change offood, the possibilities of draughts and chilling, for merely apleasure trip--the risks are too great and the possibilities of futuretrouble too far reaching. If you are in touch with the milk laboratory of a large city, you willfind that they make a specialty of preparing feedings which are goodfor a number of days for the traveling baby, and we strongly advisethat their preparations be accepted; but in the event of not being intouch with such a laboratory we suggest the making of a carryingice-box covered with wicker, which must be kept replenished with ice. Food kept in such a device may be kept fresh for twenty-four toforty-eight hours. Plans other than the laboratory preparations or theice-box are risky, and should not be depended upon. Many of our railway dining cars now pick up fresh, certified milk atstations along the line for use on their tables, and where such is thecase fresh preparations of milk may be made on a trans-continentaltrip by the aid of an alcohol stove. Malted milk may also be used, provided you have accustomed the baby to its use a week before leavinghome, by the gradual substitution of a fourth to a half ounce each dayin the daily food; all of which, of course, should be done under yourphysician's direction. If possible, leave baby at home in his familiar, comfortableenvironment in the care of a trained nurse and a trusted relative, andunder the supervision of the baby's own physician. He is much betteroff, much more contented, and we are all aware of the fact thatcontentment and familiarity of sights and people promote goodappetite, good digestion, and happiness--the very essentials ofsuccess in baby feeding. We speak touchingly and sympathetically tothe mother who must leave her babe; and likewise we wish to cheer heras we remind her that by wireless messages and night letters it ispossible to keep in touch with loved ones though a thousand milesaway. The sanitation and modification of cow's milk, as well as stools, etc. , are taken up in later chapters. RULES FOR THE BOTTLE-FED 1. Never play with a baby during or right after a meal. 2. Lay the baby on his side when nursing the bottle. 3. Three full hours should intervene between feedings. 4. Don't give the food too hot--it should just be warm. 5. Make the test for warmth on the inner side of your arm. 6. Give a drink of water between each meal if awake. 7. Never save the left-overs for baby. 8. If possible, give three feedings each day in the cool air, with baby comfortably warm. 9. Do not jump, bounce, pat, or rock baby during or after meals. 10. Never coax baby to take more than he wants, or needs. 11. No solid foods are given the first year. 12. Orange juice may be given at six months; while, after four months, unsweetened prune juice is better than medicine for the bowels. CHAPTER XVII MILK SANITATION Cow's milk, like mother's milk, is made up of solids and water. In aprevious chapter we learned that in one-hundred parts of mother'smilk, eighty-seven parts were water and thirteen parts were solid. These thirteen parts of solids consist of sugar, proteins, and salts;this is likewise the case with cow's milk, except that in the case ofthe cow's milk, the sugar is decreased while the proteins areincreased as will be noted by the accompanying comparative analysis: MOTHER'S MILK Fat % 4. 00 Sugar 7. 00 Proteins 1. 50 Salts 0. 20 Water 87. 30 ------ % 100. 00 COW'S MILK Fat % 4. 00 Sugar 4. 50 Proteins 3. 50 Salts 0. 75 Water 87. 25 ----- % 100. 00 Mother's milk is absolutely sterile, that is, free from the presenceof germs; on the other hand, cow's milk is anything but sterile--themoment it leaves the udder it begins to accumulate numerous bacteria, all of which multiply very rapidly. Cow's milk is generallytwenty-four to forty-eight hours old before it can possibly reach thebaby. It is just as important to keep in mind these facts of milkcontamination--dirt, filth, flies, and bacteria--as it is to plan forthe modification of cow's milk for the purpose of making it morenearly resemble mother's milk. While mother's milk has about the samepercentage of fat as cow's milk, it is almost twice as rich in sugar, and has only one-fourth to one-third as much protein. This protein isvastly different from that found in cow's milk, which you recall has atough curd, as seen in cottage cheese. While mother's milk contains asmall amount of casein similar to that found in the cheese of thecow's milk, the principal protein constituent is of another kind(lactalbumin), and is much more easy of digestion than the casein ofcow's milk. This is a most important point to remember, because the baby's stomachis not at first adapted to the digestion of the heavier and tougherprotein curds of cow's milk. It requires time to accustom the infantstomach to perform this heavier work of digestion. There are a numberof factors which must be borne in mind in the modification of milk, whether it be cow's milk, or goat's milk (for many European physiciansuse goat's milk entirely in the artificial feeding of infants):namely, the cleanliness of the milk, the acidity of milk, thedifference in the curd, the percentage of sugar, and the presence ofbacteria. SUGAR In the modification of cow's milk, sugar must be added to make up forthe sugar which is decreased when the water was added to reduce theprotein. There are several sorts of sugar used in the modification ofmilk. These sugars are not added to sweeten the milk alone, but tofurnish a very important element needed for the growth of the baby. Sugar is the one element which the infant requires in the largestamount. Milk sugar is probably most universally used in the modification ofmilk, but a good grade of milk sugar is somewhat expensive, costingfrom thirty to sixty cents a pound, and this places it beyond thereach of many mothers. It is added to the food mixtures in theproportion of one ounce to every twenty ounces of food. Cane sugar(table sugar) may also be used, but it must be clean and of goodquality. It is used in rather less quantity than that of milk sugar, usually from one-half to one-third of an ounce by measure to eachtwenty ounces of food. Dextri-maltose (malt sugar) is very easy ofdigestion and may be used in the modification of milk. Maltose seemsto help the children to gain more rapidly in weight than when onlymilk or cane sugar is used. It is also exceedingly useful inconstipation, as its action is more laxative than any of the othersugars; but it should not be given to children who vomit habitually orhave loose stools. ACIDITY Like mother's milk, the cow's milk is neutral as it comes from theudder; but, on standing, it quickly changes, soon becoming slightlyacid, as shown by testing with blue litmus paper. In fact, what isknown as ordinarily fresh milk, if subjected to the litmus paper test, always gives an acid reaction. This acidity is neutralized by addinglime water to the formula in the proportion of one ounce to eachtwenty-ounce mixture. Ordinary baking soda is sometimes prescribed byphysicians in place of the lime water. In the event of obstinateconstipation, milk of magnesia is sometimes added to the day'sfeedings. CREAM There may be procured in any large city an instrument called the creamgauge, which registers approximately (not accurately) the richness ofmilk. Some milk, even though rich, parts with its cream very slowly;while some poor milk allows nearly all the cream quickly to rise tothe surface. We know of no way for the mother to determine the amountof cream (without the cream gauge) except by the color and richness ofthe milk. In cities it is very convenient to send a specimen of themilk to the laboratories to be examined by experts, who will gladlyrender a report to both physician and mother. The lactometer is a little instrument used to estimate the specificgravity of milk. An ordinary urinometer such as used by physiciansin estimating the specific gravity of urine may also be used. Thespecific gravity of cow's milk should not register below 1028 or above1033. [Illustration: Fig. 11. A Sanitary Dairy _Courtesy of Lakewood Farm_ _Courtesy of Lakewood Farm_] HERD MILK Milk from a single cow is not to be desired for baby's food because ofits liability to vary from day to day, not to mention the danger ofthe cow's becoming sick. Authorities have agreed that herd milk ofHolstein or ordinary grade cows is best for infant feeding. Thismixed-herd milk contains just about the proper percentage of fat;whereas, if Jersey milk must be used, some of the cream should betaken away. Our milk should come from healthy cows which have beentested for tuberculosis at least every three months. Annatto is sometimes added to milk to increase its richness of color. To test for annatto proceed as follows: To a couple of tablespoons ofmilk add a pinch of ordinary baking soda. Insert one-half of a stripof filter paper in the milk and allow it to remain over night. Annattowill give a distinct orange tint to the paper. The commonly used milkpreservatives are boracic acid, salicylic acid, and formaldehyde, anyof which may be readily detected by your health officials. SANITARY DAIRIES In close proximity to most large cities there is usually to be foundone or more sanitary dairies. It is a joy indeed to visit a farm ofthis kind with its airy stables and concrete floors, which are washedwith water coming from a hose. The drainage is perfect--all filth isimmediately carried off (Fig. 11). The cows are known to be free fromtuberculosis, actinomycosis (lumpy jaw), and foot and mouth disease. The milkmen on this farm wear washable clothes at the milking time, and their hands are painstakingly cleansed just before the milkinghour. Previous to the milking the cattle have been curried outside themilking room and their udders have received a careful washing. Themilkman grasps the teat with clean hands, while the milk is allowed toflow through several thicknesses of sterilized gauze into the sanitarymilking pail. This milk is at once poured into sterile bottles, isquickly cooled and shipped in ice to the substations where thedelivery wagon is waiting. In the ideal delivery wagon there areshallow vats of ice in which the bottles are placed, thus permittingthe milk to reach the baby's home having all the while been kept at atemperature just above the freezing point. And why all this trouble? Why all this worry over temperature andcleanliness? Babies were not so cared for in the days of ourgrandmothers. The old-fashioned way of milking the cows with dirtyclothes and soiled hands, while cattle were more or less covered withmanure, with their tails switching millions of manure germs into themilking pail, produced a milk laden not only with manure germs--theone great cause of infantile diarrhea--but also swarming with numerousother mischief making microbes. Even tuberculosis, that much dreadeddisease germ of early infancy, may come from the dairy hands as wellas from infected cows. There used to be many dairymen like the old farmer who, wheninterrogated by the health commissioner concerning the cleanliness ofhis milk, laughed as he reached down into the bottom of a pail ofyellow milk and grabbing up a handful of manure and straw, said:"That's what makes the youngsters grow. " But it does not make themgrow; it often causes them to die, and even if they do live, they livein spite of such contaminated food, for the germ which is always foundin the colon of the cow (_coli communis_), probably kills more babiesevery year than any other single thing. It is possible to reduce the growth of these germs by keeping the milkat a very low temperature from the time it leaves the cow until themoment it gets to the home refrigerator. Those which survive thisprocess of refrigeration may be quickly rendered harmless bypasteurizing or sterilizing at the time of preparing baby's food. In the absence of the modern sanitary dairy, we would suggest that themilk supply be improved by giving attention to the following: The cattle should be tested for tuberculosis every three months. Thewalls of the cowhouse should be whitewashed three times a year. Themanure should be stored outside the barn. The floor of the cowhouseshould be sprinkled and swept each day. The cattle should be keptclean--curried each day, and rubbed off with a damp cloth beforemilking. The udders should be washed before each milking. The milkercan wear a clean white gown or linen duster which should be washedevery two days, while his hands should be washed just before themilking. The milking pail should be of the covered sanitary order. Thebarn should be screened. CERTIFIED MILK Immediately after leaving the cow, the milk should be cooled to atleast 45 F. It should at once be put into bottles that have beenpreviously sterilized and then be tightly covered, and should be keptin ice water until ready for consumption. No matter how carefully themilk is handled, it is infected with many bacteria, but if it isquickly cooled, the increase of the bacteria is greatly retarded. Under no circumstances buy milk from a grocery store out of a largecan. Go to your health officer and encourage him in his campaign forsanitary dairies and certified milk. Such milk as we have described under the head of sanitary dairies, when it has been tested by the board of health and has received theapproval of the medical profession, is known as "certified milk;" and, although the price is usually fifteen to twenty cents a quart, whencompared with the cost of baby's illness it will prove to be cheaperthan the dirty milk which sickens and kills the little folks. There is no doubt that the increased use of "certified milk" has beena great factor in the reduction of deaths from infant diarrhea inrecent years. BOILING THE MILK When certified milk cannot be had, it is absolutely dangerous to giveraw, unboiled, or unpasteurized milk to the baby, particularly in warmweather; for the countless millions of manure germs found in eachteaspoon of ordinary milk not only disturbs the baby's digestion, butactually makes him sick, causing colic, diarrhea, and cholerainfantum. The only way this milk can be rendered safe is by cookingit--actually killing the bacteria. This process of boiling, however, does not make good milk out of bad milk nor clean milk out of thatwhich is dirty, it simply renders the milk less dangerous. There are two methods of killing bacteria--sterilization andpasteurization. By sterilization is meant the process of rendering themilk germ free by heating, by boiling. Many of the germs found in milkare comparatively harmless, merely causing the souring of milk; butother microbes are occasionally present which cause serious diseases, such as measles, typhoid and scarlet fever, diphtheria, tuberculosis, and diarrhea. It is always necessary to heat the milk before using inwarm weather, and during the winter it is also important wheninfectious or contagious diseases are prevalent. Milk should be sterilized when intended for use on a long journey, andmay be eaten as late as two or three days afterward. To sterilize milk, place it in a well-protected kettle and allow toboil for one hour and then rapidly cool. This process renders it moreconstipating, and for some children many of its nutritive propertiesseem to be destroyed, as scurvy is often the result of its prolongeduse. When a child must subsist upon boiled milk for a long period, heshould be given the juice of an orange each day. Children are notusually strong and normal when fed upon milk of this character forindefinite periods. All living bacteria (except the spores or eggs)may be destroyed by boiling milk for one or two minutes. PASTEURIZATION When baby is to use the milk within twenty-four hours, "pasteurization" is better than boiling as a method of destroyingmicrobes. There are many pasteurizers on the market which may be depended upon, among which are the Walker-Gordon Pasteurizer, and Freeman'sPasteurizer; but in the absence of either of these pasteurization maybe successfully accomplished by the following method: On the bottom of a large kettle filled with cold water, place anordinary flatiron stand upon which is put a folded towel. On thisplace the bottle of milk as it comes from the dairyman, with the capof the bottle loosened. The cold water in the kettle should come up towithin an inch of the top of the bottle of milk. Heat this waterquickly up to just the boiling point--until you see the bubblesbeginning to rise to the top. The gas is then turned down or thekettle is placed on the back of the range and held at thisnear-boiling point for thirty minutes, after which it is taken to thesink and cold water is turned into the water in the kettle, until thebottle of milk is thoroughly cooled. It is now ready to be made upinto the modified food for baby. Never let pasteurized milk stand in the room, nor put it near the icewhen warm. It must be cooled rapidly, as described above; that is, within fifteen or twenty minutes. The "spores" of the milk are not killed by pasteurization and theyhatch out rapidly unless the milk is kept very cold, and, as alreadystated, it should be used within twenty-four hours afterpasteurization. THE CARE OF BOTTLED MILK The certified milk or the ordinary milk that has been delivered toyour home and is to be used without pasteurization or sterilization, should receive the following care: 1. It should be placed at once in a portion of the ice box that is notused to store such foods as radishes, cabbage, meats or any other opendishes of food whose odors would quickly be absorbed by the milk. Themilk should never be left standing on the doorsteps in the sun, formany reasons: the sun heats the milk, encourages the growth ofbacteria, and a passing cat or dog, whose mouth often contains thegerms of scarlet fever, tonsilitis, and diphtheria, should it behungry, laps the tops of the bottles, particularly in the winter whenthe cream has frozen and is bulging over the edge. 2. It should never be kept in the warm kitchen, as when visiting hersick baby we discovered one young mother doing. In answer to myquestion, she explained; "Doctor, we do not take ice in the wintertime, everything is ice outdoors, so I just set the bottle outside thewindow bringing it in whenever I need to give the baby some food. Iforget to put it out sometimes, but really now, does it matter?" Itreally matters much, for you see, reader, the milk is first freezingthen thawing and it is rendered entirely unfit for the baby. 3. Milk should be kept covered and protected from dust and flies; itshould be kept in glass jars which have been sterilized by boilingbefore being filled, and then placed in the refrigerator. If the milkis sour, or if there is any sediment in the bottle, it is unfit forbaby's use. CHAPTER XVIII HOME MODIFICATION OF MILK In a previous chapter it was found from comparing the analysis ofmother's milk with that of cow's milk, that they widely differed inthe proteins and sugar. The art of so changing cow's milk that itconforms as nearly as is possible to mother's milk is known as"modification. " Where protein, sugar, and fat are given in properamounts, healthy infants get along well; but when either the fats orproteins are given in excess, or when the digestion of the child isderanged, there is often no end of mischief. There are two groups of milk formulas that are useful. First, those inwhich the fats and proteins are about the same, known as "whole milk, "or "straight" milk mixtures; second, those in which the fats are usedin larger proportions than proteins, and known as "top milk"--milktaken from the upper part of the bottle after the cream has risen. Andsince the larger proportion of babies take the lower fats or "wholemilk" formulas, and seem to get along better than the babies who havethe "top milk" formulas, we will first take up the consideration ofthe modification of whole milk. PREPARATION FOR MODIFICATION To begin with, everything that comes in contact with the preparationof baby's food must be absolutely clean. The table on which thearticles are placed, and any towel that comes in contact with thearticles or the mother's hands, or those of the nurse, must bethoroughly scrubbed. There is only one way to prepare the utensils that are to be used inmaking the baby's food, and that is to put them in a large kettle andallow them to boil hard for fifteen minutes just before they are tobe used. The articles needed are (Fig. 12): 1. As many bottles as there are feedings in one day. 2. A nipple for each bottle. 3. Waxed paper for each bottle top. 4. Rubber bands for each bottle. 5. A two-quart pitcher. 6. A long-handled spoon for stirring the food. 7. A tablespoon. 8. A fork. 9. An eight-ounce, graduated measuring glass. 10. A bottle of lime water. 11. A fine-mesh, aluminum strainer. 12. A square of sterile gauze for straining the food (should be boiled for fifteen minutes with the utensils). 13. One plate, and later a double boiler (14). 15. The sugar. 16. The milk. 17. Ready for the ice box. 18. Refrigeration. BOTTLES AND NIPPLES There is but one bottle which can be thoroughly washed and cleaned, and that is the wide-mouthed bottle. It should hold eight ounces andshould have the scale in ounces blown in the side (Fig. 10). Thenipple for this bottle is a large, round breast from which projects ashort, conical nipple, which more nearly resembles the normal breastthan do the old-fashioned nipples so frequently seen on thesmall-necked nursing bottles. There is a great advantage in this, inthat the baby cannot grasp the nipple full length and thus causegagging. These bottles and nipples are known as the "Hygeia, " and haveproven to be a great source of comfort to the baby as well as to themother or nurse whose duty it is to keep them clean. There are anumber of other nursing bottles on the market, which, if they areused, must be thoroughly cleansed with a special bottle brush eachday. The neck is small and the nipple is small and great care must betaken in the cleansing of both of them. CARE OF BOTTLES AND NIPPLES When there is a bottle for each individual feeding in the day, immediately after each nursing both bottle and nipple should berinsed in cold water and left standing, filled with water, until thebottles for one day's feeding have all been used. The nipples shouldbe scrubbed, rinsed, and wiped dry and kept by themselves until theirboiling preparation for the following day's feeding. [Illustration: Fig. 12. Articles Needed for Baby's Feeding] If the same bottle is to be used for the successive feedings duringthe day, it should be rinsed, washed with soap and water, and bothbottle and nipple placed in cold water and brought quickly to theboiling point and allowed to boil for fifteen minutes. No bottles ornipples must ever be used after a mere rinsing; boiling, preceded by athorough washing in soap and water, must take place before they areused a second time. New nipples are often hard and need to be softened, which is readilydone by either prolonged boiling or rubbing them in the hands. All new bottles should be annealed by placing them on the stove in adishpan of cold water and allowing them to boil for twenty minutes, and then allowing them to remain in the water until they are cold. When bottles are treated in this manner they do not break so readilywhen being filled with boiling water or hot food. PREPARING THE FOOD In a large preserving kettle place all the utensils needed in thepreparation of the food--pitcher, spoon, fork, measuring glass, bottles, nipples, cheesecloth for straining, agate cup, wire strainer, in fact everything that is to be used in the preparation of the food. Now fill the kettle with cold water and place over the gas and allowto boil for fifteen minutes. On a well-scrubbed worktable place aclean dish towel, and on this put the utensils and the bottles rightside up. The nipples on being taken out of the boiling water will dryof themselves; they should be placed in a glass-covered jar until theyare needed for each individual feeding, the nipples not being placedon the bottles as they go to the ice box. Having been given your formula by your physician, proceed in thefollowing way. Suppose we were preparing the food for a normaltwo-months old baby that weighed ten pounds, with the prescription asfollows: BABY SMITH. R_{x} Whole Milk ounces 11 Cane Sugar level tablespoons 2 Boiled Water ounces 12½ Lime Water ounces 1 Amount at Each Feeding ounces 3½ Number of Bottles 7 Interval Between Feedings hours 3 DETAILS OF PREPARATION Two level tablespoons of cane sugar are placed in the agate cup anddissolved in a small amount of boiling water. The solution should beperfectly clear, and if it does not clear up put it over the heat fora few moments. This is now turned into the eight-ounce measuring glass which is thenfilled with boiling water and emptied into the two-quart pitcher. Weneed four and one-half more ounces of boiling water to complete theprescription requirement of twelve and one-half ounces. The bottle of milk, if properly certified, need not be pasteurized;but if it is not, it should have been previously pasteurized while theutensils were boiling according to the suggestions found in thechapter on "milk sanitation. " The top of the milk bottle should bethoroughly rinsed and wiped dry, and after a thorough shaking of themilk, the cover is removed with the sterile fork and eleven ounces aremeasured out by measuring glass and poured into the pitcher. All isnow stirred together with an ounce of lime water, which should neverlook murky, but should be as clear as the clearest water and shouldalways be kept in the ice box when not in use. The sterile cheesecloth which has been boiled for fifteen minutes isnow put over the nose of the pitcher, the contents of which isaccurately measured into the seven clean, empty bottles, eachcontaining three and one-half ounces. Over the top of each of thenursing bottles is placed a generous piece of waxed paper which isheld down by a rubber band. Each meal for the day is now contained ina separate bottle, and all are placed in a covered pail of watercontaining ice, and put in the ice box. If the prescription for the baby's food contains gruel, it is preparedin the following manner: Suppose the baby is eight months old and the prescription called fortwo level tablespoons of flour and eight ounces of boiled water. Thetwo level tablespoons of flour, whether it be wheat (ordinary breadflour), or barley flour, are put into a cup and stirred up with coldwater, just as you would stir up a thickening for gravy; now measureout eight ounces of water and allow it to come to a boil in the innerpan of the double boiler, into which the thin paste is stirred untilit comes to a boil. After boiling for twenty minutes, remeasure in themeasuring glass and what water has been lost by evaporation must beadded to complete accurately the prescription requirement of eightounces; this is now added to the other ingredients of theprescription. TABLE FOR INFANT FEEDING We now offer a monthly schedule--a table which is the result of ourexperience in feeding hundreds of babies in various sections ofChicago. It is not a schedule for the sick baby, but it is a carefullytabulated outline for the normal, healthy, average child ranging fromone week to one year in age. In offering this table we remind themother, if the baby is six months old and not doing well on the foodit is getting and a change is desired by both mother and physician, that it is far better to begin with the second or third month'sprescription and quickly work up to the sixth month's. This change mayoften be accomplished in two or three days. In all large cities there are to be found milk laboratories which makeit their business to fill prescriptions for the modification of milkunder the direction of baby specialists. This milk can be absolutelyrelied upon. In specialized diet kitchens in many large hospitals, these feeding prescriptions also may be filled. ARTIFICIAL FEEDING SCHEDULE ==========+========+=======+=======+=======+========+=======+========+ Age | | | | | | | Amount | | Baby's | Whole | Cane | Wheat | Boiled | Lime | at | | Weight | Milk | Sugar | Flour | Water | Water | Feeding| ----------|--------|-------|-------|-------|--------|-------|--------| | | | Level | Level | | | | | Pounds |Ounces | Table-| Table-| Ounces | Ounces| Ounces | | | | spoon | spoon | | | | ----------|--------|-------|-------|-------|--------|-------|--------| 1 week | 7½ | 2½ | 1 | | 5 | ½ | 1 | ----------|--------|-------|-------|-------|--------|-------|--------| 2 weeks | 7½ | 4½ | 1½ | | 9 | ½ | 2 | ----------|--------|-------|-------|-------|--------|-------|--------| 3 weeks | 7¾ | 7 | 2 | | 10 | ½ | 2½ | ----------|--------|-------|-------|-------|--------|-------|--------| 4 weeks | 8 | 9 | 2 | | 11 | 1 | 3 | ----------|--------|-------|-------|-------|--------|-------|--------| 2 months | 10 | 11 | 2 | | 12½ | 1 | 3½ | ----------|--------|-------|-------|-------|--------|-------|--------| 3 months | 12 | 15 | 2 | ½ | 15 | 1 | 4½ | ----------|--------|-------|-------|-------|--------|-------|--------| 4 months | 13 | 18 | 2½ | 1 | 13½ | 1½ | 5½ | ----------|--------|-------|-------|-------|--------|-------|--------| 5 months | 14 | 21 | 2½ | 1½ | 13½ | 1½ | 6 | ----------|--------|-------|-------|-------|--------|-------|--------| 6 months | 15 | 23 | 2½ | 1½ | 10½ | 1½ | 7 | | | | | | | | | ----------|--------|-------|-------|-------|--------|-------|--------| 7 months | 16 | 25 | 2 | 1½ | 8½ | 1½ | 7 | | | | | | | | | ----------|--------|-------|-------|-------|--------|-------|--------| 8 months | 17 | 27 | 1½ | 2 | 8 | 1½ | 7¼ | | | | | | | | | ----------|--------|-------|-------|-------|--------|-------|--------| 9 months | 18 | 29 | 1 | 2 | 8 | 2 | 7¾ | | | | | | | | | ----------|--------|-------|-------|-------|--------|-------|--------| 10 months | 19 | 30 | ¾ | 2 | 8 | 2 | 8 | | | | | | | | | ----------|--------|-------|-------|-------|--------|-------|--------| 11 months | 20 | 31 | ½ | 2 | 8 | 2 | 9 | | | | | | | | | ----------|--------|-------|-------|-------|--------|-------|--------| 12 months | 21 | 32 | | | 7 | 2 | 9 | | | | | | | | | | | | | | | | | ----------|--------|-------|-------|-------|--------|-------|--------| 18 months | 24 | 36 | | | | | 12 | | | | | | | | | ----------+--------+-------+-------+-------+--------+-------+--------+ ==========+=========+==========+=========+==========+======== Age | Number | Interval | | Soups | Total | of | Between | Fruit | and | Daily |Feedings | Feedings | Juices | Broths |Calories ----------|---------|----------|---------|----------|-------- | | | | | | in 24 | Hours | | | | Hours | | | | ----------|---------|----------|---------|----------|-------- 1 week | 8 | 3 | | | 112 ----------|---------|----------|---------|----------|-------- 2 weeks | 7 | 3 | | | 184 ----------|---------|----------|---------|----------|-------- 3 weeks | 7 | 3 | | | 267 ----------|---------|----------|---------|----------|-------- 4 weeks | 7 | 3 | | | 309 ----------|---------|----------|---------|----------|-------- 2 months | 7 | 3 | | | 351 ----------|---------|----------|---------|----------|-------- 3 months | 7 | 3 | | | 447 ----------|---------|----------|---------|----------|-------- 4 months | 6 | 3 | | | 553 ----------|---------|----------|---------|----------|-------- 5 months | 6 | 3½ | | | 628 ----------|---------|----------|---------|----------|-------- 6 months | 5 | 4 | one | one | 680 | | |teaspoon |tablespoon| ----------|---------|----------|---------|----------|-------- 7 months | 5 | 4 | two | ¼ | 732 | | |teaspoons| cup | ----------|---------|----------|---------|----------|-------- 8 months | 5 | 4 |one-half | ¼ | 767 | | | orange | cup | ----------|---------|----------|---------|----------|-------- 9 months | 5 | 4 | one | ½ | 854 | | | orange | cup | ----------|---------|----------|---------|----------|-------- 10 months | 5 | 4½ | one | ¾ | 875 | | | orange | cup | ----------|---------|----------|---------|----------|-------- 11 months | 5 | 5 | one | 1 | 906 | | | orange | cup | ----------|---------|----------|---------|----------|-------- 12 months | 5 | 5 | one | 1 cup | | | | orange | arrowroot| 950 | | | | cracker | ----------|---------|----------|---------|----------|-------- 18 months | 3 | 6 | toast, gravies, baked | | | potato and apple, etc. ----------+---------+----------+---------+----------+-------- Note 1 ounce of whole milk equals 21 calories 1 level tablespoon of cane sugar equals 60 calories 1 level tablespoon of milk sugar equals 45 calories 1 level tablespoon of flour equals 25 calories The juice of 1 average orange equals 75 calories 1 cup of average bouillon equals about 100 calories (This table is calculated on the basis of about 45 calories for eachpound of baby weight) TOP-MILK FORMULA Top milk is the upper layer of milk which has been removed afterstanding a certain number of hours in a milk bottle or any other tallvessel with straight sides. It contains most of the cream and varyingamounts of milk. It may be removed by a small cream dipper which holdsone ounce, or it may be taken off with a siphon, but it should neverbe poured off. To obtain seven per cent top milk which is the one mostordinarily used in the preparation of top milk formulas, we take offvarying amounts--according to the quality of the milk--which DoctorHolt describes as follows: From a rather poor milk, by removing the upper eleven ounces from a quart, or about one-third the bottle. From a good average milk, by removing the upper sixteen ounces, or one-half the bottle. From a rich Jersey milk, by removing the upper twenty-two ounces, or about two-thirds the bottle. Cream is often spoken of as if it were the fat in milk. It is reallythe part of the milk which contains most of the fat and is obtained byskimming, after the milk has stood usually for twenty-four hours; thisis known as "gravity cream. " It is also obtained by an apparatuscalled a separator; this is known as "centrifugal cream, " most of thecream now sold in cities being of this kind. The richness of any creamis indicated by the amount of fat it contains. The usual gravity cream sold has from sixteen to twenty per cent fat. The cream removed from the upper part (one-fifth) of a bottle of milkhas about sixteen per cent fat. The usual centrifugal cream haseighteen to twenty per cent fat. The heavy centrifugal cream hasthirty-five to forty per cent fat. The digestibility of cream depends much upon circumstances. Manyserious disturbances of digestion are caused by cream. It is convenient in calculation to make up twenty ounces of food at atime. The first step is to obtain the seven per cent milk, then totake the number of ounces that are called for in the formula desired. One should not make the mistake of taking from the top of the bottleonly the number of ounces needed in the formula, as this may be quitea different per cent of cream and give quite a different result. There will be required in addition, one ounce of milk sugar and oneounce of lime water in each twenty ounces. The rest of the food willbe made up of boiled water. These formulas written out would be as follows: FORMULA FROM SEVEN PER CENT MILK I II III IV V VI VII VIII IX Oz. Oz. Oz. Oz. Oz. Oz. Oz. Oz. Oz. 7 per cent milk 2 3 4 5 6 7 8 9 10 Milk sugar 1 1 1 1 1 ¾ ¾ ¾ ¾ Lime water 1 1 1 1 1 1 1 1 1 Boiled water 17 16 15 14 13 12 11 10 9 --- --- --- --- --- --- --- --- --- 20 20 20 20 20 20 20 20 20 The approximate composition of these formulas expressed in percentagesare as follows: Formula Fat Sugar Proteins I 0. 70 5. 00 0. 35 II 1. 00 6. 00 0. 50 III 1. 40 6. 00 0. 70 IV 1. 75 6. 00 0. 87 V 2. 00 6. 00 1. 00 VI 2. 40 6. 00 1. 20 VII 2. 80 6. 00 1. 40 VIII 3. 10 6. 00 1. 55 IX 3. 50 6. 00 1. 75 It is necessary to make the food weak at first because the infant's stomach is intended to digest breast milk, not cow's milk; but if we begin with a very weak cow's milk the stomach can be gradually trained to digest it. If we began with a strong milk the digestion might be seriously upset. Usually we begin with number one on the second day; number two on thefourth day; number three at seven to ten days; but after that make theincrease more slowly. A large infant with a strong digestion will beara rather rapid increase and may be able to take number five by thetime it is three or four weeks old. A child with a feeble digestionmust go much slower and may not reach number five before it is threeor four months old. It is important with all children that the increase in the food be made very gradually. It may be best with many infants to increase the milk by only half an ounce in twenty ounces of food, instead of one ounce at a time, as indicated in the tables. Thus, from three ounces the increase would be to three and one-half ounces; from four ounces to four and one-half ounces, etc. At least two or three days should be allowed between each increase in the strength of the food. PEPTONIZED MILK Another modification which at times may be ordered by your physicianis peptonized milk. Since it is infrequent for the proteins of milk tobe the cause of indigestion, peptonized milk has only a limited use, chiefly in cases of acute illness. The milk is peptonized in thefollowing manner: Place the peptonizing powder (it is procurable in tubes or tabletsfrom the drug store) in a small amount of milk, and after being welldissolved, put into the bottle or pitcher with the plain or modifiedmilk, after which the whole is shaken up together. The bottle is thenput into a large pitcher containing water heated to about 110° F. Oras warm as would bear the hand comfortably, and left for ten or twentyminutes (if the milk is to be partially peptonized). To completelypeptonize the milk, two hours are required. Either of these formulasis only used on the advice of a physician. BUTTERMILK In many cases of chronic intestinal indigestion, buttermilk is used inplace of the milk. It is prepared as follows: After the cream has beentaken from the milk and it has been allowed to come to a boil, it iscooled to just blood heat. A buttermilk tablet, having first beendissolved in a teaspoonful of sterile water, is now stirred into thequart of warmed, skimmed milk and allowed to stand at room temperaturefor twenty-four hours at which time it should look like a smoothcustard. With a sterile whip this is now beaten and is ready for thesugar and the boiled water which is added according to the writtenprescription from the doctor. CONDENSED MILK Under no circumstances should condensed milk be used as the sole foodof the baby for more than one month. Children often gain upon it, butas a rule they have little resistance, and they are very prone todevelop rickets and oftentimes scurvy; and, as noted elsewhere, orangejuice should always be administered at least once during thetwenty-four hours as long as condensed milk is used. Of all the brands of condensed milk, those only should be selectedwhich contain little or no cane sugar. Perhaps the "Peerless Brand" ofevaporated milk is the most reliable and in the preparation of foodfrom this evaporated milk the same amount of sugar, etc. , should beadded as we do in the preparation of "whole milk" or "top milk. " We do not in any way advise the use of condensed milk. Fresh milkshould always be used where it is obtainable, but in traveling itsometimes has to be used. Holt says, "It should be diluted twelvetimes for an infant under one month and six to ten times for those whoare older. " Malted milk is a preparation suitable in some cases where fresh cow'smilk is not obtainable. Even better than condensed milk, this foodwill be found serviceable in traveling, or in instances where onlyvery bad cow's milk is within reach. SPECIAL FOODS Most patent foods are made up of starches and various kinds of sugars, and some of them have dried milk or dried egg albumin added. Manyflours under fanciful names are sold on the market today. Forinstance, one flour with a very fanciful name is simply the oldfashioned "flour ball" that our great, great grandmothers made; and, by the way, perhaps there is no flour for which we are more gratefulin the preparation of infant food than the flour ball which isprepared as follows: A pound of flour is tied tightly in a cheeseclothand is put into a kettle of boiling water which continues to boil forfive or six hours, at the end of which time the cheesecloth isremoved and the hard ball, possibly the size of an orange, is placedon a pie pan and allowed slowly to dry out in a low temperatured oven. At the end of two or three hours, the ball, having sufficiently dried, has formed itself into a thick outer peel which is removed, while theheart which is very hard and thoroughly dry, is now grated on a cleangrater, and this flour has perhaps helped more specialists to servemore sick babies than any other form of starch known. It is used justas any other flour is used--wet up into a paste, made into a gruel, which is boiled for twenty minutes before it is added to the milk. Whey is sometimes used in the preparation of sick babies' food and isprepared as follows: To a pint of fresh lukewarm cow's milk are added two teaspoons of essence of pepsin, liquid rennet or a junket tablet. It is stirred for a moment, then allowed to stand until firmly coagulated, which is then broken up and the whey strained off through a muslin. The heavy proteins remain in the curd, and the protein that goesthrough with the whey is chiefly the lactalbumin. CHAPTER XIX THE FEEDING PROBLEM A friend of ours who presides over a court of domestic relations in alarge city, recently told us that he believed much trouble was causedin families--many divorces, occasioned, and many desertionsprovoked--because improperly fed babies were cross and irritable andso completely occupied the time of the mother, who, herself, knewnothing about mothercraft or the art of infant feeding. Consequently, the home was neglected and unhappy, quarreling abounded and failure, utter failure, resulted. The children were constantly cross, and somuch of the mother's time was consumed in caring for these irritable, half-fed babies, that the home was disheveled, the meals never ready, the husband's home-coming was a dreaded occurrence, and he, endeavoring to seek rest and relaxation, usually sought for it in thepoolroom or the saloon, with the usual climax which never fails tobring the time-honored results of debauch--despair and desertion. In the beginning of this book we paid our respects to the present-dayeducational system which does not provide an adequate compulsorycourse in which all women could be given at least a working knowledgeof home making and the care and feeding of the babies; so thatstatement need not be repeated in this chapter. But we wish to add, inpassing, that ignorance is the basis and the foundation of moreunhappy homes, broken promises, panicky divorces, and shattered hopes, as well as of more deaths during the first year of infancy, than anyother cause. And in speaking of its relationship to babycraft, webelieve that ignorance concerning normal stools, how many times a daythe bowels should move; how much a baby's stomach holds; how often heshould be fed, etc. --I say it is ignorance of these essential detailsthat lies at the bottom of many problems which come up during thefirst year, particularly the "feeding problem. " INFANT WELFARE In the city of Chicago at the time of this writing, the Infant WelfareAssociation maintains over twenty separate stations where meetings areheld for mothers, where lectures are delivered on the care and feedingof babies. Babies are brought to these stations week in and week out;they are weighed and measured and, if bottle-fed, nurses are sent tothe homes to teach the mother how properly to modify the milk inaccordance with the physician's orders. The health authorities of ourcity also maintain several such stations where mothers and babies mayhave this efficient help. A corps of nurses are employed to carry outthe instructions and to follow up the mothers and the babies in theirhomes, and thus the death rate has been greatly reduced, not only inour city but in all such cities where baby stations have beeninstituted. In a certain ward in Philadelphia the death rate wasreduced forty-four per cent in one year after the baby stations wereestablished. CHOOSING A FORMULA There are three classes of infants who require weak-milk mixtures tobegin with: namely, the baby who has been previously nursed and whosemother's milk has utterly failed; the baby just weaned; and the infantwhose power to digest is low. If these children were six months old, and the formula best suited to them is unknown, we must begin with aformula suited to a two- or three-month-old child and quickly work upto the six-month formula, which may often be accomplished within twoor three days. THE BOTTLE-FED BABY When a baby is getting on well with his food, he should show thefollowing characteristics: He should have a good appetite; should haveno vomiting or gas; he should cry but little; and he should sleepquietly and restfully. His bowels should move once or twice intwenty-four hours. His stool should be a pasty homogeneous mass. Heshould possess a clear skin and good color. He should show some gaineach week--from four to eight ounces--and he should also show mentaldevelopment. As long as a baby appears happy and gains from four to eight ounces aweek and seems comfortable and well satisfied, the feeding mixtureshould not be changed or increased. MAKE CHANGES GRADUALLY In our experience with the artificial feeding of infants, we have cometo look upon the practice of gradually changing the food formula asthe most important element in successful baby feeding. We recall one mother in the suburbs who came to us with her baby whohad been feeding on a certain proprietary food. She declared that it"just couldn't take cow's milk. " She admitted "it was not doing well, "and so she would like to have help. The baby was old enough, had itbeen normal, to have been taking whole milk for some time. We recallour having the mother prepare the proprietary food just as she hadbeen used to preparing it, and each day we had her throw away one-halfounce and put in one-half ounce of whole milk, this mixture she fedthe baby for two days. The next time, we had her take out one ounce of the mixture and put inone ounce of whole milk, which we fed the baby for three successivedays; and then one and one-half ounces were substituted which was fedto the baby for four days; and thus we carefully, slowly, andgradually withdrew the proprietary food and substituted fresh, certified cow's milk. It took us a month to complete the change, butwe are glad to add that it was done without in the least disturbingthe child. Now, had the change been made abruptly--in a day or two, or threedays--the baby would probably have been completely upset, while boththe mother and the doctor would have been greatly discouraged. Manymothers and even some physicians have jumped from one baby food toanother baby food; they have tried this and they have tried that, until the poor child, having been the victim of a number of suchdietetic experiments, finally succumbed. We cannot urge too strongly the fact that, as a rule, whenever achange is made from one food to another, it should be done gradually, unless it be the change of a single element such as that of a veryhigh per cent of cream found in top milk mixtures, when it seems to bea troublesome element in the milk. No bad effects will follow thequick change to skimmed milk with added sugar, starches, etc; but inchanging from a proprietary food to a milk mixture, the change shouldalways be made gradually, the quantity of the new food being increasedgradually. Milk should be increased by quarter (1/4) ounce additions, and it should not be increased more than one ounce in one week; whilethe mixture should not be increased as long as the baby is gainingsatisfactorily. A wise mother and an experienced physician can usuallysee at a glance when a child is doing well--by the color andconsistency of the stools, the child's appetite, his sleep, and hisgeneral disposition. COMMON MISTAKES IN FORMULAS First and foremost, we believe a great mistake is often made in usingtoo heavy cream mixtures; babies as a rule do not stand the use of toohigh a percentage of cream. Formulas that call for whole milk shouldcontain four per cent fat or cream; and while babies often gainrapidly on the higher percentage of cream found in a rich Jersey milk, nevertheless, sooner or later serious disturbances of digestionusually occur. Herd milk is, therefore, better for the babies becausein the "whole milk" of the herd of Holsteins we have only about fourper cent fat. Another common mistake is too heavy feeding at the time of an attackof indigestion; even the usual feeding may be too heavy during thistime of indisposition. It is not at all uncommon for us to dilutebaby's food to one-third its strength at the time of an acute illness. Still another trouble maker is dirt--dirt on the dish-towel, dirt onthe nipple, dirt in the milk, dirt on the mother's hands. Dirt is anever present evil and an endless trouble maker, as evidenced by stooldisturbances, indigestion, fretful days, and sleepless nights. A dirtyrefrigerator is another factor which has been responsible for muchillness and distress. Indigestion is often brought on because a nurse, caretaker, orpossibly the mother, not wishing to go down to the refrigerator in themiddle of the night, brings up the food early in the evening andallows it to become warm--to remain in a thermos bottle--and we aresure that had they been able to see the enormous multiplication ofgerms because of this warm temperature, they would never have givenoccasion for such an increase in bacteria just to save themselves atrifle of inconvenience. Still another common mistake is to use one formula too long; a feedingmixture which was good for four or possibly six weeks, must be changedas the child grows older and his requirements become greater. Let theweight, stools, general disposition and sleep of the child be yourguides, and with these in mind errors in feeding can be quicklydetected and minor mistakes speedily rectified. SYMPTOMS OF DISSATISFACTION Some of the pointed questions which are put to a young mother whobrings her child into the office of the baby specialist, are thefollowing: Does the baby seem satisfied after his feeding? Does he suck his fist? How much does he gain each week in weight? Does he sleep well? Does the baby vomit? What do his bowel movements look like? Will you please send a stool to the office? With the intelligent answers to these questions--after knowing thebirth weight and the age of the child and its general nervousdisposition--the physician can formulate some conclusion as to thebabe's general condition and can usually find a feeding formula thatwill make him grow. Vomiting, restlessness, sleeplessness and the condition of thebowels, are the telltales which indicate whether or not the food isbeing assimilated; and the stools may vary all the way from hardbullet-like lumps to a green diarrhea. Babies do not thrive well in large institutions where the food is sooften made up in a wholesale manner, for the simple reason that thefood elements are not suited to the need of each individual baby. Someinfants are unable to digest raw milk, and for them sterilized orboiled milk should be tried; others require a fat-free mixture such asskimmed milk, while still others may need buttermilk for a short time. Babies require individual care, particularly in their food, and thegood or bad results are plainly shown in the stools, weight, sleep, etc. FLATULENCE Flatulence is an excessive formation of gas in the stomach and bowelsleading to distension of the abdomen and the belching of gas, andoften the bringing up of a sour, pungent, watery fluid. Flatulence is seen in infants suffering from intestinal indigestionand the food is nearly always at fault. This condition is the resultof the faulty digestion of the sugar and starches--particularly thestarch--which should be immediately reduced. In such conditions theaddition of a slight amount of some alkaline (such as soda, magnesiaor lime water) to the food often produces good results. Great patiencemust be exercised with a child that suffers from flatulence, forimmediate improvement can hardly be expected; time is required for therestoration of good digestion. VOMITING Vomiting is perhaps more often the result of over feeding or toofrequent feeding than anything else. A healthy, breast-fed baby maynow and then regurgitate a bit, but it simply spills over because itis too full. We do not refer to this as vomiting, we refer to thebelching up or vomiting of very sour or acrid milk which leaves a sourodor on the clothing. This can all usually be rectified by lengtheningthe intervals from two to three hours and preventing bolting of foodby getting a nipple whose hole is not so large. Too much cream in thefood will also sometimes cause vomiting. Too frequent feeding at night is another cause of vomiting. When thestomach is full, the failure to lay the baby down quietly, as is sooften seen in those homes where bouncing and jolting are practiced, may also result in vomiting. Vomiting may be the first sign of many acute illnesses such as scarletfever, measles, pneumonia, whooping cough, etc. The treatment for acute vomiting is simple. All foods should bewithheld--nothing but plain, sweetened water should be administered, while it is often advisable to give a dose of castor oil. A physicianshould be called at once if the vomiting continues, and not until thevomiting has entirely ceased for a number of hours and water is easilyretained, should food be given, and even then it should be begun onvery weak mixtures. OVER-FEEDING The size of the child's stomach should be the guide to the quantity offood given, and attention is called to the table given in a previouschapter. All food taken in excess of his needs lies in his stomach andintestines only to ferment and cause wind and colic. The symptoms ofover-feeding are restlessness, sleeplessness, stationary weight (orloss in weight), and oftentimes these very symptoms are interpreted bythe mother as sufficient evidence that the baby needs more food; andso the reader can see the terrible havoc which is soon wrought wheresuch ignorance reigns. WEIGHT The weighing time should immediately follow a bowel movement and justbefore a feeding time; then, and only then, we have the real weight ofbaby, as a retained bowel movement may often add from four to fiveounces to the child's weight. There should be a careful record of eachweighing, for there may develop a great difference if differentmembers of the family endeavor to keep the weight in their minds. Thenormal baby should gain four to eight ounces a week up to six months, and from then on the weekly gain is from two to four ounces; in otherwords, by six months the baby should double his birth weight and atthe end of a year his weight should be three times the birth weight. Astationary or diminishing weight demands careful attention; a gooddoctor should be called at once. Likewise, a very rapid increase inweight is not to be desired, as we do not want a fat baby, but we dodesire a well-proportioned and alert baby, and, as someone has said, it is better to have little or no gain during the excessive heat thanto upset the digestion by over-feeding, designed to keep the babygaining. In weighing, usually the outside garments are removed, leaving on ashirt, band, diaper, and stockings with the necessary pins; the littlefellow thus protected is placed into the weighing basket and at eachsuccessive weighing, these same clothes or others just like them arealways included in the weight, and it should be so reported to thephysician. THE STOOLS In the chapter "Baby's Early Care, " the first stools were described indetail, and there we learned that the dark, tarry, meconium stools arequickly changed within a week to the normal canary-yellow stool, having the odor of sour milk. The bottle-fed babies' stools differ somewhat in appearance; they arethicker and a lighter color, but should always be homogeneous if thefood is well digested. They do not have nearly the number of bowelmovements each day that the breast-fed baby does. If a bottle-fedbaby's bowels move once a day and he seems perfectly well otherwise, we are satisfied. And curds (white lumps), or mucus (sedimentary, slimy phlegm), indicate that the food is not well digested. BOTTLE FEEDING AND CONSTIPATION A bottle baby may be constipated because the proteins are too high, the fat too high, the food of an insufficient quantity or quality, orthe milk have been boiled, while weak babies really may lack themuscular power to produce a bowel movement. With the help of yourphysician endeavor to arrive at the cause of the constipation, and, if the baby is two or three months old, from one to two teaspoons ofunsweetened prune juice may be administered. Milk of magnesia may beadded to the food (leaving out the lime water), or a glutensuppository may be used. The change from milk sugar to malt sugar has helped many infants;while the giving of orange juice (after six months) is very beneficialin many cases. A small amount of sweet oil may be injected into therectum which will lubricate the hard lumps and thus favor comfortableevacuation. The periodicity of the bowel movement (at definite timeseach day) is a matter of great importance. Immediately after a meal, if the child is old enough, he should be placed on the toilet chair. Abit of cotton, well anointed with vaseline and inserted into therectum just before meals, will often aid in producing a bowel movementshortly after the meal has been taken. Abdominal massage should be administered in all instances ofconstipation, beginning with light movements and gradually increasing, with well-oiled hands. DIARRHOEA Diarrhoea usually accompanies acute intestinal indigestion and is sooften associated with the common disorders of infancy that we referthe reader to the chapter "Common Disorders of Infancy. " Dark stoolsshould always be saved for the physician to observe, as theyfrequently contain blood. Stools full of air bubbles with pungent sourodor show fermentation; in which cases the starches should be reduced, if not entirely taken away from the food mixtures. Green stools meanputrefaction from filth-germs; a thorough cleansing of the bowelshould be immediately followed by a reduction in the strength of thefood and the boiling of the milk. REGULATION OF THE STOOLS At a certain time each day the napkin should be removed and the childshould be held out over a small jar. It is surprising to note howquickly and readily the little fellow cooperates. Diaper experiencesmay be limited to much less than a year if the mother has patienceenough and the baby has the normal intelligence to enter into thisregulation regime. We recall one caretaker who complained bitterlybecause the child under her care constantly wet his diaper; so thecaretaker was instructed to keep a daily schedule of the baby'sactions for five days; and, to her surprise, she discovered that thebaby urinated about the same time each day. A regularity was alsonoted concerning the bowel movements. The variations in the time of the urinations were only fifteen ortwenty minutes, so nearly did the kidneys act at the same time eachday. The caretaker was instructed to remove the diaper and hold thebaby out at the earliest occurrence on the daily schedule, and, to theastonishment of the entire family, no further accidents occurred, andthe child soon acquired the habit of letting them understand when hewas about to wet his diaper. Bowel movements may be regulated moreeasily than the urination. After the child is about a year old, veryfew accidents should occur. MIXED FEEDING In many instances, and particularly if the infant is under six monthsof age, and where he has had to have additional feeding from thebottle--under such circumstances the breast milk may be continued as"partial feeding, " at least until the baby has reached his ninth ortenth month, at which time it may be wholly discontinued. At each nursing time the baby empties both breasts, and the amount hedraws may readily be estimated by carefully weighing him before andafter each nursing. By referring to the directions in a previouschapter, the quantity of food needed for his size and age may bedetermined; while the deficit is made up from a bottle of milkcontaining properly modified cow's milk. If the mother's health admits, or if the breasts continue to secrete apartial meal for the babe, mixed feeding should be continued untilafter the ninth or tenth month, when it can gradually be reduced fromfour or five times each day to once or twice a day, until it isfinally omitted altogether. In the meantime, the baby is graduallygetting stronger food and at eleven or twelve months the little fellowis able to subsist and thrive upon whole milk. INFANT FEEDING PUZZLES It is very difficult to explain how some babies thrive on some certainfood while others grow thin and speedily go into a decline on the samerégime. The hereditary tendencies and predispositions undoubtedly havea great deal to do with such puzzling cases. Again, sometimes a slight variation in technic or some other triflingerror in connection with the preparation of the baby's food, may bemore or less responsible for the variation in the results obtained. Notwo mothers will prepare food exactly alike even when both arefollowing the same printed directions and these slight discrepanciesare enough to upset some delicately balanced baby. On the other hand, some babies are born with such strong digestivepowers and such a powerful constitution that they are easily able tosurvive almost any and all blunders as regards artificial feeding, while at the same time they also manifest the ability to surmount ascore of other obstacles which the combined ignorance and carelessnessof their parents or caretakers unknowingly place in the pathway ofearly life which these little folks must tread. The fact that so many babies do so well on such unscientific feedingonly serves to demonstrate the old law of "the survival of thefittest"--they are born in the world with an enormous endowment of"survival qualities"--and in many cases the little fellows thrive andgrow no matter how atrociously they are fed. There may be other factors in the explanation of why some babies do sowell on such poor care, but heredity is the chief explanation, whileadaptation is the other. If the little fellows can survive for a fewweeks or a few months, the human machine possesses marvelous powers ofadaptation, and we find here the explanation why many a neglected babypulls through. INFANT FOODS Rickets and scurvy have so often followed the prolonged use of theso-called "infant foods" which have flooded the market for the pastdecade, that intelligent physicians unanimously agree that they areinjurious and quite unfit for continued use in the feeding of infants. If they are prescribed to replace milk during an acute illness, or atother times when the fats and proteins should be withheld for a shortperiod, both the physician and the mother should be in the possessionof definite and exact knowledge as to just what they do and do notcontain. To provide such knowledge, we present the analysis (Holt) ofsome of the more commonly used infant foods. 1. _The Milk Foods. _ Nestle's Food is perhaps the most widely known. The others closely resembling it in composition are the Anglo-Swiss, the Franco-Swiss, the American-Swiss, and Gerber's Food. These foodsare essentially sweetened, condensed milk evaporated to dryness, withthe addition of some form of flour which has been dextrinized; theyall contain a large proportion of unchanged starch. 2. _The Liebig or Malted Foods. _ Mellin's Food may be taken as a typeof the class. Others which resemble it more or less closely areLiebig's, Horlick's Food, Hawley's Food, malted milk, and cereal milk. Mellin's food is composed principally (eighty per cent) of solublecarbohydrates. They are derived from malted wheat and barley flour, and are composed chiefly of a mixture of dextrins, dextrose, andmaltose. 3. _The Farinaceous Foods. _ These are Imperial Granum, Ridge's Food, Hubbell's Prepared Wheat, and Robinson's Patent Barley. The firstconsists of wheat flour previously prepared by baking, by which asmall proportion of the starch--from one to six per cent--has beenconverted into sugar. In chemical composition these four foods are very similar to eachother, consisting mainly of unchanged starch which forms fromseventy-five to eighty per cent of their solid constituents. 4. _Miscellaneous Foods. _ Under this head may be mentioned Carnrick'sSoluble Food and Eskay's Food. The composition of the foods mentioned is given in the accompanyingtable. COMPOSITION OF INFANT FOODS Malted Nestle's Mellin's Eskay's Milk Ingredients Food Food Food (Horlick's) Per cent Per cent Per cent Per cent Fat 5. 50 0. 24 1. 16 8. 78 Proteins 14. 34 11. 50 5. 82 16. 35 Cane Sugar 25. 00 ... ... ... Dextrose ... ... } 53. 46[1] ... Lactose (milk sugar) 6. 57 ... } } 49. 15[2] Maltose } 27. 36 60. 80 ... } Dextrins } 19. 20 14. 35 18. 80 Carbohydrates (soluble) 58. 93 80. 00 67. 81 67. 95 Starch 15. 39 ... 21. 21 ... Inorganic Salts 2. 03 3. 59 1. 30 3. 86 Water 3. 81 4. 73 2. 70 3. 06 Ridge's Imperial Carnrick's Ingredients Food Granum Food Per cent Per cent Per cent Fat 1. 11 1. 04 7. 45 Proteins 11. 81 14. 00 10. 25 Cane Sugar ... ... ... Dextrose 0. 52 0. 42 ... Lactose (milk sugar) ... ... Maltose ... ... Dextrins 1. 28 1. 38 ... Carbohydrates (soluble) 1. 80 1. 80 27. 08 Starch 76. 21 73. 54 37. 37 Inorganic Salts 0. 49 0. 39 4. 42 Water 8. 58 9. 23 3. 42 [1] Chiefly Lactose. [2] Largely Maltose. CHAPTER XX BABY'S BATH AND TOILET From earliest girlhood, women have loved their dolls, and one of thegreatest joys connected with the adored experience was themake-believe bath and the dressing of the make-believe baby; so now, when we are the happy possessors of real live dolls, we should goabout the task with the same lightheartedness of a score of years agowhen we hugged, kissed, bathed, and dressed our dolls. There is onebig advantage now, the doll won't break; but, we sigh as we stop tothink, we can't stick pins into it as we all did into the sawdustbodies of our dolls those years and years ago. THE FIRST WEEK In the chapter on "Baby's Early Care, " this subject was fullydiscussed and we only wish to repeat, in passing, that before baby'sbath or toilet is undertaken the hands of the mother, nurse, orcaretaker must be scrupulously clean. And while the first day's bathusually consists of sweet oil, albolene, or benzoated lard, if the newbaby happens to come during the very warm days of July or August andthe oil seems to irritate the soft downy skin, as it often does duringthose hot days, a simple sponge bath may be substituted. The corddressing remains as the doctor left it, and if there be anyinterference, let it be subject to his orders. The cord usually drops off, and the abdomen is entirely healed by theseventh to the tenth day, after which time baby is daily sponged foranother week. And now we will describe in detail the simplest, easiestmanner of administering an oil bath or a sponge bath. GIVING THE BATH A large pillow or a folded soft comfort is placed on a table in a warmroom--temperature not below 75 F. On baby's tray near by, and withinreaching distance, are the boracic acid solution in a small cup, amedicine dropper, the warm saucer of oil, the toothpick applicators(made by twisting cotton about one end, making sure the sharp end ofthe pick is well protected), a glass jar of small cotton balls madefrom sterile absorbent cotton, the castile soap, talcum powder, needleand thread. A vessel of warm water, several old, soft, warmed towelsand the clean garments required, complete the layout. Into the warm, soft blanket on the pillow or comfort we place thepartially undressed baby, for the binder, diaper, and socks are notremoved until the head-and-face toilet is completed. The top of the head, behind the ears, the folds of the neck, and thearmpits are now gently but thoroughly rubbed with oil, which is thenall rubbed off with a soft linen towel. The eyes next receive two orthree drops of the boracic acid solution, put in by the aid of themedicine dropper, while, with a separate piece of cotton, the surplussolution is wiped off each eye, rubbing from the nose outward. Then with the applicator made by wrapping cotton about the end of atoothpick, oil is put into each nostril, all the time exercising theutmost care not to harm the tender mucous membrane. The ears are alsocarefully cleansed with a squeezed-out dip of boracic acid on theapplicator. Unless there is an inflammation present in the mouth, and thephysician in attendance has ordered mouth swabbing, do not touch it;for much harm is done the mucous membrane of the baby's mouth by theforceful manner in which much of the swabbing is done. The face andhead are then washed with warm water; very little soap is needed and, when used, must be most thoroughly rinsed off. THE SECOND WEEK And now during the second week, we proceed to sponge the baby's body;the hands are washed with soap and rinsed, and, only those who haveperformed this feat know just how tightly they hold shut their littlefists. These hands must be relaxed, and all the lint, dirt, andperspiration be thoroughly washed away. The arms, shoulders, chest, and back are then sponged. All the time the nurse or caretaker isstanding while carrying out this most pleasant task. At any time shemay quickly cover the babe and stop for this or that with noinconvenience to herself or the child. After the thorough drying of baby's upper body, a bit of talcum is putunder the arms, in the folds of neck, etc. , and the shirt is slippedon. Next the band, diaper, and stockings are removed and after firstoiling the groin and the folds of the thighs and the buttocks, thesame sponging, drying, and powdering is done here as on the upperbody. The band is now applied, and _sewed on_. The diaper, stockings, booties, and--if a winter baby--the skirt and outing flannel gown (forbabies should wear only night dresses for the first two or threeweeks) are now slipped over the feet and drawn upward, and baby isready for nursing or for his nap. TEMPERATURE OF BATHS First few weeks, 100 F. ; early infancy, 98 F. ; after six months, 97F. , cooling down to 90 F. A wooden bath thermometer may be purchased for twenty-five cents andit should be in every home where babies are bathed. In the absence ofa thermometer do not depend upon the hand to determine temperature. Thrust the bared elbow into the water and if it is justcomfortable--neither hot or cool--it is probably about the correcttemperature for baby. Do not shock the baby by dashes of cold water, for, while it may amuse an onlooker, it unnecessarily frightens yourchild, and, subconsciously, he learns to dread his bath. THE BATHING PLACE If the bathroom is warm--temperature 75 F. --that is the most logicalplace for the bath, provided baby has his own tub. Place a couple ofstrong slats several inches wide across the big tub, six inches apart, and on this place the baby's tub. Of course, care must be exercisedto prevent slipping by means of properly fitted cleats on the undersurface of the slats. The mother should always stand to bathe her babyand the small tub should be placed at such a height that she neitherhas to stoop nor bend. Thus the bathing of the baby becomes a pleasureinstead of a "job" or an "irksome task. " If the bathroom is not warm then the kitchen table or a small tablepulled up near the stove is a place par excellence for the dip. Many boils seen on young baby's tender skin have been traced to thecareless use of the family tub to bathe the baby in. Not until thechild is two or three years of age, when his skin has become moretoughened, should he be allowed to use the family tub. FREQUENCY OF BATHS To begin with, we never bathe either a baby or an adult immediatelyafter a full meal. From one hour to one and one half hours shouldintervene. The frequency of baths depends somewhat upon the season of the year, the vitality of the child, and the warmth of the home. We have seen many infants who were bathed too often. The vitalityexpended upon the necessary reaction following a tub bath was too muchfor the little fellow; the daily bath was stopped and a semi-weeklybath substituted, much to the gain of the child. Of course in thisinstance the hands, face, and buttocks received a daily sponging. The oil bath may be administered daily. In robust children the tubbath may be a daily affair; while in pale, anemic little folks, thetub bath is perhaps better given twice a week. In hot summer days asponge bath may be given many times a day. BEST HOUR FOR BATHING Again this depends upon several factors; the warmth of the house orapartment, the vitality of the child, and the kind of bath to beadministered. An oil bath may be given any time--often it may be administeredentirely under the bed clothes, only care must be taken to keep oilfrom the blankets. Many of our mothers prefer to give the tub bath at five o'clock in theafternoon, when the house is thoroughly warm, and the child is therebyprepared for the long night's sleep. Before dressing in the morning anoil bath or rub may be given in such cases. If the forenoon is selected as the time for bathing the child, then anhour just before the mid forenoon meal is the best. In either event, be regular about it--do it at the same time every day. Let thecaretaker attend to her many duties, and, as far as possible, mothers, bathe your baby yourself. The folds of the skin, the creases in theneck, the clenched fists, must all receive particular care, and no onein all the world will ever care as you--the mother--cares. SOAP AND WATER Select a soap free from irritants and excess of alkalis. There are fewkinds that equal the old-fashioned, white castile soap ourgrandmothers used. Very hard water which makes the skin rough and sore may be improved byboiling, but if possible substitute rain water for it. A flannel bagtied over the faucet and changed each day will help to clarify muddywater, provided the stream flows gently through it. ROUTINE OF THE TUB BATH Just as we directed the nurse or caretaker to stand while the oil rubor sponge bath was given, so we admonish the mother to stand while thetub bath is given. First, get everything in readiness for the bath asdirected for the oil bath, and then the baby's tub setting on thesecurely cleated slats placed across the top of the family tub may befilled with water by means of a hose attached to the faucet. Thetemperature should be 100 F. When baby is dipped in to be rinsed. The head and face toilet are identical with that described before, andwith the baby undressed and wrapped in a warm towel placed insidethe warm blanket on the pillow or comfort as before mentioned, weproceed with a good lather of castile soap and water to lather thebaby's body all over--under the arms, the neck, chest, groins, thighs, buttocks, legs, feet, and between the toes, while the genitals alsoreceive their share of attention. The foreskin of the boy baby isgently pushed back and cleansed thoroughly; while the vulva of thelittle girl baby, having first been swabbed with boracic acid, is nowgently lathered and cleansed. Now grasp the ankles and legs with theright hand and support the upper back and neck and shoulders with theleft and gently lower the baby into the water in a semi-recliningposition (See Fig. 13). The water should cover the shoulders. Keep agood firm supporting left hand under the head, neck, and shoulders, and with the right, rinse all soap from the body. [Illustration: Fig. 13. Supporting the Baby for the Bath] After this is thoroughly done, lift the baby out onto a fresh warmtowel inside the warm blanket on the pillow, and remain standing, while you gently pat (never rub) the baby dry. All the little folds, creases, and places between fingers and toes, are carefully patted_dry_, and where any two skin surfaces rub together put on a bit oftalcum. The dressing takes place in the manner already described--first theshirt, then the band (sewed on), the diaper, stockings, skirt, andgown. Please note that the soap bath is contra-indicated (should not begiven) in case of eczema. BABY'S DAILY RUB This soap bath should be administered for cleanliness only, and shouldbe given twice a week. If a tub bath is to be given on other days, after the routine head and face toilet, the baby is simply dipped intothe water and the soft skin gently rubbed. If the sponge or tub bath is given in the afternoon just before thelong sleep at night, then the oil rub should take place before themid-forenoon meal; and likewise, if the sponge or tub bath is givenduring the mid forenoon, then the oil rub or dry hand rub is givenbefore the going-to-bed time. The rub should be a daily procedure forthe first two years. Nothing rougher than the soft palm of the handshould be rubbed on baby's soft skin. USE AND ABUSE OF TALCUM Babies have come to my clinic with _cakes_ of talcum under their arms, and particularly between their thighs and in the crease of thebuttocks. Here the well-meaning but thoughtless mother had reasoned, "a little is good; more is better" which is not always the case. Talcum is not used to replace careful drying, and it should never befound in quantities on the baby's skin any more than you would expectto find quantities of face powder caked in the creases of the neck orbehind the ears of an adult. The skin is first cleaned, then pattedentirely dry, and, as a finishing touch, a bit of talcum is put on bymeans of a puff. TONIC AND MEDICATED BATHS Tonic baths are usually given to older children when they are able toenter into the sport and frolic of a cool bath. Baths are called tonicbecause they call forth from the body a reaction--a sort ofcirculatory rebound. This rebound or reaction brings the blood to theskin, increases the circulation, and tones up the nerves. The roomshould be properly warmed and, if necessary, some form of exercise becontinued after the bath to prevent the chill that sometimes follows apoorly administered bath. In the case of the anemic child, after six months of age, the mother'shand dipped in cold water may briskly rub the chest and back until itglows or becomes red. The child should enjoy this bath. Never frightena child by throwing cold water on it or by giving it a too sudden coldplunge; great harm may be permanently done by these efforts to"toughen the baby. " The simple medicated baths may be administered according to thefollowing directions: _Salt. _ Use half a teacup of common salt or sea salt to each gallon ofwater. The salt should first be dissolved in a cup of warm water toprevent the sharp particles from pricking the skin. The doctorsometimes orders a salt bath. _Starch. _ Add a cup of ordinary, cooked laundry starch for everygallon of water in the bath. _Soda. _ A soda bath requires two tablespoons of ordinary baking sodato a gallon of water, dissolving it in a little water before adding itto the bath. _Bran. _ Make a cotton bag of cheesecloth or other thin material, sixinches square. Fill loosely with bran. Soak the bag in the bath water, squeezing it frequently until the water becomes milky. Starch, soda, and bran baths are often used in place of the ordinarysoap and water bath when the skin is inflamed, as in cases of chafingor prickly heat. FEAR OF BATHS Force and harshness are not likely to cause baby to overcome very muchof the fear of a tub bath. Patience, perseverance, and purposefuldiversion of mind will bring sure results. In the case of a very young baby, have a helper stretch a towel acrossthe filled baby tub, lay the baby in it, with its head well supported, and then gently lower the towel into the water, keeping the head out. (Most anyone would fear an all-over ducking, if he had ever beencompletely ducked into water by a careless or mischievous friend). In the case of older children, celluloid ducks, fish, or boats mayfloat about on the water, and the entire bath be forgotten by thelittle fellow's enjoyment of "his boats. " OUT OF DOOR BATHING Although a baby under two years should never be given a sea bath, a word of caution about sea bathing for young children may not be amiss. The cruelty with which well-meaning parents treat young, tender children by forcibly dragging them into the surf, a practice which may be seen at any seaside resort in the summer, can have no justification. The fright and shock that a sensitive child is thus subjected to is more than sufficient to undo any conceivable good resulting from the plunge. On the other hand, a child who is allowed to play on the warm sand and becomes accustomed to the water slowly and naturally will soon learn to take delight in the buffeting of the smaller waves, but he should not be permitted to remain more than a minute or two in the water, and should be thoroughly dried, dressed immediately, and not left to run about the beach in wet clothing. MILK CRUST Any roughness on the scalp must receive immediate attention. Thisroughness, or milk crust, is entirely avoidable; it is the result ofaccumulated oil and dirt. When it has formed a complete crust or cake, it may quickly become eczematous and require a physician's advice;however, in the beginning, at the first sight of brown patches orroughness, oil the scalp thoroughly at night with vaseline or coldcream, which should be gently rubbed off in the morning. This vaseline or cold cream should be applied repeatedly, severalnights in succession, followed by the morning's gentle rubbing anddaily washing of the head. Often the washing with water must beentirely avoided; only sweet oil or vaseline being used in those caseswhere the crusting seems to be persistent. THE EYES, EARS, AND NOSE At birth the eyes are particularly cared for. First, the mucus isgently swabbed off the closed lids from the nose side outward, andthen follows the application of one drop of twenty per cent argyrol ortwo per cent silver nitrate, either of which thoroughly disinfects theeye and prevents the growth or development of any bacteria that mayhave gotten into the child's eye during the descent of the headthrough the birth canal. The neglect of this procedure may sometimesresult in lifelong blindness. Under no circumstances should "a mere cold in the eyes" be neglected;it may result in blindness. Call your physician at once, and if he isnot at hand, wash out the eye thoroughly every hour with warmed tenper cent boracic acid solution, by means of a medicine dropper, usinga separate piece of cotton for each eye, for if the slightest bit ofdischarge be carried from one eye to the other an inflammation willquickly appear. From birth, especially during the first week, baby's eyes are verysensitive to light; hence they must be carefully protected. Babiesshould be so placed during their outings, sleep, or naps, that they donot directly gaze at either the sunlight or sky. The lining of thehood of the carriage should be green, instead of white, as much eyestrain is thus prevented. The daily care of the normal, well eye has been already described, andwhile it need not be reiterated, we may say, in passing, that if theeyelid be at all inclined to be sticky or adherent, never use force, but instead, gently swab with boracic acid. As a preventive of thiscondition, a little vaseline from the tube may be rubbed on the edgesof the lids at night. In the toilet of the ears, never attempt to introduce anything beyondthe external ear, which may be carefully cleansed with a soft cloth. It is often found necessary to apply oil to the creases behind theears before the daily bath. There should be no irritation, redness, orroughness present, all such conditions being readily prevented by theuse of oil or vaseline before the bath. With the sharp point removed, make a cotton applicator out of atoothpick, and gently (with no force, whatever) introduce vaseline oroil into the nose. This should be a part of baby's daily toilet. Anystoppage of mucus or snuffiness in the nose should be reported at onceto baby's physician. Young babies often have adenoids. CARE OF THE MOUTH Leave the well mouth alone until the teeth appear, and then keep theteeth very clean (allowing no particles of milk to accumulate at theirbases) with a soft bit of cotton and gentle rubbing. When a childattains the age of two, he should have his own toothbrush; previous tothis time all food particles should be removed from between the teethwith waxed silk floss. All decay should be promptly attended to by acompetent dentist. Thrush and ulcers are often caused, not prevented, by the frequentwiping out of baby's tender mouth. The treatment of thrush and othermouth infections will be considered in a later chapter, "The CommonDisorders of Infancy. " THE CARE OF THE GENITAL ORGANS Before the bath, the baby girl's genitals are carefully swabbedbetween all the folds with boracic acid solution. The foreskin of theboy baby should be pushed well back and washed gently with water. Ifthe foreskin of the male child be long, tight, or adherent, circumcision is advised. See our chapter, "Teaching Truth. " The genitals of both the boy and girl should be kept scrupulouslyclean every day, with as little handling as possible, and, upon theappearance of the least swelling, discharge, or even redness, thephysician's attention should be at once called to it. In a laterchapter, the subject of irregularities of sex habits will be taken up. CARE OF THE BUTTOCKS Often, because of irritating bowel movements, the buttocks becomereddened, chafed, and sometimes raw in places. Some poor little babiesare sometimes roughly rubbed--scoured on the buttocks--much like thekitchen sink, many times a day, and it is not surprising that theybecome reddened, chafed, and very much inflamed. The buttocks require a gentle swabbing and thoroughgoing "patting dry"after each soiling or wetting of the diaper, but no soap is requiredin this region but once a day, and even then it should be usedsparingly. When the buttocks are inflamed, after a good cleansing with water anda thorough drying, vaseline or zinc ointment should be applied on apiece of sterile cotton, and this application should be repeated aftereach changing of the diaper. Wet diapers should be removed at once, for the acidity of the urine causes more chafing. A dusting powdercomposed of starch two parts, and boracic acid one part, may be dustedon after a cleansing with oil. Great care should be exercised in the thorough daily rinsing of thediapers as well as in the tri-weekly boil in the laundry. White soaponly should be used in their cleansings; no washing sodas or otherpowders should be used. OTHER SPECIAL CARE Under the arms and in the creases of the neck the skin sometimesbecomes irritated because of neglect. To prevent such chafing thefollowing program should be carefully carried out: 1. Not too much soap--and no strong soap. 2. Careful rinsing of the skin area. 3. Avoid harsh rubbing, but thoroughly dry. 4. The use of talcum powder in all folds of the skin. With a fine camel's hair brush the hair should receive its brushingafter the cleansing of the scalp. Combs are for just one purpose andthat is to part the hair. The brush should be used to do all thesmoothing. While the frequent trimming of the hair has no marked effect upon itsgrowth, yet the comfort the little girls enjoy, especially during thewarm-weather months, should not be denied them. And certainly the boy should become a boy when he puts on trousers andnot be made the laughing stock of his mirthful companions just becausehis "beautiful long curls are much admired by the mother and hisaunts. " The finger nails should be trimmed round with the scissors, while allhangnails are properly cared for every day. Toe nails should be cutstraight across and the corners never rounded off. Many ingrowingnails may be thus avoided. CHAPTER XXI BABY'S CLOTHING The Eden story suggests that in the beginning of our racial experienceartificial clothing was unnecessary; but after a time, in thatselfsame garden, proper clothing became an important problem and hasremained so ever since. Everybody seems to agree, however, that baby'sclothing in particular should at least be comfortable. It may give thechild great discomfort because it may be too warm, or it may not bewarm enough, or it may be too tight, and so, in the discussion ofbaby's clothing in this chapter, we are going to keep in mind thesetwo things--comfort and heat. GENERAL SUGGESTIONS The choice of material demands some thought and attention. As a rule, baby's clothing materials should be light in weight, good moistureabsorbers, and at the same time able to retain the body heat. Mostlayettes have the common fault of being prematurely outgrown; and soit is well to allow for ample growth in making baby's first clothes. Since the principal object of clothing is to insure a uniform bodytemperature, it is important that the mother be constantly on herguard to keep the baby cool enough in the summer and warm enough inthe winter. The mothers of various races and nations have their own ideasconcerning the clothing of their babies. One mother will wrap her babyin cotton, which is held in place by means of a roller bandage, and asyou visit this home during the first week of baby's life, you will behanded a little mummy-shaped creature--straight as a little poker--allwrapped up in cotton and a roller bandage. The surprising feature isthat the baby does not seem to complain. In another district of the city we find the baby dressed in starchedclothes, ribbon sashes, bright ribbon bows on its arms and around itsneck. At first glance you wonder if the little child is not many yearsolder and is about to make a visit to a county fair, but on inquiry wefind that he has only been prepared for the event of circumcision onthe eighth day. And if you go into the forest of primeval days you will find anothermother bandaging her baby to a board, head and all, and he seems tolive and thrive in his little woven nest strapped on the back of hisIndian mother. Other babies in the warmer portions of the earth have almost less thannothing on, and are left to be swung by the breezes in little basketstied to the boughs of trees; being taken up only when it is time tofeed. BABY'S LAYETTE In preparing an outfit for the newcomer it is wise to provide for thenecessities only, because of the fact that since the baby grows veryfast the layette will soon have to be discarded; it is always possibleto get more clothing after the baby is here and started on his littlecareer. We offer the following list of essentials for the new bornbaby: Slips 8 to 10 Skirts (flannel) 3 Shirts 3 Light-weight wool wrappers 2 Abdominal bands 3 to 5 Diapers (first size) 2 doz. Diapers (third size) 2 doz. Stockings, pairs 3 Booties, pairs 3 Nightgowns 7 Handling blankets 2 Silkaline puffs 2 Baby blankets, pair 1 Hair or cotton mattress 1 Basinet 1 BANDS AND SHIRTS The binder should be made of an unhemmed strip of flannel six incheswide and twenty inches long, so that it goes around the abdomen oncewith a small overlap. This binder should be sewed on instead of beingpinned, and serves the purpose of holding the dressings of the cord inplace. It is usually worn from four to six weeks, when it is replacedby a silk and wool barrel-shaped band with shoulder straps and tabs atthe bottom, both front and back, to which may be pinned the diaper. This band is worn through the first three or four years to protect theabdomen from drafts and chilling, thus guarding against thoseintestinal disturbances which are caused by sudden weather changes. There is great danger of having the bellyband too tight, and, in theearly weeks, it is often the cause of great discomfort--ofteninterfering with the normal expansion of the stomach at meal time. No matter what the season, the new-born baby should be clothed in alight-weight silk and wool shirt, preferably the second size. Afterthe first month, if the weather is exceedingly warm, this woolen shirtmay be displaced by a thin silk or lisle shirt. In buying thesecond-size shirts always secure the stretchers at the same time, forin the laundering they soon shrink so that they are very uncomfortablefor the young babe. DIAPERS There are a number of materials on the market from which comfortablediapers may be made for the baby. The cotton stockinet (ready-madeshaped diaper) is excellent, fitting smoothly at the waist, while itis large and baggy at the seat, thus permitting not only a comfortablefeeling but the free use of the hips, without the bulkiness of theordinary diaper. The large square of cheesecloth is easily laundered, and if an insidepad is used makes a very acceptable diaper. The stork diapers are made of materials resembling turkish towelingand are used to some extent. This diaper should not be confused withthe stork rubber diaper which will be spoken of later. Birdseye cotton is popular and extensively used. It absorbs quickly, and is much lighter in weight than linen. The first- and third-sizewidths should be purchased as a part of the layette, and the number ofdiapers needed depends upon the opportunities to wash them out, fordiapers are never used but once without washing; they should always bequickly rinsed and dried in the sunshine if possible. So if there aregood laundry privileges, and daily washing is possible, the mother canget along with fewer diapers, but no less than four dozen should beprovided. The diaper pad will be found convenient and serviceable in the earlydays when the skin of the child is so very tender. This pad should bepieces of clean old linen or small pads of absorbent cotton. CHANGING THE DIAPER During the mother's waking hours, the diaper should be changed as soonas it is soiled or wet. If the child cries during the night it shouldbe changed immediately, but the mother should not feel called upon tolay awake nights merely to change the baby's napkin when it is soiled. If she places a pad underneath the baby, which will absorb the urinequickly, he often does not awaken or become chilled. The pad should besufficiently thick to ensure that the nightgown does not get wet. RUBBER DIAPERS Rubber sheeting diapers of any description should never be used. Avoidall patent diapers with a covering or an inner lining of rubber, for, like the rubber diaper, they not only irritate the child but alsoretain moisture and heat, which produce such irritation and itchingthat the subsequent "habit-scratching" often lays the foundation forfuture bad practices. It is far better for the mother to carry aboutwith her, whenever it is necessary to take the baby away from home, arubber pad which she puts on her lap underneath the little fellow, thus affording ample protection to herself without in the leastharming the baby. STOCKINGS AND BOOTIES During the winter months merino stockings are required, while duringthe summer months a thin wool or silk stocking is sufficient; on theextremely hot days thin cotton hose may be worn. During infancy, thestockings should be fastened to the diaper with safety pins, while onthe second-year child, hose supporters attached to the waist are foundvery convenient. A friend told me the other day of a mother who told her the followingstory: "Do you know, I don't have any trouble any more about my babykeeping up his socks for I have fixed it so they won't come off anymore. Every time I looked at his feet he had kicked off his socks andthey were no good to him at all, so I took little chunks of brownlaundry soap, moistened them and rubbed his legs, as well as theinside of his socks and I never, never have any more trouble with themcoming off. " It does not seem possible in this enlightened age that a mother couldbe so ignorant as to keep the socks up with brown soap, but the friendassured me it was a true story, and while it may shock some of myreaders as it did me, I must add, in passing to another subject, thatthe use of round garters on little babies and young children is justabout as shocking. During the fall, winter, and spring, booties are worn on top of thestockings. These booties should be crocheted or knitted out of theheavy Germantown yarn, and there should be enough of them so that thechild may have a clean pair on every day. SKIRTS AND PETTICOATS The flannel petticoat is made with yokes instead of bands, and duringthe fall, winter, and spring these yokes are made of flannel like theskirt and should have long sleeves of the same material. The yokesshould be made large enough so that they may be used during the entirefirst year (the plait in the front can easily be taken out when thebaby is six months old so that it may be used much longer than if theyoke is made without a plait). For the hot summer months, the yokesshould be a thin cotton material without sleeves; and, if the baby ishoused in an over-heated apartment, this fact should be borne in mindand the winter skirt should be made accordingly. We have found, however, that the baby who is amply protected and uniformly dressed, does not require the outer bundlings that the poorly dressed childrequires. Part wool and cotton materials are very comfortable in theoverheated city apartments. White skirts are not necessary for smallbabies. They only add extra weight and it is always foolish to putanything on a small baby simply for looks. NIGHTGOWNS, WRAPPERS, AND SLIPS The nightgowns should be made of soft cotton flannel or stockinet. Thelatter is really the better, and can be purchased in sizes up to twoyears; it is absorbent, easily laundered, and may be convenientlydrawn up at the bottom by means of a drawstring. At least seven nightgowns are needed. A fresh nightgown should be usedeach day and each night during the first four or five weeks of baby'slife; while as he gets older (two or three years), the night drawerswith feet in them are used to advantage. The wrappers are usually made of challis, nun's veiling, cashmere, orother light woolen materials which can be readily washed. They arevery serviceable to wear over the baby's thin slips and on cool nightsthey may be used over the nightdress. They should be simply made, containing no heavy seams, and at the neck there should be thesimplest kind of a soft band that will in no way produce friction orin any other way irritate the baby's skin. Slips are usually made of some very soft material such as nainsook, batiste, pearline, or sheer lawn cloth. Twenty-seven inches is thelength that will be found both comfortable and convenient. All laces, ruffles, and heavy bands which will scratch or irritate should beavoided as eczema is often caused by such mistakes. SLEEPING BAG The sleeping bag is of inestimable value, affording extra and securecovering for the child, and peace of mind for the mother. In the earlyweeks it should be made of light flannel, but as the child gets olderthe sleeping blanket is made according to illustration (See Fig. 5) bymerely folding a blanket in such a manner that the child cannotpossibly uncover himself. The mother can sleep undisturbed, knowingthat the baby is always safely protected by at least one warm blanketcover. COMMON FAULTS WITH MOST LAYETTES As a usual thing the first clothes are made too small. The sleeves aretoo short as well as too small around. There is nothing moreuncomfortable than a tight sleeve. Everyone of our readers knows that, and we recall one poor little fellow who kept up a fretful cry untilwe took the scissors and cut the tightly stretched sleeve up to andincluding the arm hole. He then relaxed and went to sleep. Sleevesshould be made two inches longer than they are needed at first, and itis a very simple matter to pin them up or turn them back at the wrist. They should be loose and roomy. The yokes of the dresses usually are too tight before the slips arediscarded. Heavy seams and raw seams irritate and often make uglyimpressions on the baby's skin. Usually the first layette is profusely embroidered, and, while it isbeautiful to look at, the mother feels when she sees it outgrown soquickly that a lot of vital energy was wasted on garments thatmattered so little as long as baby was comfortable. Baby is dear andsweet enough without the fuss and furbelows of such elaborategarments. Heavy materials are sometimes used where lighter ones would servebetter. ERRORS IN CLOTHING A soiled garment should never be put back on the baby. Dirt drawsflies, and flies are breeders of disease. Sour-smelling garmentsshould be changed at once. They are likely to make the baby sick andinterfere with his appetite if left on indefinitely. The care of thediaper has already been mentioned. The main symptom of too much clothing is sweating, and when the babysweats something must come off. If he has perspired so much that hisclothes are moist, the clothing should be changed and the skin welldried with talcum powder. The feet and hands should be kept warm, butthe little head should always be kept cool. When the baby is cryingand getting his daily exercise, remove some of the covering, loosenhis diaper, and let him kick and wave his arms in perfect freedom. When the baby's feet and hands are cool he is not warm enough. Cottonunderskirts cannot be used in the dead of winter on little babies. They do not hold the body heat as woolen garments do. The baby's feetshould always be warm and this is particularly necessary in poorlynourished children. The outer wrapper of woolen material should beadded to such baby's clothing. It is a safe rule to follow that ifbaby's hands are warm and he is not sweating, he is "just aboutright. " SHORT CLOTHES At the age from four to six months, baby's clothes are shortened. Thisshould not take place at the beginning of winter if it can be avoided. If the first layette has consisted of only the necessary garments, they are nearly worn out by the time the short clothes are due; ofthose that do remain, the sleeves should be lengthened, the arm holesenlarged, and all the little waists let out. Creeping garments andbibs are now added to baby's outfit, as well as leggings and othernecessities for outdoor wear. Remember that all garments must beloose--then baby is happy. About the same number of garments are found necessary for the shortclothes as were required at first; except that a large number ofcreeping rompers should be added. These creeping rompers should not bemade of dark materials that do not show the soil. We desire the dirtto be seen that we may keep the baby clean, and if the creeping romperis made of a firm, white material it may be boiled in the laundry, thus affording ample and thorough cleansing. We attributed a sick spell of one baby to the dark-blue calicocreeping romper which he wore day in and day out because it "did notshow" the soil. White ones are much to be preferred, not only forlooks but chiefly for sanitary reasons. CAPS AND WRAPS The cap should be made of a material that will protect from drafts andcold air, but not of such heavy materials as will cause too muchsweating. There are a number of outside wraps that can be purchasedready-made and which are comfortable, convenient, and warm. Theyshould be long enough not only to cover the baby's feet well, but topin up over the feet, thus giving good protection from winds anddrafts. During the summer months nainsook caps or other thin materials are tobe preferred to the heavy crocheted caps that are sometimes worn bybabies. No starch should be used in the caps or strings, and thereshould be no ruffles to scratch the delicate skin of the baby. In allthese outer garments, as well as the under garments, the irritation ofthe skin must be constantly borne in mind, as eczema is often producedin this manner. THE FIRST SHOES The first shoe that is usually worn during the creeping days is a softkid shoe without hard soles. It is important that this soft shoe beworn to protect the child's foot from chilling drafts while creepingabout. As the baby nears one year of age the hard-sole shoe is secured whichmust be wide, plenty long and comfortable in every respect, andwithout heels. Rubbers and overshoes may be worn on damp and colddays. Moccasins and slippers do not give sufficient support to theankles, so, when the baby begins to walk, the shoes should be high andof sufficient support to the tender ankles. PLAY SUITS As the baby grows up into the child, the tiny clothes are laid asideand the boy is given substantial garments that in no way remind him ofgirls' clothing. A child's feelings should be respected in thismanner, and while it often adds joy to the mother's heart to see herboy "a baby still, " remember that he is not only chagrined but isnervously upset by these "sissy clothes. " A child three or four years of age should still wear the woolen bindersupported from the shoulders, over which is the union suit, stockings, and the buttoned waist from which hang the hose supporters. The mostcomfortable and easily laundered garment we know of for the small ladis the "romper, " which should be made of washable materials that maybe readily boiled. For cool days a Buster Brown coat of the samematerial, with patent-leather belt, may be slipped on over thiswashable romper--which completes the boyish outfit. We recall the pleasant days with our own little fellow when he wasbetween the ages of two and one-half and five years. We were oftencompelled to be away from home--on the train, in the hotel--and whentraveling we used a black, smooth silk material which was made up intorompers with low neck and short sleeves. There were three suchrompers, and two Buster Brown coats with wide, black, patent-leatherbelts which completed the traveling outfit. During the warm days onthe train the coat was folded carefully and laid aside. In the earlymorning and in the cool of the evening the coat was put on, and healways looked neat and clean. At night, before undressing him, theentire front of the romper was cleansed with a soapy washcloth, rinsed, and rubbed dry with a towel, and, after carefully spreading toavoid wrinkles, it was hung over the foot of the bed. The coats weresponged or pressed once or twice a week, and this simple outfit servedits purpose so well that it was repeated three different summers. The little girl as she leaves her babyhood days should be put intogarments that do not necessitate the constant admonition, "Keep yourdress down, dear. " We like to see knickerbockers, the exact color ofthe dress, made for every outfit, in which the little girl may kick, lie down, jump, dance, climb--do anything she pleases--unmindful ofthe fact that her "dress is not down. " The same undergarments are usedfor the little girl as were mentioned for the little boy. WINTER GARMENTS Always bear in mind the over-heating of the child with heavy garmentsindoors, and the danger of skin chilling and drafts on going out toplay in this over-heated condition. Let the children dress comfortablycool in the house, and as they go out to play add rubber boots orleggings and rubbers, sweaters, caps with ear laps or the stockinetcap. Allow them the utmost freedom in clothes, and always encourageromping in the cool frosty air. CLOTHING RULES Do not overload the baby with clothing. Dress according to the temperature of the day and not the season of the year. Avoid starched garments. Avoid tight bellybands or old-fashioned pinning blankets. Change all clothes night and morning. Use woolen shirts and bands. See that hands and feet are always warm. Protect the abdomen night and day with the band. Use the sleeping bag on cold nights. Baby should sleep in loose stockings at night. Avoid chilling the child. Use hot water bags if necessary. CHAPTER XXII FRESH AIR, OUTINGS, AND SLEEP Fresh air is just as important and necessary for the baby as for theadult. Neither baby, youth, nor adult can receive the full benefit ofhis food--in fact it can not be burned up without the oxygen--withoutan abundance of fresh air. During the early weeks of life, the airbaby breathes must be warm; nevertheless, it must be warmed _fresh_air, for baby requires fresh air just as much as he needs pure food. INDOOR AIRING The delicate child often requires more fresh air than does the normalbaby. Both appetite and sleep are improved by fresh air. The digestionis better, the cheeks become pink, and all the signs of health areseen in the child who is privileged to breathe fresh air. During the early days, say after the third week, baby should be wellwrapped up with blanket and hood, tucked snugly in his basinet orcarriage, while the windows are opened wide and the little fellow ispermitted to enjoy a good airing. Even in the winter months thewindows may be raised in this way for a few minutes each day. These"airings" may be for ten minutes at first, and, as the child growsolder, they may be gradually increased to four or five hours daily. The carriage or basket should stand near the window, but not in adirect draft. OUTDOOR LIFE In summer, a baby one week old may be taken out of doors for a fewminutes each day; in the spring and fall, when baby is one month old, it may go out for an airing; while, during the winter months, theairing had better be taken indoors until he is about two months old, and even at that age he should go out only on pleasant days and shouldalways be well protected from the wind. A young baby may enjoy the fresh air in his carriage or crib on theporch, on the roof under suitable awnings, in the yard, under thetrees, and even on the fire escape. In fact, at proper age and inseason, he may spend most of his time out of doors in the fresh air, if he has proper protection from the sun, wind, and insects. BEST HOURS FOR AIRING During the balmy days of summer and early autumn, baby may spend mostof the time outdoors between seven in the morning and sunset. Duringthe cooler days of winter and the cool and windy days of spring, thebest hours for the airing are to be found between eleven in themorning and three in the afternoon. At six weeks, perhaps an hour a day in the fresh air is sufficient;while at six months, four to six hours a day are a necessity, and fromthen on--the more the better. Now we realize that the mother of the farm household does not alwayshave as much time to take the baby out for his airings as many of ourcity mothers; but we suggest to this busy mother that the baby berolled out on the porch or in the yard, within her sight and hearing, and allowed to enjoy the fresh air while the mother continues herwork. It is virtually a crime to try to keep baby in the kitchen, hour afterhour, while the busy mother is engaged at her tasks. A hammock, a cribon casters, or a carriage, is just the coziest place in the world forbaby--out on the porch. THE COUNTRY BABY The average city baby really gets more fresh air than ninety per centof the country babies. Our city apartments are usually steam heated, and our windows are open in the winter nearly as much as in thesummer. The country home is often only partially heated by two orthree stoves. The windows are closed in summer to keep out the dust, heat, and flies, in the winter to shut out the cold, and so the babywho lives in such a home has little chance to get fresh air. The city mother is constantly talked to about the benefits of freshair. The daily paper brings its health column to her, her pastor talksof it on Sunday, and--best of all--the older children come home fromschool and reiterate the doctrine of fresh air that is constantlybeing preached to them at school. Screen the windows, rural mother, and oil the roads in front of yourresidence, and then keep your windows open. Remember that baby'shealth is of more value than the meadow lot or even a fortune later onin life. Plan for a new heating plant, if necessary, so that the homecan be both warmed and ventilated during the winter. WHEN NOT TO TAKE BABY OUT If a sheltered corner of the porch is within the reach of the mother, we can hardly think of a time when the baby cannot be taken out. Itmay rain, the wind may blow, it may snow or even hail, but baby liesin his snug little bed with a hot water bottle or a warmed soapstoneat his feet. As long as the finger tips are warm, we may know he iswarm all over, and a long nap is thus enjoyed in the cool fresh air. When the sheltered corner of the porch is lacking, we wish to cautionthe mother concerning the following weather conditions: 1. When the weather is excessively hot, take him out only in the earlymorning and late in the afternoon. 2. In extremely cold, below zero, weather, let his airing be indoors. 3. Sharp and cold winds may do much mischief to baby's ears, as wellas blow much mischief-making dust into his nose and eyes. In the caseof dust or sand storms, baby remains in the house. 4. All little people enjoy the rain, and only when the raincoat, rubbers, and umbrella are missing should they be robbed of the"rainy-day fun". In the case of baby's outing on rainy days, ampleroof protection is the only factor to be considered; if it isadequate, then take him out; if it is lacking, let the airing be doneindoors. WINTER OUTINGS The very young baby is taken out for a fifteen-minute airing duringthe noon hour when he is two months old; before this time he receiveshis airing indoors. The interval is gradually lengthened until most ofthe time between eleven and three is spent out of doors. The reddenedcheeks, the increased appetite, all tell the story of the invigoratingbenefits of cool, fresh air. Most babies dislike heavy veils, and theymay be avoided by a fold of the blanket arranged as a protectionshield from the wind. The wind shield, procurable wherever baby carriages are sold, shouldbe a part of the outdoor equipment, as it greatly helps in theprotection of the baby. The wind should never blow in his face; neither should he lie, unprotected, asleep or awake to gaze up into the sunshine or thesky--or even at a white lining of the hood of his carriage. The liningshould be a shade of green, preferably dark green. And while it may benecessary during the summer to suspend a netting over the carriage toprotect from flies, mosquitoes, etc. , it should never lie on his face. OPEN WINDOWS Many of our readers recall with sadness of heart a little hunchbackchild or a life-long invalid confined to a bed or wheel chair becausesome careless but well-meaning caretaker or mother left an open windowunguarded; and--in an unlooked for moment--baby crawled too near, leaned out too far, and fell to the ground. The little fellow waspicked up crippled for life; and so while it is very essential tobaby's health to have open windows, admitting fresh air, they shouldbe amply guarded. Screens afford protection if well fastened, and intheir absence a slat three inches wide and one inch thick may besecurely fastened across the opening, thus preventing all suchtragedies with their life-long regrets. SLEEP If any of our readers have seen a new-born baby immediately after hehas been washed, dressed, and comfortably warmed, they have observedthat he usually goes to sleep at once, and that he generally sleepsfrom four to six hours. Babies, especially new-born babies, need justfour things: warmth, food, water, and sleep. And while the babies sleep they are not to be disturbed by the fondmother's caresses and cuddling--feeling of the tiny hands, smoothingout the soft cheek, or stroking his silky hair--for all such mothersare truly sowing for future trouble. Let baby absolutely alone whilesleeping, and let this rule be maintained even if some important guestmust be disappointed. If such cannot wait till baby wakens, then hemust be content with the mental picture drawn from the mother's vividdescription of baby--his first smile, his first tooth, his firstrecognition of the light, etc. The wise mother cat never disturbs hersleeping kittens. SLEEP REQUIREMENTS Sleeping, eating, and growing occupy the whole time of young babies. Until they are two months old they need from eighteen to twenty hourssleep out of each twenty-four; and not less than sixteen hours up tothe end of the first year. At six months, baby should sleep right through the night from six inthe evening until six in the morning, with a ten o'clock feed, whichshould be given quietly, in a darkened room, the babe beingimmediately returned to his bed. At two or three years of age, twelve to fourteen hours of sleep isrequired; while at four to five years, eleven to twelve hours areneeded; when they attain the age of thirteen years they should stillhave ten hours of unbroken sleep each night. As a general rule, children should sleep alone; even in the case oftwo brothers or two sisters, separate beds are far better than adouble bed for both hygienic and moral reasons. Baby should have a separate bed. The temptation to nurse him on theleast provocation, as well as the danger of overlying, are reasonsenough for such an arrangement. PUTTING BABY TO SLEEP At five-thirty in the afternoon, baby should be undressed, rubbed orbathed, made perfectly comfortable, and fed; then, my mother reader, he should be laid down in his little bed and allowed to go to sleep, without any coaxing, singing, rocking, or even holding his hand. Babies will do this very thing and continue to do it if you neverbegin to rock, jolt, bounce, or sing to them; and, mind you, if you dosing to them or rock them, or even sit near without doing anything but"just hold their tiny hands, " there will come a time when you greatlydesire to do something else--you have many urgent duties awaitingyou--and baby not being old enough to understand the circumstances, begins to wail out his feeling of neglect and abuse. It is nothingshort of wicked thus to spoil a child. We have seen so many beautiful babies go to sleep by themselveswithout any patting, dangling, or rocking, that we encourage and urgeevery mother to begin right, for if the little one never knowsanything about rocking and pattings he will never miss them; and evenif the baby is spoiled through extra attention which sickness oftenmakes necessary, then at the first observance of the tendency on thepart of the child to insist on the rocking, or the presence of a lightin the sleeping-room, or the craving for a pacifier, we most stronglyurge the mothers to stick to the heroic work of "letting him cry itout. " The notion that the household must move about on tiptoes is not onlyunnecessary but perfectly ridiculous. From the very hour of his birth, let the child become accustomed to the ordinary noises of the home, and if this plan is early started he will prove a blessing and a rayof sunshine to the family and not an autocrat to whom all must bow andbend the knee. BEDTIME AND SLEEPING POSITION Bedtime is regulated somewhat by the hour of rising in the morning. Usually, up to two years, baby is put to bed from five to six P. M. Regularity is urged in maintaining the bedtime hour. The seven o'clock bedtime hour is later established and continueduntil the young child attains school age, when retiring at the curfewhour of eight o'clock gives our boy or girl from ten to eleven hoursof sleep, which is essential to proper growth, calm nerves, and anunruffled temper. The first few days finds our little fellow sleeping nine-tenths of histime. Let him lie on his right side, for this favors the completeclosure of the fetal heart valve, the foramen ovale. Whether baby lies on his stomach, his side, or with the hands over hishead is of little or no consequence. His position should be changedfirst from one side to the other until he is old enough to turnhimself. WAKING UP AT NIGHT Before baby is three months old, he should receive nourishment duringthe night at nine and twelve, and again at six in the morning. Afterfour or five months a healthy child should not be fed between thehours of ten P. M. And six A. M. At this age, many children sleepright through from six P. M. To six A. M. Without food. After five months, if a healthy baby awakens between ten P. M. And sixA. M. Warm water may be given from a bottle; he soon forgets aboutthis and the night's sleep becomes unbroken. There are many otherreasons than the need of food that cause the wakefulness of the child;and since the baby should, after a few months, sleep undisturbed andpeacefully, if he is wakeful and restless--crying out in a peevishwhine--and then quiets down for a few moments only to cry out again, you may suspect one of a half-dozen different things. Let us, therefore, summarize the things which may disturb baby's sleep: 1. _Lack of Fresh Air. _ Babies cannot sleep peacefully in a hot, stuffy room, or in a room filled with the fumes of an oil lamp turnedlow. A crying fretful baby often quiets down as if by magic, providinghe is not hungry and the diaper is dry, when taken into a cool roomwith fresh air. After the first two months the temperature of thesleeping room should be fairly cool and fresh. 2. _Clothes and Bedding. _ The night clothes may be irritating andcausing perspiration, while the bedding may be wrapped too snuglyabout the child. If baby's neck is warm and moist, you may know thathe is too warm. If the diaper is wet it should be changed at once. Oneof the worst habits a baby can possibly get into is to become soaccustomed to a wet diaper that it does not annoy him. In coldweather he is changed under the bed clothing without exposure orchilling. It may be the bedding is cold and, if so, it should bewarmed up by the use of the photophore previously described, or bymeans of the flannel-covered hot water bottle. 3. _The Food. _ Too little, too much, or the wrong kind of food, willdisturb baby's sleep. Indigestion is very easily produced in babieswho are improperly fed. For instance, the mother's milk may be lackingin nourishment and baby may really be hungry; or, as in the case of abottle-fed baby, it is usually due to over feeding. Many mothers wehave known who sleep with their babies or who sleep very near them, nurse them every time they wake up or murmur, and this soon becomesone of the biggest causes of disturbed sleep. 4. _Spoiling. _ A lighted nursery or bedroom, rocking to sleep, joltingthe carriage over a door sill or up and down, the habit of pickingbaby up the moment he cries, late rompings--any and all of these maydisturb sleep, as well as unsettle the tender nervous system of thechild, thus laying the foundation for future nervousness, neurasthenia, and possibly hysteria. This is particularly true in thecase of the children who have nervous parents. 5. _Reflex Causes. _ Wakefulness is sometimes due to reflex nervouscauses such as the need for circumcision, or the presence of adenoids, enlarged tonsils or worms. Does baby have to breathe through hismouth? Then you may suspect adenoids or other conditions which shouldbe removed. 6. _Chronic Disorders. _ The presence of scurvy or syphilis causes thechild to cry out sharply as if in acute pain, while in older childrentuberculosis of the spine or hip is attended by a sharp, painfulcrying out during sleep. Malnutrition or anemia are also conditionswhich greatly disturb sleep. 7. _Soothing Syrups. _ Untold trouble, both physical and nervous, isbound to follow the giving of soothing syrups. These medicines sootheby knocking the nerves senseless and never by removing the cause. Theycontain morphin, opium, cocain, heroin, and other drugs which deadenpain, and are most dangerous to give baby. DAILY NAPS The morning nap from the sixth month on should be from two to threehours long, out on the porch, well protected; while the afternoon napmay be from one to one and a half hours long with an interval of twoor three hours before bedtime. The child should be wakened at regularintervals for feedings during the day--every three hours until he issix months old, and then every four hours. These naps should be takenin a cool place--on the porch, on the roof, in the yard, under a tree, or on the protected fire escape. If the nap is to be taken indoors, then lower the windows from the topand darken the room. All children should take daily naps until theyare five or six years old. CHAPTER XXIII BABY HYGIENE Possibly if all our babies could grow up in a mild, warm climate, outof doors, where they were cared for by mothers who had nothing else todo but enjoy nature in a garden, their babies unhampered by clothesand other conventionalities inflicted upon us by our present standardsof living--well, if that were our environment, probably this chapteron baby hygiene would not need to be written. But realizing thatvariable climatic conditions, the indoor life, and the necessarybundling up with clothes, all tend to increase the ever-present dangerof infection from thickly settled peoples and their domesticpets--these facts, together with the further fact that modern socialconditions make it necessary for some mothers to toil long hours--allthese influences, I say, considered separately or combined, make itimperative for us to give thoroughgoing consideration to theessentials of baby hygiene. The subjects of fresh air, sleep, bathing, etc. , have been duly discussed in previous chapters. WATER DRINKING As soon as the newborn baby has been washed and dressed, before he isput to sleep, he is given two teaspoons of warm, boiled water in asterile bottle with a clean nipple. This is repeated every two hourswhen he is awake, until he is old enough to ask for water himself. This water should contain no sugar, or anything else--just clean, boiled water. It is better to give this water from a bottle; for incase of enforced weaning, this practice of taking his water from abottle, will have made him acquainted with that method of feeding. URINATION The baby may pass very little urine during the first day or two of hislife, but if the warm, boiled water is administered regularly, theurine will soon become more abundant. As the child nears two years of age, if put to bed at six P. M. Heshould be taken up at ten or eleven to urinate. In older children, bed wetting is often corrected by serving the lastmeal not later than four P. M. And not allowing any liquids after thathour. The physician should be consulted in all instances where the habit ofbed wetting extends beyond three years. The subject will be treatedmore fully in a later chapter. EXERCISE A baby pen, lifted up from the floor, well protected at the sides, andcovered with mosquito bar--if exposed to flies or mosquitoes--affordssplendid opportunity for exercise. Here the little fellow may lay on awell-padded mattress and kick, move his arms, and otherwise roll aboutto his own satisfaction. It should not be in the direct sunshine, butrather in a protected, somewhat shady place, yet where the air is pureand fresh. Much exercise is obtained from the daily cry. Here, the arms, legs, hands and feet, as well as the body, are all exercised until the babyis pink. A good rebound of blood is flowing through the well-warmedskin, while the baby is greatly benefited by such daily exercise. Later on, "creeping" is urged, but not forced. With regard tostanding--he will pull himself up on his feet just as soon as naturequalifies him, and so he needs no urging or coaxing in this matter. Older children should be encouraged in active romping, games, etc. , rather than to spend the entire day in the more sedentary amusements, puzzle pictures, etc. It is a most abnormal situation when a three-, or four-year-old childis content to sit quietly all day. There is usually somethingseriously wrong with a child who never soils his rompers, who nevermakes a noise, and who does not seem to enjoy normal play and fun. Let the little folks early learn that the home is theirs to enjoy andthat their little friends are welcome; and thus you may be spared sucha reproof as one little lad of four unknowingly gave his mamma. Hislittle friend was approaching the stairs of the play room, when thethoughtless mother carelessly and impatiently remarked: "Oh, are yougoing to bring Ned upstairs? you'll make so much noise. " The littlehost met his friend at the top with the words: "They don't want boysin the house, we'd better go outdoors. " The mother "woke up" andarranged a little "party" upstairs for the two husky, healthy--andnoisy--boys. During the creeping days remember that the floor is the coolest partof the room, and in the absence of the creeping pen, which is "builtup" two feet above the floor, extra clothing should be put upon thechild while on the floor. During the damp days of early spring and thecool days of late fall, as well as on the bleak days of winter, babyis better off if he is kept off the floor. It is a fine plan to put anumber of table boards on top of the springs of the baby's bed; inthis way a sort of pen is produced which is high above the cold floorand the baby is content to spend much of his time in this little pen, happy with his playthings. KISSING THE BABY We most strongly protest against the haphazard, promiscuous kissing ofbabies. Many forms of disease, such as tuberculosis, syphilis, diphtheria, influenza, common colds, etc. , may be carried to the childin this way. The baby, notwithstanding his attractiveness, his beauty, and hisgrace, should not be overfondled. Kissing the hand is not much betterthan the mouth, for the hand quickly finds its way to the mouth. If itbe necessary to kiss a baby, then let the kissing be done on the backof the neck or on top of his head, but never on the face or hand. SUCKLING HABITS There came into the office one day a woman forty or more years of age, whose mouth was markedly disfigured, and on my inquiring as to theprobable cause she said: "Doctor, it is the result of sucking my thumbwhen I was a mere child, too young to know better, and every time Ilook into the glass, which I assure you is only when I am compelledto, I curse my parents for not breaking me of that habit. " Theindulgent parents were hated and despised for neglecting their duty, because of the disfigurement which resulted from this unrestrainedhabit of early childhood. Thumb sucking, finger sucking, or pacifier sucking, are all filthyhabits, and should be early discouraged. To aid in overcoming thehabit of sucking the thumb or biting the fingernails, the ends of thefingers and edges of the nails may be painted with a solution of aloesor quinine. In extreme cases, a splint may be placed on the anteriorbend of the elbow, thus preventing the possibility of raising the handto the mouth. The "sugar teat" of our mother's generation has passed, as has alsothe "mumbling" of food for the young child; we no longer give thebabies concentrated sugar, nor do we "chew" our children's food at thetable. Extreme cases of chalk or dirt eating have been noted; such tendenciesare decidedly abnormal, and require medical attention. KEEP BABY WARM Much colic and fretfulness may be avoided if baby is kept warm. Thefinger tips are a good thermometer, for if they are warm the feetusually are. "Bundling" is unnecessary, but careful attention shouldbe paid to keeping the feet and hands warm without making the childsweat; that is an art, and all mothers should attain it. An extraflannel wrapper and a pair of heavy wool booties in the winter aregood warmth producers. Cotton flannel petticoats should be replaced bywarm woolen ones, and when the baby begins to get about on his handsand knees a pair of loosely fitting wool tights, made from discardedwoolen underwear are of inestimable comfort and value. In the effortto avoid draughts and body chilling, ever bear in mind baby's need offresh air and the dangers of sweating, for the sudden cooling of asweating child is a forerunner of pneumonia, cold catching, diarrhoea, and other troubles. BABY'S TEMPERATURE During early infancy, baby's temperature sometimes varies greatly; forinstance, a rectal temperature may register 97. 5 or 100. 5 F. While thechild may be in perfectly good health. The baby's temperature should be taken at the rectum--which shouldnormally register 99. 5 F. This temperature, as stated above, mayregister 100. 5 F. , with no other symptoms of illness. In taking rectaltemperature the thermometer should remain in place two minutes. The groin is the next best place to take the temperature; here thethermometer should remain five minutes, and the registry is usually adegree lower than that of the rectum. The baby's temperature usually is a good guide to the severity of anyillness. In case the temperature runs above 101 F. The physicianshould always be notified and his orders carefully followed. Slightcauses often produce a high temperature of 103 to 105 F. For a shorttime; but such a temperature of long duration means serious troubleand demands expert advice and attention. Abnormal temperature will bemore fully considered in that section of this work entitled "CommonDisorders of Infancy. " BABY BOUNCING The common custom of bouncing or trotting baby on the knee is aharmful one. The young and growing nervous system of the child isdecidedly injured by this constant jolting and jiggling, to saynothing of the "spoiling" effects of this practice. There is a vastdifference between the sensitive nervous system of the infant, withits liability to shock and disturbances, and that of the settled anddeveloped nervous system of an adult. The strength of the mother ornurse is so great that the jarring not only often causes indigestionand vomiting in the infant, but sometimes also lays the foundation for"wrecked nerves" in later life. The tossing of baby in the air comes in for the same condemnation. Baby is not "our plaything, " and must not be bounced and tossed aboutlike a rubber ball. CARRIAGES AND GO-CARTS The first carriage should be roomy and comfortable. The bed should bethirty-three inches long and fourteen inches wide, and should betwenty-eight or thirty inches from the floor. The wheels should berubber tired. The cover should be a good sized hood containing a darklining, and provided with a wind shield. This dark lining creates aneutral shade for the eyes and protects them from the glare of the sunand the bright skies. The bed of the carriage should be soft and warm; and, with the sizebefore mentioned, there is ample room for the "tucking in" with warmblankets, which are first spread out on the bed and then the babyplaced into the blanket, after which it is brought up and over him. The folding go-cart and the small carrying-basket are to be used onlyin an emergency. They are convenient in traveling or shopping for themother who has no maid or caretaker with whom to leave the baby; butthey are not satisfactory pleasure vehicles, neither should the babybe left to sit fastened in one of these carts for any great length oftime. The mattress of the carriage should be of hair, while needed warmthmay be secured by the use of a thick, light-weight woolen blanket, placed under the child and brought up and around him. A top covering for the carriage must have washing or dry cleaningqualities. A crocheted afghan, a washable embroidered cover, or a firmsilk puff, are good covers. The one thing to be remembered is thateverything about the carriage soils readily, and if this thoughtenters into the selection of fabrics, you will not be disappointedwhen cleaning time comes. The carriage pillow should be of down, except in the very hot months, when hair is preferable. Simple, easily laundered slips may be madefrom two men's-size handkerchiefs. BOW LEGS Particularly in boys and men, bow legs are not only awkward but are anoticeable deformity; even the little folks notice them and oftenremark about it, as did one child who sat profoundly eyeing a veryimportant visitor who stood before the cheerfully lighted gratewarming himself. The little fellow suddenly exclaimed, "Oh, Mister, look out! You're warping. " Such a painful experience might have beensaved this distinguished gentleman had his mother or caretaker noturged his standing too soon; and at the same time had fed him on theproper food, so as to avoid "rickets. " The ossification or hardeningof the bones of the legs continues all through childhood and is ofteninterfered with by improper feeding during the first two years oflife. Urging the little people to stand too early is to bediscouraged. Nature prepares them for it when the right time comes;which time varies--thin children standing and walking usually muchearlier than heavy children. LIFTING THE BABY A very young baby should be lifted from his bed by grasping theclothing below the feet with the right hand, while the left hand slipsunderneath the back and with spreading fingers supports the neck andhead. It is then raised upon the left arm. During the early months theentire spine must be supported in this manner (See Fig. 6). Ingrasping a baby under the arms or about the waist, undue pressure ismade upon the abdomen and chest. Serious injury often follows thecareless lifting of the older child by his wrists or hands. Thethrowing or whirling of the older children by the arms is stronglycondemned. Dislocations have followed such careless so-called fun. PREVENTION OF FALLS In the selection of the high chair, care should be given to thepossibility of overturning. Fortunately, baby's bones are onlypartially ossified, else he would sustain many fractures in thefrequent falls and bumps. When we pause to consider the thoughtlessmanner in which many babies are left on beds and in unguarded chairs, it is not strange that they fall so often. Open windows must be carefully protected by well-fastened screens orby slats of wood. Beds afford a good place for a romp or play, buthigh-backed chairs should be placed at the side to prevent a fall. Astrap across the waist should be fastened to the sides of the carriageto prevent falling out. Everything possible should be done to preventfalls. Outdoor hammocks are exceedingly dangerous for the baby. Neverleave a child in one unguarded. A little caution, a large amount ofcommon sense--the "good use of brains"--will prevent scars and otherlifelong deformities. THE BABY'S BREASTS Never allow anyone to manipulate or "break down" a swollen breast in agirl or boy baby during the first week or two. This swelling occursoften and should not be interfered with. A hot compress of boracicacid solution may be applied, after which a piece of sterile gauzeshould be placed over the swollen part and held on by a muslinbandage. Secure medical attention if the swelling does not go down ina day or two. VISITING Unless absolutely necessary, babies should not be taken on trains andstreet cars; nor should they take long journeys into the country toattend "reunions. " Infections accompany crowds, and baby is far betteroff at home, in the quiet of his natural surroundings, than he is inthe dust, closeness, and bustle of illy ventilated cars, streets, shops, movies, or even at church. Many an infant has been sacrificedby a train journey to "show him off" to the fond grandparents; scoresof babies acquire whooping cough at the movies; and many a baby hasnearly lost his life by catching measles, scarlet fever, or diphtheriaat church; while the only thing accomplished by the church experimentwas the spoiling of the entire service by its fretful, tired cry--theinfant's only means of protest. THE RUNABOUT BABY "Runabouts" are the little folks between the age of one and threeyears, and they require good care, good feeding, and warm andcomfortable dressing. In general, they need the same fresh air, daily outings, and dailynaps of the younger child. Their hands need washing oftener, and theirclothing, which is usually a play romper, should be either of white orfast colors that it may be most thoroughly boiled, thus getting agood disinfection. Their eyes, nose, and ears, as well as the genitalorgans, all require the most rigid daily cleanliness. The "bugbear" second summer need not be feared by the mother who takesparticular care to see that: 1. The drinking water is boiled or distilled. 2. The orange is not overripe. 3. The banana is not underripe or overripe and is not eaten in chunks. 4. The milk is fresh and pasteurized. 5. The baby does not eat candy, ice cream, or other forbidden foods. 6. The baby's bowels move daily. 7. He does not remain dirty. 8. He naps daily. 9. He is protected from dust, flies, flees, and mosquitoes. 10. He does not go visiting, to church, shops, or "movies. " The second summer is no harder than the first, as good clean water, easily digested foods, and good general hygiene are all a baby needsat this time. A large army of little folks grow up in spite of thelittle care they get and the place in which they live. Did they notpossess good vital resistance, sound nerves, and good digestion, thechildren of the "slums" and of the "ghetto" would quickly succumb totheir unhygienic surroundings. TOYS In selecting toys for the infant, it must be borne in mind that theywill be put to the mouth, and hence they should not be: 1. Toys with sharp points. 2. Small enough to swallow, or to push into the nose. 3. Covered with hair or wool. 4. Glass that is easily broken. 5 Painted toys. 6. Toys that may be taken apart and the small parts swallowed. 7. Paper books that may be chewed or torn. Bear in mind that babies are easily amused with such simple toys as: 1. A half-dozen clothes pins. 2. An aluminum pan and a spoon. 3. Rubber toys (easily washed). 4. Celluloid dolls, ducks, and other floating toys. 5. Blocks. 6. A large rubber ball. The older children have wonderfully good times out of doors with aspade, a cart, and the sandpile. Boys most thoroughly enjoy a trackwith its engine and cars, switches, etc. They build shamfortifications, truly works of art, with their blocks, while the girlsare happiest with dolls and household sets. However, occasionally wemeet a mother who has a girl who is really a boy in her tastes fortoys, and so we say to that mother: give the little girl the desire ofher heart; if it's a train instead of a doll, or a toy gun instead ofa doll's trunk, well and good, let her have them. What we want arefree and easy, natural, children. They are much more likely to havegood nerves, clean thoughts, sound digestion, and equalizedcirculation. CHAPTER XXIV GROWTH AND DEVELOPMENT The newborn baby comes into the world in an absolutely helplesscondition and completely unconscious of his surroundings. Heunconsciously performs certain acts, such as opening his eyes, crying, urination, movement of the bowels, and even nursing of the breast; butthere is probably no distinct voluntary action connected with any ofthese acts. All of his senses at birth are practically dormant, but asthe days and weeks go by, they begin to awaken. SPECIAL SENSES The baby cries, but the tears do not actually flow over the lids untilhe is three or four months old, and while the baby may fix his eyesupon objects and distinguish light from darkness, he will not wink norblink when the finger is brought close to the eye. Vision is probablynot complete until the beginning of the third month. Infants are said to be deaf for the first twenty-four to forty-eighthours after birth, and some authorities hold that they are deaf forseveral days. Taste is early developed, as a newborn baby will often repeatedly showa desire to taste sweet things, while if sour or bitter things are putto the tongue, it shows its displeasure. HAIR AND SCALP The newborn baby usually comes into the world with a good head ofhair, but the end of the first or second week witnesses the fallingout of much of this hair, and falling may continue for even anotherweek or two. The hair is often worn off on the back of the headbecause of constant friction upon the pillow. Children differ greatly in the growth of hair. Some of them come intothe world with heavy hair, and others lose it quickly and remainnearly bald-headed until after the first year. As the second hair grows in, it is usually lighter than it was atbirth and lighter than it will be later in life, as the hair has atendency to grow darker as the years go by. The scalp should receive the care already mentioned. As the hair comesin it should be shampooed once in two weeks and brushed often, makingit healthy and vigorous. MISSHAPEN HEADS It is wise to turn the baby first on one side and then on the otherand not allow him to sleep night after night on one side of his head. The newborn head may be misshapen by laying the child constantly onone side, and the ear may be misshapen if it is allowed to curl underor become pressed forward. Markedly protruding ears may be partiallycorrected by having the child wear a well-ventilated cap made for thepurpose. THE SALIVA Many mothers think that the presence of drooling or the excessive flowof saliva is associated with teeth cutting. While it may be associatedwith the teeth, this is not usually the case; it is more probably dueto the beginning of a new function of secretion. The newborn baby hasonly enough saliva to furnish moisture for the mouth, and not untilthe age of four or five months does saliva really flow, and since theteeth appear a bit later we often confuse the institution of a newsecretion with the oncoming teeth. SENSATIONS AND RECOGNITION The young baby manifests a number of sensations early in its career. Hunger and satisfaction as well as comfort and discomfort seem to berecognized by the little fellow. He early learns that the approach ofsomeone when he cries usually means that he is to be taken up, and heusually ceases crying as soon as he is taken up. He early manifests asense of comfort when he is cuddled; there also is early present amanifestation of the desire to sleep, and the satisfying pleasure of adrink of water. At the age of three months he has recognized many things such as thelight or a bright object. He distinctly recognizes his mother andoften smiles at her approach. He recognizes his hands at four months, and now begins to recognize other members of the household aside fromhis mother. Even as early as one month, he may smile at his mother. Attwo months of age he will often smile at other members of the family. He laughs out loud or chuckles during the fourth or fifth month. But, on the whole, he must be considered as just a little animal whosegreatest needs are to have his appetite and thirst satisfied, hislittle body clothed, and his little nerves put to rest--to sleep. SITTING ALONE At four months the normal baby will hold up his head; and if he issupported at the back with a pillow, he will sit erectly--holding hishead up--at six months; while at eight months or not later than nine, the normal child should sit alone on the floor with no support. Laterin the ninth month he often manifests a desire to bear his weight uponhis feet. Care is here urged that the mother protect the little fellowat this time and not allow him to rest his weight upon his feet but amoment or two at a time. He will reach for a ball suspended from the top of his carriage or bedas early as the fifth month. About this time he discovers his toeswhile in his bath. He will handle a rattle at six or seven months, andshows delight in such toys. DENTITION In both the upper and lower jawbones of the newborn infant there arehidden away in snug little cavities two sets of tiny teeth; the firstset, or milk teeth, and the second set, or permanent teeth. Theserudimentary teeth grow as the baby grows and push their way up or downfrom the jawbones until they finally make their appearance through thegums. The milk teeth appear in a definite way and in five definitegroups. There should be no physical disturbance at the appearance of theteeth, which is a physiological process, and it is to be deplored thatall of the ills of babyhood are laid upon the teeth with the carelessremark: "Oh, its his teeth!" Many, many illnesses are neglectedbecause our inexperienced mother has been told that she can expect"anything to happen when the baby is cutting its teeth. " Now, it istrue that the babies of many families do have trouble in cutting theirteeth, but the majority of babies cut their teeth comfortably and thefirst knowledge anyone has of it is the appearance of the toothitself. As the teeth push their way nearer the surface of the gums, there is a broadening and a hardening of the gums themselves, and itis the exception rather than the rule that the baby needs any help incutting his teeth. Usually by the time the baby is seven months old it has two centralteeth on the lower jaw (the central incisors), which constitute thefirst group. The second group of teeth to appear is the four uppercentral teeth which are all through by the time the baby is twelvemonths old, and are often through at ten months. Then there is a pauseof from one to three months before the next teeth appear--the fouranterior molars. As these four anterior molars come in, the twolateral incisors appear on the lower jaw, which now gives us, by thetime the baby is fourteen or fifteen months old, four central teethupper, four central teeth lower, and the four anterior molars, whichmake twelve teeth. Another pause of two or three months and then we get the four canine, which fill in the space between the first molars and the front teeth. The canine on the upper jaw are commonly known as the eye teeth, whilethe canine teeth on the lower jaw are spoken of as the stomach teeth. This brings us to the age of eighteen to twenty-four months, whenthere is still another pause of two or three months, after which timethe big teeth or the four posterior molars appear, which completes thefirst set of twenty teeth--the milk teeth. When baby is twenty monthsold the milk teeth are often all in. The complete set should appearnot later than the thirtieth month. During the life of the milk teeth the child should be taken to thedentist at least once a year, better once in six months, for alldefective teeth must be properly and promptly cared for. Inexpensivebut sanitary fillings should be placed in all decayed teeth, for theroots of the first teeth are very soft and infection readily spreadsto the jaws and the permanent teeth and serious trouble often beginsthus early. If dentition is seriously delayed, investigation should be startedconcerning the general condition of the child, for this delay oftenaccompanies ill health. When the child is six years old, the mother should be watchful, for itis at this time that the first permanent teeth appear just behind thelast molar of the milk teeth. They do not replace any of the teethpresent, and many times they come through and decay without receivingany attention. It is seldom necessary to assist these milk teeth asthey come through the gum, and should the gums become highly coloredand swollen it is not wise to lance them, for if the teeth are notready to come through immediately, the gum only toughens the more andmakes the real cutting still more painful. This is the time to cut down the baby's food as well as to look forother digestive disturbances, for the number of stools may increaseand vomiting may occur, and by reducing the quantity and quality ofthe food and encouraging abundant water drinking, much trouble may beavoided. Under no circumstances urge the baby to eat when he refuseshis food, when the gums seem swollen and red during the teething time. You will find that he will enjoy orange juice, pineapple juice, orprune juice. All of these digestive symptoms are simply the result of"feeling bad, " and if heavy food of his regular feeding is greatlydiminished he will get along much better than if fed his regularallowance of food. APPEARANCE OF THE TEETH The normal child has: Six teeth at one year. Twelve teeth at one and one-half years. Sixteen teeth at two years. Twenty teeth at two and one-half years. When the child is six years old the first permanent tooth appears justback of the last of the milk teeth. By the time he is seven, the fourcentral teeth, two above and two below, are out and the new ones beginto appear. The order of their appearances is as follows: Four first molars 6 years Four central incisors 7 years Four lateral incisors 8 years Four first bicuspids 9 to 10 years Four second bicuspids 10 to 11 years Four canines 11 to 13 years Four second molars 12 to 15 years Four third molars 17 to 25 years DENTAL SUGGESTIONS A better plan than to lance swollen gums is to rub them gently withice wrapped in a soft cloth, or to dip the finger in ice water and rubthe gums--this often gives the baby much relief. Often the baby finds comfort in biting on an ivory ring, but theutmost care must be used in keeping it clean and avoidingcontamination by allowing it to drop on the floor. Convulsions are never the symptoms of teething. Consult a physician atonce, as such seizures probably spring from causes other thanteething. Cleansing of the teeth should be carried out systematically everymorning by means of a piece of cotton which has been dipped in aboric-acid solution or a solution of bicarbonate of soda (commonbaking soda). A soft brush may be used for cleansing, and when thereare particles of food between the teeth they should be removed bystrands of waxed floss. Throughout life, frequent visits should be made to the dentist; duringearly childhood days he should be on the lookout for symptoms whichindicate deformity--narrow jaws and other conditions which affect thepermanent teeth. During adolescence and adult life the teeth should beexamined every six months and cleansings of the mouth should become apart of the daily toilet. THE WEIGHT During the first year, nothing gives us so much information concerningthe child's general well-being as the weight. Such a record will notonly enlighten the mother concerning the development of the child, butthe grown-up child appreciates the record and preserves it along withthe other archives of babyhood days. Every Sunday morning, when thefather is at home, the baby should be weighed and an accurate recordkept. It is important that the baby be weighed each time in the samegarments--shirt, band, diaper, and stockings--for every ounce must beaccounted for. Until the baby is five or six months old he should gain from four toeight ounces a week. Anything short of this is not enough and shouldbe reported to the physician. After six months the gain is about apound each month. This varies somewhat; possibly during the tenth andeleventh month the gain is lessened, but by the close of the firstyear the baby should have trebled its birth weight. Dr. Griffith gives us the following very interesting bit ofinformation concerning the weight of boys and girls after the firstyear, and to him also belongs the credit for the accompanying tableshowing the growth, height, and weight of the child up to sixteenyears of age. After the first year we notice that, taking it all together, there is a gradual increase in the number of pounds and a decrease in the number of inches added yearly, four inches being gained in both the second and third years, three inches in the fourth and fifth years, and after this two inches a year. The gain in weight is four pounds yearly from the age of three to that of seven years, then five, then six, and then about nine pounds. It sometimes happens that at about the age of nine in girls and eleven in boys there is almost a cessation of growth for a short time. Later, at about twelve years, girls take on a particularly rapid growth, and decidedly exceed boys of the same age in weight, and sometimes in height also. At fifteen or sixteen years the rapidity of growth in girls, both in weight and height, will be greatly diminished, while boys of this age will often begin to develop very rapidly, and will soon materially exceed the other sex in both respects. TABLE SHOWING GROWTH IN HEIGHT AND WEIGHT Age. Height. Weight. Birth 19 inches. 7 lbs. 8 oz. 1 week 7 " 7½ " 2 weeks 7 " 10½ " } Gained 1 oz. 3 weeks 8 " 2 " } a day; 1 month 20½ inches 8¾ " } 7 oz. A week 2 months 21 " 10¾ " } 3 months 22 " 12¼ " } {Gained 3/4 oz. A day; 4 months 23 " 13¾ " } {5-1/2 oz. A week. 5 months 23½ " 15 " } {Double original weight. 6 months 24 " 16¼ " } {Gained 2/3 oz. A day; {4-2/3 oz. A week. { 7 months 24½ " 17¼ " } { 8 months 25 " 18¼ " } {Gained 1/2 in. A month. 9 months 25½ " 18¾ " } { 10 months 26 " 19¾ " } {Gained about 1 lb. A month. 11 months 26½ " 20½ " } { 1 year 27 " 21½ " } {Treble original weight. 2 years 31 " 27 " } { 3 years 35 " 32 " } {Gain 4 in. A year. 4 years 37½ " 36 " } Double original length. 5 years 40 " 40 " } {Gained 3 in. And 4 lbs. } {a year. 6 years 43 " 44 " } {Gained 2 in and 4 lbs. 7 years 45 " 48 " } {a year. 8 years 47 " 53 " } {Gained 2 in. And 5 lbs. 9 years 49 " 58 " } {a year. 10 years 51 " 64 " } {Gained 2 in. And 6 lbs. 11 years 53 " 70 " } {a year. 12 years 55 " 79 " } 13 years 57 " 88 " } 14 years 59 " 100 " } {Gained 2 inches and 15 years 61 " 109 " } {about 9 lbs. A year. 16 years 63 " 117 " } GENERAL DEVELOPMENT The accompanying illustration (Fig. 14), taken from Dr. Yale, represents the developmental changes at one, five, nine, thirteen, seventeen, and twenty-one years. Each figure is divided into fourequal parts, and as we watch the development from the baby who at oneyear, as Dr. Yale says, is four heads high, at the age of twenty-onethe legs and the trunk have much outgrown the growth of the head, sothat at this age the head is only two-thirteenths or less of the wholelength of the body. The legs have grown more rapidly and equalone-half the entire body length. The trunk has not kept pace with thelegs, for as you will see from the diagram the line reaches the navelof the child in one year, while in the adult it is much lower. Therapid growth of the legs is accomplished after nine years of age. [Illustration: Fig. 14. Developmental Changes] The proportions of the head, chest, and abdomen are exceedinglyimportant in the growing child. At the end of the first year the head, chest, and abdomen are about uniform in circumference. The head maymeasure one-fourth of an inch more, but the chest and abdomen shouldboth measure eighteen inches in circumference at this time. Shouldthe head or the abdomen be two inches larger than the chest; theattention of the physician should be called to it, for either areindicative of conditions that should be carefully investigated. NORMAL BREAST WEANING As a general rule the normal, healthy, breast-fed baby is given afeeding of a bottle each day after he is ten months old. These bottlesare increased in number until, by the time the baby is a year old, heis gradually weaned from the breast. Should the ninth month of baby'slife arrive in the hot summer months we urge the mothers to continuebreast feeding, with possibly the addition of some fruit juices, asnoted elsewhere, until early autumn. Under no circumstances should thebaby be weaned and compelled to use cow's milk during the season ofthe year when the risks of contamination are greatest. If the baby isnursed up to the close of his first year he hardly need be trained touse the bottle, but may take his food from a cup. From one to twomonths should always be consumed in weaning the baby, unless suddenweaning is necessitated by ill health, as noted elsewhere. The babyshould have, if possible, from thirty to forty days to accustomhimself to cow's milk exclusively. If the child is weaned slowly there should be no trouble with thebreasts, but in the instance of sudden weaning the mother shouldrestrict her liquids, put on a tight breast binder, and for a day ortwo should take a dose of a saline cathartic, which will assist intaking care of the liquids and thus decrease the secretion of milk. NORMAL BOTTLE WEANING If the bottle food is agreeing with the baby he should be allowed touse it up to the end of the first year when he will be given wholemilk with possibly the addition of a little lime water. We see noreason why the child should give up his bottle during the second yearunless other food is refused--unless he will not accept other foodthan from his bottle--and if you are convinced that he has formed the"bottle habit, " then the milk should be put into a tiny cup or glass, and he should learn to sip it along with his solid foods; but if hetakes his other foods without any hesitancy, then we know no reasonwhy he should not take his milk in this comfortable manner from hisbottle at least two or three feedings each day. If you desire to wean him from his bottle, serve the first part of itwith a spoon from a cup or glass and then give him the remainder inthe bottle. The beautiful picture of a big, robust baby lying on hisback, knees flexed, both hands holding his beloved bottle stilllingers in my mind as one of the pleasant memories of my lad'sbabyhood days, and at the close of the second year, when the belovedbottle was left behind, I believe I missed something as well as didthe lad. I recall no difficulty with his taking the food from a cup. Thesuccess of all normal weanings is due entirely to the fact that it isdone gradually and slowly, and under no circumstances should it beroughly and abruptly attempted--particularly in case of the bottlefeeding. TRAINING THE BOWELS AND BLADDER Reference is made to this subject in another part of this book--wherewe went into the detail of keeping the daily record of thesephysiological occurrences--and it was found that the bowels moved andthe bladder was emptied at about the same time each day. Any mother, caretaker, or nurse, who will take the time to keep a daily record ofthe hours of defecation and urination, will observe the time carefullyand will catch the child on nearly every occasion before an accidentoccurs. Often as early as four months the bowels will move in aninfant's chamber at regular times each day. The nurse or mother placesthis receptacle in her lap and holds the child gently and carefullyupon it. A little later it can be made to sit on a special chairprepared for the purpose, and at eight or nine months by carefultraining the urination can be controlled, and by the end of the firstyear the diapers ought to be discontinued. If the child has not learned to control the bladder by the age of twoyears, medical attention should be called to the fact and remedialmeasures instituted. BABY'S SPEECH The baby should begin to talk at one year. He early learns to say"mamma" and "papa, " and gradually adds nouns to his vocabulary, sothat at eighteen months the normal child should have a vocabulary ofone hundred to one hundred and fifty words. As he nears the two-yearmark, he has acquired a few simple verbs and he can possibly put threewords together, such as, "Willie wants drink. " Pronouns come in late, as we all recall that the young child usually speaks of himself by hisown name. Children are born mimics. If you talk baby talk to them, they willtalk baby talk back. For instance, a well known author told us justthe other day that for many years no other name was given to thesewing machine in his house but the word "mafinge, " and not until hewent to school did he correct the word "bewhind, " for in the nurseryhe learned the line "wagging their tails bewhind them. " Baby talk isvery cunning, and often the adult members of the family pick it up andkeep it up for years, and only when they are exposed in public, as onemother was on a suburban platform by her four-year-old lad shouting, "Mamma, too-too tain tumin, too-too tain tumin, " do they sense theirresponsibility and realize how difficult it is to form new habits. This poor mother tried in vain to have her little fellow say, as didanother little lad two and one-half years old, "Mother, the train'scoming; let's get on. " Many words of our beloved language at best are hard to understand; solet us speak correct English to the little folks and they will rewardus by speaking good English in return. If at two years the child makes no attempt at speech, suspicionsshould be aroused concerning mutism or other serious nervous defects. Medical advice should be sought. DEFECTIVE SPEECH All guttural tones which may be occasioned by adenoids or enlargedtonsils, all lisping, stuttering, or defective speech of all wordsshould be taken in hand at the very start, as they are usuallyovercome by constant repetition of the correct manner of speaking theparticular word in question. Children of defective speech need specialtraining, and should in no way be allowed rapidly to repeat littlenursery rhymes, as oftentimes this rapid repetition of rhymes by achild with hereditary nervous defects may occasion stuttering orstammering later on. CALISTHENICS Special exercise should not be forced upon young children. Physicalculture, along with many other things intended for sedentary adults, should never be forced upon little folks who get all of the exercisethey need in the many journeys they take building their blocks, sailing their boats, tearing down imaginary houses, making imaginaryjourneys--from morning until night the little feet are keptbusy--never stopping until the sandman comes at sleepy time. Do notyourself attempt to stimulate a child who seems backward. Consult yourphysician. You had much better put a child out to grow up in the yardby himself with his sandpile than to force calisthenics or advancephysical training upon him. BOW LEGS AND WALKING Do not attempt to hasten nature in aiding the child to walk. Let himcreep, roll, slide, or even hunch along the floor--wait until he pullshimself to his feet and gradually acquires the art of standing alone. If he is overpersuaded to take "those cute little steps" it may resultin bow legs, and then--pity on him when he grows up. Sometimes flatfoot is the result of early urging the child to rest the weight of thebody upon the undeveloped arch. A defect in the gait or a pigeon toeis hard to bear later on in life. A certain amount of pigeon-toeing isnatural and normal. If the baby is heavy he will not attempt to walkat twelve months. He will very likely wait until fourteen or fifteenmonths. The lighter-weight children sometimes walk as early as elevenmonths, but they should all be walking at eighteen months, and if not, it is usually indicative of backward mentality. If the training of the bowels and bladder will replace the diaperswith drawers, the baby will attempt to walk sooner than whenencumbered with a bunglesome bunch of diaper between the thighs. Thelittle fellow runs alone at sixteen months and thoroughly enjoys it, and the wise mother will pay no attention to the small bumps which aregoing to come plentifully at this particular time. SUMMARY OF BABY'S DEVELOPMENT He discovers his hands at three or four months. At six months he sitsalone, plays with simple objects, grasps for objects, and laughs aloudfrom the third to the fifth month. He says "goo goo" at four or fivemonths. At one year he should stand with support, listen to a watchtick, follow moving objects, know his mother, play little games, suchas rolling a ball, should have trebled his birth weight, and have atleast six teeth, and should use three words in short sentences. Ateighteen months he should say "mamma" spontaneously, walk and runwithout support, should have quite a vocabulary, should be able toperform small errands like "pick up the book, " and should have twelveto sixteen teeth. At two years he should be interested in pictures, able to talk intelligently, and know where his eyes, nose, mouth, hands, and feet are. At three years, he should enumerate the objectsin a picture, tell his surname, and repeat a sentence with six words. In the case of a premature baby or a very delicate child, or as aresult of a prolonged illness or a very severe sickness, such asspinal meningitis, the time of these mental and physical developmentsmay all be postponed, while rickets, which will be spoken of later, isoften the cause of late sitting, late standing, and late walking. DIET AFTER THE FIRST YEAR Milk is the principal article of diet during the second year. Itshould be given with regularity at distinct intervals of four meals aday. It may be given from the nursing bottle, unless the child hasacquired the bottle habit and refuses to eat anything else but thefood from his bottle, in which case it should be given from a cup. Beginning with the sixth month, aside from his milk, be it breastmilk or bottle milk, he is to be given orange juice once each day aswell as the broth from spinach and other vegetables. This is necessaryto give the child certain salts which are exceedingly essential to thebottle baby. At the close of the year when he is taking whole milk he should begiven arrowroot cracker, strained apple sauce, prune pulp, fig pulp, mashed ripe banana (mashed with a knife), a baked potato with sauce orgravy (avoiding condiments), and a coddled egg. Fruit juices may beadded to the diet, such as grape, pineapple, peach, and pear juice. Later in the second year he may be given stale bread and butter, andfor desserts he may have cup custard, slightly sweetened junket, andsuch fruit desserts as baked apple and baked pear. We do not think it is necessary to give children much meat or meatjuices. We appreciate that there is a diversity of opinion upon thissubject, but we do not hesitate to say that in the families where meatis little used, the children seem to grow up in the normal manner withsound healthy bodies, sometimes having never tasted it. When meat isused, it should be well cooked to avoid contamination with suchparasites as tapeworm and trichina; it should also be well chewedbefore swallowing, as many of the intestinal disturbances of the olderchildren are due to the swallowing of unmasticated food such ashalf-chewed banana, chunks of meat, rinds of fruit, and the skins ofbaked potatoes. Let the children's diet be simply planned, well cooked, thoroughlymasticated, and above all things have regular meal hours, and no"piecing" between meals; and if the mother begins thus early with herlittle fellow, she will be rewarded some later day by hearing him sayto some well-meaning neighbor, who has just given him a deliciouscookie or a bit of candy: "Thank you, I will keep it until meal time. "Children learn one of the greatest lessons of self control infollowing the teaching that nothing should pass the lips between mealsbut water or a fruit-ade. Children in the second year require fourmeals a day, one of which is usually only the bottle or a cup of milk. These meals are usually taken at six, ten, two, and six in theevening. Oftentimes this early six o'clock meal is just a bottle orcup of milk, as may also be the evening meal. CANDY Now, a word about candy. Pure candy is wholesome and nourishing. It ishigh in calorific value, and children should be allowed to have it ifit does not enter the stomach in solutions stronger than ten orfifteen per cent. We can see at a glance that chocolate creams, bonbons, and other soft candies should never be given to children. Candies that they can suck, such as fruit tablets, stick candy, sunshine candy, and other hard confections that are pure, and freefrom mineral colorings and other concoctions such as are commonly usedin the cheaper candies, may safely be given at the close of themeals--but never between meals. All such articles as tea, coffee, beer, soft candies, condiments, pastries, and fried foods, should be positively avoided in the case ofall children under five and six years of age. The diet from now on will be considered in the chapter "Diet andNutrition. " PART III THE CHILD PART III THE CHILD CHAPTER XXV THE SICK CHILD To the mother who has passed through the experience of bringing thechild into the world is usually given that intuitiveness which helpsher in caring for that child when it is well and in recognizingcertain symptoms when it is sick. The newborn baby brings with him alarge responsibility, but as the weeks pass by his care becomes lessand less of a nervous strain, as the routine duties, so nearly alikeeach day of his little life, have made the task comparatively easy;but when the baby gets sick, particularly if he is under one year ofage, and it is impossible for him clearly to make known his wants, andbeing unable to tell where it hurts or how badly it hurts, the averagemother is likely to become somewhat panicky; and this confusion ofmind often renders her quite unfit successfully to nurse the sickbaby. THE NURSE It is often wise to secure the services of a trained nurse, and if thefamily purse will allow such services, a good, sincere, capable, practical nurse should be engaged, for her firm kindness will oftenaccomplish much more than the unintentional irritability and anxioussolicitude of an overworked and nervous mother. Usually the mother not only attempts the care of the sick baby withthe long night vigil--often not having the opportunity to take a bathor change her raiment day in and day out--but she often attempts tomanage the entire household as well, including the getting of themeals and keeping the house cleaned, and it is not to be wondered atthat her nerves become overtaxed and in an unlooked for moment shebecomes irritable and cross with the sick child. No matter how low the financial conditions of the family may be, outside help is always essential in cases of severe or long-continuedillness of the children. Should the mother insist upon caring for thebaby herself, then all household duties should be given over tooutside help, and as she takes the rôle of the nurse, the same dailyouting and sleep that an outside nurse would receive should be hers toenjoy. Dr. Griffith has so ably detailed the "features of disease" that wecan do no better than to quote the following:[A] [A] From Griffith's _Care of the Baby_, copyrighted by W. B. SaundersCompany. POSITION The position assumed in sickness is a matter of importance. A child feverish or in pain is usually very restless even when asleep. When awake it desires constantly to be taken up, put down again, or carried about. Sometimes, however, at the beginning of an acute disease it lies heavy and stupid for a long time. In prolonged illnesses and in severe acute disorders the great exhaustion is shown by the child lying upon its back, with its face turned toward the ceiling, in a condition of complete apathy. It may remain like a log, scarcely breathing for days before death takes place. Perfect immobility may also be seen in children who are entirely unconscious although not exhausted. A constant tossing off of the covers at night occurs early in rickets, but, of course, is seen in many healthy infants, especially if they are too warmly covered. A baby shows a desire to be propped up with pillows or to sit erect or to be carried in the mother's arms with its head over her shoulder whenever breathing is much interfered with, as in diphtheria of the larynx and in affections of the heart and lungs. The constant assumption of one position or the keeping of one part of the body still, may indicate paralysis. When, however, a cry attends a forcible change of position, it shows that the child was still because movement caused pain. Sleeping with the mouth open and the head thrown back often attends chronic enlargement of the tonsils and the presence of adenoid growths in young children, although it may be seen in other affections which make breathing difficult. In inflammation of the brain the head is often drawn far back and held stiffly so. Sometimes, too, in this disease the child lies upon one side with the back arched, the knees drawn up, and the arms crossed over the chest. A constant burying of the face in the pillow or in the mother's lap occurs in severe inflammation of the eyes. GESTURES The gestures are often indicative of disease. Babies frequently place the hands near the seat of pain; thus in slight inflammation of the mouth they tend to put the hand in the mouth; in earache to move it to the ear; and in headache to raise it to the head. In headache or in affections of the brain they sometimes pluck at the hair or the ears, although they may often do this when there is no such trouble. Picking at the nose or at the opening of the bowel is seen in irritation of the intestine from worms or oftener from other cause. A child with a painful disease of its chest may sometimes place its hand on its abdomen, or a hungry child try to put its fists into its mouth. In approaching convulsions the thumbs are often drawn tightly into the palms of the hands and the toes are stiffly bent or straightened. Very young babies, however, tend to do this, although healthy. The alternate doubling up and straightening of the body, with squirming movements, making of fists, kicking, and crying, are indications of colic. This is especially true if the symptoms come on suddenly and disappear as suddenly, perhaps attended by the expulsion of gas from the bowel. SKIN COLOR The color of the skin is often altered in disease. It is yellow in jaundice, and is bluish, especially over the face, in congenital heart disease. There is a purplish tint around the eyes and mouth, with a prominence of the veins of the face, in weakly children or in those with disordered digestion. A pale circle around the mouth accompanies nausea. The skin frequently acquires an earthy hue in chronic diarrhea, and is pale in any condition in which the blood is impoverished, as in Bright's disease, rickets, consumption, or any exhausted state. Flushing of the face accompanies fever, but besides this there is often seen a flushing without fever in older children the subjects of chronic disorders of digestion. Sudden flushing or paling is sometimes seen in disease of the brain. FACIAL EXPRESSION The expression of the face varies with the disease. In whooping cough and measles the face is swollen and somewhat flushed, giving the child a heavy, stupid expression. There is also swelling of the face, especially about the eyes, in Bright's disease. Repeated momentary crossing of the eyes often indicates approaching convulsions. In very severe acute diarrhea it is astonishing with what rapidity the face will become sunken and shriveled, and so covered with deep lines that the baby is almost unrecognizable. The same thing occurs more slowly in the condition commonly known as marasmus. Often the face has an expression of distress in the beginning of any serious disease. If the edges of the nostrils move in and out with breathing, we may suspect some difficulty of respiration, such as attends pneumonia. The baby sleeps with its eyes half open in exhausted conditions or when suffering pain. THE HEAD The head exhibits certain noteworthy features. Excessive perspiration when sleeping is an early symptom of rickets. It must be remembered, however, that any debilitated child may perspire more or less when asleep. Both in rickets and in hydrocephalus (water on the brain) the face seems small and the head large, but in the former the head is square and flat on top, while in the latter it is of a somewhat globular shape. The fontanelle is prominent and throbs forcibly in inflammation of the brain, is too large in rickets and hydrocephalus, bulges in the latter affection, and sometimes sinks in conditions with only slight debility. THE CHEST The chest exhibits a heaving movement with a drawing in of the spaces between the ribs in any disease in which breathing is difficult. A chicken-breasted chest is seen in Pott's disease of the spine, and to some extent in bad cases of enlargement of the tonsillar tissue; a "violin-shaped" chest in rickets; a bulging of one side in pleurisy with fluid; and a long, narrow chest, with a general flattening of the upper part, in older children predisposed to consumption. THE ABDOMEN The abdomen is swollen and hard in colic. It is also much distended with gas in rickets, and is constantly so in chronic indigestion in later childhood. It is usually much sunken in inflammation of the brain or in severe exhausting diarrhea or marasmus. It may be distended with liquid in some cases of dropsy. THE CRY The study of the cry furnishes one of the most valuable means of learning what ails a baby. A persistent cry may be produced by the intense, constant itching of eczema. The paroxysmal cry, very severe for a time and then ceasing absolutely, is probably due to colic, particularly if accompanied by the distention of the abdomen and the movements of the body already referred to. A frequent, peevish, whining cry is heard in children with general poor health or discomfort. A single shrill scream uttered now and then is often heard in inflammation of the brain. In any disease in which there is difficulty in getting enough air into the lungs, as in pneumonia, the cry is usually very short and the child cries but little, because it cannot hold its breath long enough for it. A nasal cry occurs with cold in the head. A short cry immediately after coughing indicates that the cough hurts the chest. Crying when the bowels are moved shows that there is pain at that time. A child of from two to six years, waking at night with violent screaming, is probably suffering from night terrors. In conditions of very great weakness and exhaustion the baby moans feebly, or it may twist its face into the position for crying, but emit no sound at all. This latter is also true in some cases of inflammation of the larynx, while in other cases the cry is hoarse or croupy. Crying when anything goes into the mouth makes one suspect some trouble there. If it occurs with swallowing, it is probable that the throat is inflamed. With the act of crying there ought always to be tears in children over three or four months of age. If there are none, serious disease is indicated, and their reappearance is then a good sign. COUGHING The character of the cough is also instructive. A frequent, loud, nearly painless cough, at first tight and later loose, is heard in bronchitis. A short, tight, suppressed cough, which is followed by a grimace, and, perhaps, by a cry, indicates some inflammation about the chest, often pneumonia. There is a brazen, barking, "croupy" cough in spasmodic croup. In inflammation of the larynx, including true croup, the cough may be hoarse, croupy, or sometimes almost noiseless. The cough of whooping cough is so peculiar that it must be described separately when considering this disease. Then there are certain coughs which are purely nervous or dependent upon remote affections. Thus the so-called "stomach cough" is caused by some irritation of the stomach or bowels. It is not nearly so frequent as mothers suppose. Irritation about the nose or the canal of the ears sometimes induces a cough in a similar way. Enlarged tonsils or elongated palate or throat irritation may also produce a cough. THE BREATHING The breathing of a young child, particularly if under one year of age and awake, is always slightly irregular. If it becomes very decidedly so, we suspect disease, particularly of the brain. A combination of long pauses, lasting half a minute or a minute, with breathing which is at first very faint, gradually becomes more and more deep, and then slowly dies away entirely, goes by the name of "Cheyne-Stokes respiration, " and is found in affections of the brain. It is one of the worst of symptoms except in infancy, and even then it is very serious. The rate of respiration is increased in fever in proportion to the height of the temperature. It is increased also by pain in rickets, and especially in some affections of the lungs. Sixty respirations a minute are not at all excessive for a child of two years with pneumonia, and the speed is frequently decidedly greater than this. Breathing is often very slow in disease of the brain, particularly tubercular meningitis. Poisoning by opiates produces the same effect. Frequent deep sighing or yawning occurs in affections of the brain, in faintness, or in great exhaustion, and may be a very unfavorable symptom. Breathing entirely through the mouth shows that the nose is completely blocked, while snuffling breathing is the result of a partial catarrhal obstruction. A gurgling in the throat not accompanied by cough may indicate that there is mucus in the back part of it, the result of an inflammation, sometimes slight, sometimes serious. "Labored" breathing, in which the chest is pulled up with each breath while the muscles of the neck become tense, the pit of the stomach and the spaces between the ribs sink in, and the edges of the nostrils move in and out, is seen in conditions where the natural ease of respiration is greatly interfered with, as in pneumonia, diphtheria of the larynx, asthma, and the like. Long-drawn, noisy inspirations and expirations are heard in obstruction of the larynx, as from laryngeal diphtheria or spasmodic croup. THE PULSE The rate of the pulse is subject to such variations in infants that its examination is of less value than it would otherwise be. In early childhood its observation is of more service, although even then deceptive. Slight irregularity is not uncommon. Unusual irregularity is an important symptom in affections of the brain or heart. Fever produces an increase in the pulse rate, the degree of which depends, as a rule, upon the height of the temperature. Slowing of the pulse is a very significant symptom, seen particularly in affections of the brain, and sometimes in Bright's disease and jaundice. THE TEMPERATURE The temperature is of all things important to remember in infancy and childhood because fever is easily produced and runs high from slight causes. Even slight cold or the presence of constipation or slight disturbances of digestion may in babies sometimes produce a temperature of 103 F. Or more. We do not speak of fever unless the elevation reaches 100 F. A temperature of 102 or 103 F. Constitutes moderate fever, while that of 104 or 105 F. Is high fever, and above 105 F. Very high. A temperature of 107 F. Is very dangerous, and is usually not recovered from. The danger from fever depends not only upon its height, but upon its duration also. An elevation of 105 F. May be easily borne for a short time, but it becomes alarming if much prolonged. THE MOUTH The tongue of newborn infants is generally whitish and continues to be so until the saliva becomes plentiful. After this we usually find it coated in disturbances of the stomach and bowels and in nearly any disorder accompanied by fever. In scarlet fever the tongue becomes bright red after a few days, and in measles and whooping cough it is often faintly bluish. In the latter affection an ulcer may sometimes be found directly under the tongue, where the thin membrane binds it to the floor of the mouth. In thrush the tongue is covered with white patches like curdled milk. A pale, flabby tongue, marked by the teeth at its edges, indicates debility or impaired digestion. In prolonged or very high fever the tongue grows dry, and in some diseases of the stomach or bowels it may look like raw beef. Grinding of the teeth is a frequent symptom in infants in whom dentition has commenced. It generally indicates an irritated nervous system. Most often this depends upon some disturbance of digestion; less often upon the presence of worms. The symptom is present during or preceding a convulsion, and may occur, too, in disease of the brain. In some babies it appears to be only a nervous habit. NURSING The manner of nursing or swallowing frequently affords important information. A baby whose nose is much obstructed or who has pneumonia can nurse but for a moment, and then has to let the nipple go in order to breathe more satisfactorily. If it gives a few sucks and then drops the nipple with a cry, we must suspect that the mouth is sore and that nursing is painful. If it swallows with a gurgling noise, often stops to cough, and does as little nursing as possible, we suspect that the throat may be sore. The ceasing to nurse at all, in the case of a very sick baby, is an evidence of great weakness or increasing stupor, and is a most unfavorable symptom. THE URINE Urine that is high-colored and stains the diaper, or that shows a thick, reddish cloud after standing, may accompany fever or indigestion. Sometimes the urine under these conditions is milky when first passed. In some babies a diet containing beef juice or other highly nitrogenous food will produce the reddish cloud, or even actual, red, sandlike particles. A decidedly yellow stain on the diaper occurs when there is jaundice. A faint reddish stain seldom indicates blood. The amount of urine passed is scanty in fever, in diarrhea, and especially in acute Bright's disease. In the latter disease the urine is often of a smoky or even a muddy appearance. The possibility of the occurrence of this symptom after scarlet fever must always be kept in mind, in order that a physician may be summoned very quickly, since it is a serious matter. THE STOOLS We find that the passages are often putty-colored in disorders of the liver, frequently bloody or tarry in appearance in bleeding within the bowel, and liable to be black after taking bismuth, charcoal, or iron, and red after krameria, kino, or haematoxylon. Infants who are receiving more milk than they can digest constantly have whitish lumps in their stools, or even entirely formed but almost white passages. The presence of a certain amount of greenish coloration of the passages is not infrequent. This is usually an evidence of indigestion, but passages which are yellow when passed and turn to a faint pea green some time later are not an indication of disease. WHEN BABY GETS SICK When baby shows that he is sick, take his temperature as directedelsewhere, cut down the feeding to at least one half, or, if histemperature is around 102 F. Give him nothing but rice water or barleywater. If he is constipated give him a cleansing enema, and if hot andfeverish a sponge bath may be administered. He should then be put intoa bed with light covers and wait further orders which the doctor willgive on his arrival. Give the baby no medicine unless ordered to do soby the physician. Known to every physician who undertakes the care of children, is thefailure of many well-meaning mothers to call him early. The motherattempts the care of the baby herself, and not until the conditiongets beyond her knowledge and wisdom does she seek medical advice. Inthe early hours of an approaching cold, the beginning of intestinalindigestion, or at the beginning of bronchitis, if the physician cansee the child early, prolonged illness may be avoided as well asunnecessary expense and many heart-breaking experiences. FEEDING THE SICK BABY Feeding the sick baby differs somewhat with the character of theindividual disease, but in the outset of any and all diseases theintestinal tract should not be overburdened with food. At the approachof any illness, the food should at least be cut down one half; forinstance, in the case of a serious acute illness accompanied by fever, not only should the strength of the food be reduced one half, butwater should be given plentifully between feedings. It is better neverto urge the baby to eat at such times--for the ability to digest foodis very much reduced. In cases of acute attacks with much vomiting and fever, all milkshould be immediately stopped and rice water or barley watersubstituted. When vomiting ceases and the fever approaches normal andfood is desired, begin with boiled skim milk in small amounts, welldiluted with cereal water, and do not approach the normal amount ofmilk for twenty-four to forty-eight hours. In this way the weakdigestive organs are not overtaxed and they gradually resume theirusual work of good digestion. When a baby seems to have no appetitefor food, lengthen the intervals from three to four or five hours, forfeeding when food is not desired usually aggravates diseasedisturbances. EXAMINING SICK CHILDREN And now, above all times, the early seed sowing of teaching the childself-control, teaching him to gargle if he is sufficiently old enough, to open his mouth and allow observation without resistance, bringssure results. The great harm of making the doctor and his medicine athreat to obtain obedience also brings its harvest at this time; forthe doctor, of all people, ought to be regarded as the child's bestfriend. When baby is sick, the doctor is needed, his daily visits mustnot be resisted, his medicines must not be feared--these and suchother matters should be made a part of every child's early education. Under no circumstances or conditions should we directly falsify to achild. Nothing is accomplished by telling a child it will not hurtwhen you know that it will hurt, or that the medicine tastes good whenyou know it is bad-tasting. Every physician can recall unnecessarydisturbances in the office because a mother has allowed a child toacquire a wrong mental attitude toward the family physician. One mother told her little girl in my office when I wished to make anexamination for adenoids which necessitated my putting my finger backof the child's uvula, "Now Mary, the doctor won't hurt you at all, itwill feel nice. " I turned to the little girl and said: "Mary, it willnot feel nice, it really won't hurt you, but it will feeluncomfortable. " It was a grave mistake to tell her that it would feelnice. The child resisted, and, while the examination was successfullymade, the greatest of tact had to be used in securing the friendshipof the child after the examination. It is far better when the throat is to be examined to wrap the childin a shawl or a sheet with his arms placed at his side, and for amember of the family to take him in her lap and hold him securelywhile the physician quickly makes the observation. And while weappreciate that sickness is not the time to introduce new methods oftraining, in instances where children have been spoiled, it is farbetter quietly and firmly to go about the task in a manner that youknow can be carried through to a successful finish. TREATMENT OF SICK CHILDREN A sick child should be encouraged to lie in his bed much of the time, and the bed should be kept clean and cool. He should never be set upsuddenly or laid back quickly. In the case of a broken leg, all rapidmovements should be avoided. A simple story or a soothing lullaby, orthe giving of a toy, will often divert attention when some painfulmovement must be made or some disagreeable task performed. Both cleanliness of the body and cleanliness of the mouth areexceedingly necessary in sickness. In all instances of disease orindisposition, the mouth must receive daily care, for stomatitis organgrene of the mouth often follows neglect. A listerine wash inproportion of one to four, or a magnesia wash, or the addition of afew drops of essence of cinnamon to the mouth wash will do much toprevent such conditions, as well as to relieve them. Applications of medicine to the throat may be made without resistanceif the tactful nurse watches her time. She should slowly introduce thetongue depressor which may be a flat stick or a spoon, when theapplication of medicine with a camel's-hair brush is quickly made tothe rolled-out throat as the child gags, and if the nurse then quicklydiverts his attention to some beautiful story or a picture or a newtoy, the treatment is soon forgotten. Under no circumstances arguewith or scold a sick child. Get everything ready, if possible behindhis back or in another room, and then with plenty of help make theapplication or the observation without words, always with gentlenessand firmness. NURSING RECORDS Whether the nurse be the mother, caretaker, practical or professionalnurse, a record should always be kept of the condition of the patient. The temperature should be reported at different periods designated bythe physician. The pulse should be recorded, the amount of urinepassed and the time it was passed, the number of bowel movements, allfeedings and the general well being of the child--whether it isrestless or comfortable, sleeping or awake, together with the waterthat he drinks. The record may be kept, if necessary, on a piece of common letterpaper, and should read something like this: March 26, 1916 7 A. M. Temperature 102; pulse 132; respiration 40; morning toilet; took 4 ounces of milk; 2 ounces of barley water; 1 ounce of lime water. 9 A. M. Enema given; good bowel movement; mustard paste applied to chest, front and back, and oil-silk jacket applied; drank boiled water, 4 ounces. 11 A. M. Took the juice of one orange; temperature 103; pulse 135. 12 Noon. Very listless and nervous; temperature 104. Has coughed a great deal. Gave mustard paste to chest, front and back, and wet-sheet pack. 1:30 P. M. Temperature 101. 8; 4 ounces of water to drink; looks better. 3 P. M. Has slept 1½ hours; temperature 102. 5; pulse 134; respiration 40; 6 ounces of food given (3 ounces of milk, 2 ounces of barley water and 1 ounce of lime water). A record like this is a great help to the physician, and such a recordmay be kept by anyone who can read and write. There are printed recordblanks which may be procured from any medical supply house and mostdrug stores. BAD-TASTING MEDICINES Castor oil has neither a pleasant smell nor taste, and nothing isaccomplished by telling the child that it does smell good or tastegood. If the patient is old enough to drink from a cup, put in a layerof orange juice and then the castor oil and then another layer oforange juice, and in this way it often can be easily taken. Someonehas suggested that a piece of ice held in the mouth just before themedicine is taken will often make a bad dose go down without so muchforcing. A taste of currant jelly, or a bit of sweet chocolate, or thechewing of a stick of cinnamon is a great adjunct to theadministration of bad-tasting medicines. All oily medicines must bekept in a cool place and should always be given in spoons or frommedicine glasses that have first been dipped in very cold water. Veryoften the addition of sugar to bad-tasting medicines will in no wiseinterfere with their action, while it often facilitates theadministration of the disagreeable dose. The majority of bad-tastingmedicines are now put up in the form of chocolate-flavored candytablets. TEMPERATURES AND PULSE The normal temperature of a baby is 98. 5 to 99 F. In the rectum. Aftershaking the mercury of the thermometer down below the 97 mark it iswell lubricated with vaseline and then carefully, gently, pushed intothe rectum for about an inch and a half or two inches, and left therefor three minutes before removing. Mothers should exercise self-control in taking the temperature, fornothing is gained by allowing a panicky fear to seize you should themercury register higher than you anticipated. Notify your physicianwhen the temperature registers above 100 F. The respirations of a child are fairly regular and rhythmic and occurabout forty times per minute during the first month of life and aboutthirty times per minute during the remainder of the year. From one totwo years, twenty-six to twenty-eight is the average. Breathing issomewhat irregular when the child is awake and may be a bit slowerwhen asleep. Before the baby is born the fetal pulse is about 150. Atbirth it ranges from 130 to 140. During the first month the pulse isfound to be from 120 to 140. By the sixth month it gets down to 120 or130, and from that on to a year the normal pulse beat of the baby isabout 120. The pulse is influenced very much by exercise and is oftenincreased by crying or nursing or any other excitement. FEVER Children get fever very easily--the digestive disturbance ofovereating, constipation, a slight bilious attack--all produce feverwhich disappears quite as suddenly as it came. The first thing to dounder such circumstances is to withhold food, give plenty of water todrink, produce a brisk movement of the bowel by giving a dose ofcastor oil, give a cleansing enema, and treat the fever as follows: After removing all of the clothes from the child, place him in a warmblanket and then prepare a sponge bath which may be equal parts ofalcohol and water; expose one portion of the body at a time and applythe water and alcohol first to one arm and then to the other arm, thechest, one leg, the other leg, the back and then the buttocks. Do notdry the part but allow evaporation to take place, and this, accompanied by the cooling of the blood which is brought to the skinby the friction, readily reduces the fever. Another procedure whichmay be employed if the fever registers high is the wet-sheet packwhich is administered as follows: Three thicknesses of wool blankets are placed on the bed and a sheetas long as the baby and just enough to wrap around him once, is wrungout of cool water and spread over these blankets. With a hot-waterbottle to the feet, the child is then laid down in the wet sheet whichis now brought in contact with every portion of his body, then theblankets are quickly brought around, and he is allowed to warm up thesheet--which lowers his temperature. Another valuable procedure is the cooling enema. Water the sametemperature as that of the body, is allowed to enter the bowel and isthen quickly cooled down to 90 or 85 F. ; in this manner much heat istaken out of the body and the fever quickly reduced. (For furthertreatment of fevers see Appendix. ) CHAPTER XXVI BABY'S SICK ROOM Visitors should never be allowed in the sick room during the height ofa disease, and during convalescence not more than one visitor shouldbe allowed at one time, and the visit then should be only two or threeminutes in length. The order and the quietness and the system of thesick room should be perfect. Visitors and loitering members of thefamily do no good and they may do much harm to the recuperatingnervous system of the child. LOCATION OF THE SICK ROOM In these days of high rents, we realize that the greater per cent ofour readers are living in apartments and homes just big enoughconveniently to care for the family during health, and while it wouldbe pleasant and convenient to have a spare room or an attic chamberthat could be used in case of illness, it is the exception rather thanthe rule that the families to whom sickness comes have these extraapartments. When a contagious or an infectious disease comes to thefamily, it is of great importance that the sick child be isolated, preferably on another floor, from that used by the immediate family. Those living in homes, more than likely can fix up a room on the atticfloor for the isolation, and those living in apartments may put thesick child in one end of the apartment, while they inhabit the otherend. One family under my observation not long ago had a child strickenwith the measles. In the same apartment there lived a puny baby notquite two years old. Coming as it did in February, the mother of thechild was apprehensive, fearing that measles would leave a severebronchitis which might mean the death of the already too-delicatebaby. She was instructed to move the baby's bed to the sun parlor inthe front of the flat, while the boy with the measles was put in theparents' room in the rear end of the flat. A sheet was suspended inthe middle of the hall leading from the living-room to the bedrooms. Door knobs were disinfected daily, a caretaker was put in charge ofthe measles patient, the mother very frequently was compelled to goback and administer a treatment, but each time she donned a largeapron and completely covered her hair with a towel, she administeredthe treatment, took off her wrappings, thoroughly washed her face andhands--disinfected them--and returned to her baby in the front part ofthe house. At night this mother slept on the floor on springs and mattress in theliving-room, and to that home the measles came and departed, and thebaby did not get them at all, so perfect was the isolation, sovigilant the disinfection, and so scrupulous the care to preventcontamination. So you see from this one instance that it is altogetherpossible to make isolation complete even on the same floor. But, mindyou, the dishes that the lad ate from were all kept in his room. Foodwas brought to the sheet and there the caretaker held her dishes whilethe cook poured or lifted the food from her clean dishes to the dishesthe caretaker brought from the sick room. Whether the sick room is in the attic or whether it be the rear end ofan apartment, if the principles of contagion and disinfection areunderstood I believe it is perfectly possible to isolate even scarletfever without danger to the other members of the family. NECESSARY FURNISHINGS For slight indispositions and trifling disorders, it is not necessaryto strip the room of its adornment, but it is well to clear off thedresser tops, protect them well with many thicknesses of newspaperscovered over by a folded sheet so that alcohol, witch-hazel and othernecessaries will not injure the mahogany or oak-top dresser. Wheneverthe children are sick, rob the room of anything that is going to be inyour way. In instances of infectious or contagious diseases, take downall silk or wool hangings, replace them by washable curtains orinexpensive ones that can be burned if necessary, and remove valuablepaintings and other bric-a-brac that later fumigation will harm orthat may gather the dust during the days of illness. Just as it is necessary for the man who mines the coal to wearsuitable garments, and for the woman who does the scrubbing to dressaccordingly, and for the nurse who cares for the case to wear washableclothes--so it is necessary to dress the sick room in garments thatare suitable, convenient, and capable of being thoroughly disinfected, fumigated, or even burned if the occasion demands. Hence, expensiverugs should be replaced by rag carpets or no rug at all, whileunnecessary articles and garments should be removed from closets, etc. Remembering that the little fellow is to remain in this room forpossibly two weeks or maybe six weeks, let us put up somebright-colored pictures that he will enjoy, bring in some books andmagazines by which he may be entertained, secure a few simple toysthat will not tax the brain, but serve as a help to pass away the longhours. There are many paper games that may be had, such as transferpictures, picture puzzles, kindergarten papers, drawing pictures, aswell as toys that may be put together to fashion new articles. A wholelot of fun can be gotten out of a bunch of burrs that can be stucktogether to make men, animals, houses, etc. Scissors and pictures areentertaining as well as paper dolls with their wardrobes. Rubberballoons, or a target gun for the boy of six will be a great source ofdelight to him; as will a doll with a trunk full of clothes for thelittle girl during her convalescent days. A tactful nurse and aresourceful mother will think of all the rest that we have notmentioned--which will amuse, entertain and keep happy our convalescentchildren, help them to forget that they are "shut ins. " THE NURSERY REFRIGERATOR It is wise in instances of the more severe childhood troubles, such asinfectious and contagious diseases, to keep as many things in the sickroom as possible, and so we remind our reader of the home-made icebox, described elsewhere in this book, in which may be kept the fruitjuices and the fruits, as well as the milk and the buttermilk. Manymedicines, particularly the oily medicines, should be kept in thishome-made ice box and five cents worth of ice a day will not only makethings taste better, especially during the warm months, but willprotect the other members of the family, for the family ice box is abig central station which must be protected against infections andcarriers of disease. In connection with the ice box, we are reminded that it would be agreat convenience to have a simple contrivance for heating bouillon, milk, or making a piece of toast, which can be readily done with anelectric heater, an alcohol stove, or a small apparatus fitting overthe gas jet. SICK ROOM DISINFECTANTS The most important thing which we are going to mention in thisdivision of the chapter is the disinfection of the door knobs. According to the directions on the poison bottle, place an antiseptictablet into a small amount of water which will make a solution of 1 to1000 of bichlorid of mercury, and several times a day disinfect thedoor knobs, particularly in the sick end of the house--thoroughlywashing and adequately rubbing with a towel moistened in thissolution. All stools and urine from the sick one will receive attention asdirected by the physician. The stools from a typhoid patient shouldstand for one-half hour in a chamber covered with a layer of lime. It is not at all necessary to have vessels containing disinfectantsubstances standing about the room and in the closet. In a roomadjoining should be kept all of the dishes used by the sick patient, his tray, half a dozen napkins, knife, fork, spoon, serving dishes, drinking glass, pitcher, etc. All bedding and all linen used by thesick member should be allowed to stand in a solution of disinfectantfor several hours when they may be wrung out of the solution, droppedinto a bucket and carried to the laundry without any danger to othermembers of the family. The nurse is not allowed to leave this room in the garments that areworn while caring for the sick. She should have her meals in anadjoining room which is also under strict isolation. THE MEDICINE CHEST The sick room medicine chest should be so placed on the wall that itis outside the reach of the smaller members of the family, for in itshould be placed poisons for external use that are capable ofproducing death if taken internally. Bottles that hold thesepoisons--such as bichlorid of mercury, lysol, carbolic acid, laudanum, paregoric, belladonna, etc. --should be so different from the otherbottles in the medicine chest that if one should reach for them withhis eyes shut or in the dark he would at once recognize that he hadhold of a poison bottle. This is absolutely necessary. It usuallymeans a bit of extra expense, but when we realize what tragedies maybe avoided by such slight expense, it must not be considered. Bottles may be procured that have been molded with points of glassprojecting from the outside which make them rough to the touch, orthey may be covered with a wire mesh or with a wicker covering whichmay easily be told from the other bottles in the case. One woman lost her life because the nurse placed two ounces ofcarbolic acid in the enema instead of two ounces of saline solution. Saline solution is nothing but salt and water, while carbolic acidcost the woman her life, simply because the carbolic acid was notplaced in a specialized poison bottle and the attendant could not readthe label in the dark. Under no circumstances keep from one year to another the remnants ofunused medicine of a former sickness, for medicines do not keep welland often lose their strength if kept longer than the physicianintended. In this medicine chest should be found the following articles: A glass graduate marked with fluid drachms (1 teaspoon), and fluid ounces (8 teaspoons). A medicine dropper. Absorbent cotton. Boric acid. Camphorated oil. Castor oil. Aromatic spirits of ammonia. Alcohol. Olive oil. Epsom salts. Soda-mint tablets. Vaseline. Zinc ointment, together with other medicines the physician orders. Ice bag, hot-water bottle and oiled silk. Besides these articles, in the nursery--in readiness for emergenciesand accidents--should be found the following: Gauze bandages of various sizes. Sterile gauze. Boric acid crystals and powder. Mustard. A pocket case of instruments containing scissors, knife, dressing forceps, etc. Syrup of ipecac. Glycerin. Tincture of iodine. Package of ordinary baking soda. Peroxid of hydrogen. Absorbent cotton. Needle and thread. Lime water. PATENT MEDICINES Aside from the giving of castor oil and the application of vaseline tothe nose, or of applying boracic acid to the eyes, no medicine shouldbe administered to the baby without competent medical advice. Thereare numerous widely advertised nostrums frequently sold as soothingsyrups to be used during the teething or during attacks of diarrhea, or cough spasms, croup, or worms, that contain dangerous drugs andshould not be given to children. Many well-meaning but ignorantmothers are slowly but surely laying the foundations for seriousnervous disorders and are often making veritable dope fiends out oftheir children. Patent medicines are dangerous things in the hands ofthe people; if we are going to give medicines to our little babies letus at least know what we are giving. Let some conscientious, scientific physician examine the baby and prescribe for its needs. If urged to use a patent medicine, examine the label carefully, forthe Federal Food and Drug Act requires the manufacturer of patentmedicines to print plainly on the label of the bottle the name andamount of certain dangerous drugs which it may contain. The drugs mentioned in this drug act and which are often used inpatent medicine nostrums are, chloral hydrate, cocaine, heroin, chloroform, alpha or beta eucaine, opium, morphin, alcohol, cannabisindica, or any derivative or preparation of any such substancecontained therein. There are many other drugs sold on the market containing syrups orflavoring materials which may do harm--which may upset the baby'sdigestion. Mothers avoid patent medicines. Consult your physician. Never give ababy any sort of medicine to induce sleep. Unless babies are sick orspoiled or hungry, they will go to sleep of themselves, and even inthe days of a high fever a wet-sheet pack seldom ever fails to put thebaby to sleep and can do no harm if properly given. This may be as good a place as any to mention the dosage of castor oilwhich is as follows: Up to three months, 1/2 teaspoon. From three to six months, 1 teaspoon. From six to nine months, 1½ teaspoons. From nine to twelve months, 1 dessert spoon (2 teaspoons). From twelve months on, 1 to 2 tablespoons. AFTER THE SICKNESS IS OVER The physician will direct when the disinfectant bath is to be given tothe patient previous to his liberation from isolation. The differentdiseases demand different treatment, but, on the whole, it is about asfollows: The day before the boy is to be allowed to go out among the familyonce more he receives a soap wash, clean sheet and bedding on the bed, and puts on clean garments. The following morning, his head thoroughlyshampooed, his nails manicured, a second soap wash is given followedby a weak bichlorid bath (1 to 10, 000 solution) which is followed byan alcohol rub. He is then allowed to go out of the sick room which isnow to be thoroughly disinfected and fumigated. After the illness is over, the sick room and the adjoining closets andante rooms must be thoroughly disinfected or fumigated. If you arelocated in a city, the health authorities will do this after aninfectious or contagious disease. Away from such conveniences, use thefollowing method: Place two ounces of crystals of permanganate of potash in a pan andhave a pint bottle of formalin near by. Everything in the room is nowexposed, dresser drawers are opened, all bedding, all garments--infact everything that is in the room--is put in such a position as tobe readily exposed to the fumes which are to follow. A line should bestretched across the room over which are thrown the bedding, garments, etc. The cracks of the windows and doors, except the one door of exit, are now sealed up with paper which has been dipped in green soap, andhaving the paper strips and pan of green soap ready just outside theexit door, the formalin is now poured over the permanganate crystals. Fumes will immediately arise and permeate every corner, crack andcrevice of the sick room. Now quickly make your exit, close the doorand seal up key hole and cracks and space under the door with paperdipped in green soap. Leave the room for six hours. After this with awell-moistened cloth to the nose, rush in and throw the windows open, hurry out and allow the room to air from twelve to twenty-four hours, after which wash woodwork and painted walls or take paper off andrepaper walls; recalcimine ceilings and closets; scrub closet shelvesand dresser drawers, bedsteads, and other furniture thoroughly. If themattress is old throw it away, but if not, sun it for several daysfollowing the fumigation. CHAPTER XXVII DIGESTIVE DISORDERS In this chapter we will consider the diseases which commonly occurduring infancy and early childhood relative to digestion and thealimentary tract. Irregularity of feeding, feeding between meals, feeding too much at any given time, as well as feeding the wrong kindof food may cause stomach disturbances and intestinal troubles. VOMITING In a previous chapter, "The Feeding Problem, " a common stomachdisturbance, vomiting, was gone into quite thoroughly, and in passingto other disorders, we wish to remind the mother that vomiting shouldalways be taken seriously. The interval between meals should usuallybe lengthened, the time spent in feeding shortened, and it is oftennecessary to withhold all milk and food of any kind for twelve oreighteen hours, giving only boiled, unsweetened water. Vomitingfrequently ushers in some acute disease, and in remote cases, when itis very persistent, it may indicate inflammation of the brain. Complete rest is essential, trotting on the knee, suddenly changingthe baby's position, or other quick movements must all be avoided. Aphysician should see the sick one and determine the cause of thetrouble. COLIC Cases of ordinary colic are usually relieved by heat to the abdomenand feet, drinking hot water in which there has been dissolved a pinchof ordinary baking soda, or a portion of a soda mint tablet, or by theuse of the photophore, as previously described. The treatment of suchordinary colic need not be given further consideration here becauseit has been described at length in a former chapter; but we do callthe attention of the mother to a more serious form of recurring colicwhich so often accompanies chronic intestinal indigestion, marasmus, and malnutrition. In most instances the food is radically at fault and should be reducedto a mixture which can more readily be digested and assimilated by thechild. Often whey mixtures, peptonized foods, or buttermilk may beindicated. The weight of the baby, the age of the baby, and the colorof the stools, must all be taken into account in the preparation ofthis easily digested food. Weak mixtures should be given at first andthen gradually and carefully the quality may be strengthened until thenormal formula is again used for the baby. Injections into the bowel of water, to which has been added one levelteaspoon of soda to the pint, will often give relief in this form ofcolic. CHRONIC INDIGESTION While this condition may occur at any time during babyhood days, itoften makes its appearance during the last half of the first year andup to the fifth year. It is accompanied by mucus in the stools, chronic flatulence, constipation or diarrhea, or the alternating ofthe two, restlessness at night, distention of the abdomen ("potbellied") accompanied by pain, a coated tongue with a fetid breath, and loss of appetite. It is a pitiable picture--the weight is usuallyreduced and the child gives the appearance of being decidedlyundernourished. This condition is usually occasioned by errors indiet, whether it be over-feeding or feeding of the wrong element offood, and, since the diet is usually responsible for the condition, inthe line of treatment diet is a prime factor. All fats must be taken from the food, sugars should be avoided, andthe amount of starchy foods, such as flour, potatoes and bread, shouldbe greatly reduced. Buttermilk, skimmed milk, eggs, green vegetables, and fruit juices should be given. In the older child, if grains areused, they should be well toasted or baked. JAUNDICE It is altogether common and physiological for the newborn baby to passthrough a few days of yellow skin which usually clears up in thesecond or third week, but it should not recur. Occasionally thisyellow tint deepens, the whites of the eyes are yellow, the urinepassed leaves a yellow stain on the diaper, while passages from thebowels are white or clay colored. If the child shows symptoms of illhealth other than the yellow tint, it should receive medicalattention. Older children troubled with jaundice should receive thefollowing treatment: The photophore as described elsewhere should beapplied to the liver and abdomen (the liver is on the right side), andthis should be followed by the application of what is known as aheating compress, consisting of three layers--a cloth wrung from coldwater, a mackintosh, and then two thicknesses of blanketflannel--which are all applied when the skin has been made red by theapplication of heat. (If the photophore is unavailable, a hot-waterbottle may be applied. ) The flannel is pinned snugly on the outside asthe wet cloth goes next to the skin with the mackintosh between. Thisshould remain on the abdomen for three or four hours, after which thehot application is again made to the liver and abdomen. Theadministration of broken doses of calomel is sometimes indicated inobstinate cases in connection with these applications of heat to theliver. Hot milk or mineral water may be taken with dry toast. In a dayor two the color should clear up, the stools should be normal again, and the treatment may be discontinued. WORMS Irritation about the rectum which cannot be otherwise explained isusually suggestive of pinworms. These seatworms or pinworms are verymuch like little pieces of cotton thread--one-fourth of an inch inlength. They grow and thrive in the lower part of the large bowel. Simple and effective treatment is as follows: It is well to bathe the parts about the rectum after each bowelmovement and often two or three times a day with a weak antisepticsolution. Itching may be controlled by the application of adisinfectant ointment, or the local applications of ice may serve thesame purpose. After a thorough cleansing of the colon by an injectionof lukewarm water containing a teaspoon of borax to the pint in orderto remove the mucus, Doctor Holt suggests that after the discharge ofthis borated enema, infusions of quassia are very helpful (SeeAppendix). Children suffering from roundworms experience a loss of appetite, varying temperature from above normal to subnormal, with colicky painsin the abdomen on coming to the table and beginning to eat. They arepale and listless, or nervous and irritable. Roundworms very much resemble earthworms in shape and color. Whiletheir home is in the small intestines they often travel to other partsof the body. They have sometimes crawled into the stomach and havebeen vomited. The only definite symptom of worms is to find the eggsor the worms themselves in the stool. No worm medicine should ever begiven by the mouth without being prescribed by a physician. Cases areon record where well-meaning mothers have killed their children bygiving an over dose of worm medicine. Tapeworms sometimes trouble children; their segments are found in thestool, and look like small pieces of tape line. The segments are flatand thin, one-fourth inch to one-half inch in width and three-fourthsto one inch in length. They are joined together and often their numberis so great the worm is many feet in length. The segments grow smallerand smaller as they approach the neck, the head of the worm being amere point. As the worm is passing from the child it should never bepulled, as the head is easily broken off, and, on remaining in thebowel, it will grow to a full-sized worm. Worms come from the eating of half-cooked meats; they enter thestomach as eggs or tiny worms, and pass out into the small intestines, where they begin to grow. They are a common parasite in the humanfamily and should be suspected in all instances where digestivesymptoms are masked or do not yield to treatment. HOOKWORM DISEASE This disease, once seen only in the southern part of the UnitedStates, is leaving its former domains as the migrating population isdistributing it more or less widely everywhere. Sandy soil and countrydistricts are infected by a tiny worm which thrives in polluted soiland enters the body through the skin of the feet. It also gets intothe body through the drinking water or from the eating of uncookedvegetables, such as are used in salads. The disease is manifested by "sallow skin, paleness, headache, swollenabdomen and sores on the legs. " Little swollen places where the wormenters the skin may be seen on the flesh. The condition yields readilyto treatment. If a child is discovered scratching his feet (especiallyin the southern part of this country), he should be taken at once to aphysician. DISORDERED STOMACH At the first symptom of a disordered stomach take all food from thebaby and give him rice water prepared by throwing a cupful ofwell-washed rice into a kettle of boiling water and allowing it tocontinue to boil for a couple of hours. The water which is strainedoff is rice water, ready for use after it is cooled. This may be givento the child at the meal hour in the place of his regular food. Itshould be kept in a glass-covered jar in the ice box. A dose of castoroil, according to the age, should be administered before the feed. Thebowels should be washed out and boiled water given freely between themeals of rice water. For a day or two (twenty-four to forty-eighthours), the child should be fed only this rice water, or until thetemperature returns to normal and he appears very hungry, at whichtime milk, which has been boiled for five minutes, may be added to therice water, first in one-half ounce quantities and graduallyincreased. Each day a little more milk is added until baby is takinghis regular food again. Many a death and many acute attacks of summer complaint are avoided bythe quick use of castor oil, and by withholding food and stopping theuse of milk as soon as the child becomes ill. STOMATITIS OR THRUSH Thrush is evidenced by fretfulness or crying on attempting to nurse. On examination of the mouth it is found to be hot and very tender andcovered with little white specks which, if looked at under themicroscope, appear to be a fungus growth. If scratched off, the mucousmembrane bleeds easily. Thrush often occurs during a fever or inconnection with other diseases, and is often due to neglect and lackof cleanliness about the bottles, nipples, etc. Taken in time it isquickly cured. An immediate dose of castor oil or milk of magnesia isindicated, and the use of a mouth wash which will be prescribed by thephysician. If neglected, it may become ulcerous or gangrenous, whichis a very serious condition. Everything pertaining to the feeding, aswell as the child's toys, hands, etc. , must be kept scrupulouslyclean. CONSTIPATION In the chapter, "The Feeding Problem, " constipation in bottle-fedbabies was discussed. The bowels should move at least once intwenty-four hours. The passages are frequently very hard and leave thebody only after a very great effort of straining. This constipation, often continuing until late childhood, should be corrected in thefollowing manner: In early infancy--as early as the fourth month--prune juice may begiven as directed elsewhere, while in later months prune pulp or figpulp, which has been carefully rubbed through a fine-mesh colander, may be given at meal time. By the time the baby is eleven or twelvemonths old, strained apple sauce may be given. We deplore the use of the water enema as a regular daily procedure; inits place we suggest the use of the enema of oil or the introductioninto the rectum of a gluten suppository or in obstinate cases aglycerine suppository. Abdominal massage should be daily administered. With a well-oiled hand, begin on the right abdomen and proceed upwardto the lower border of the right ribs and across to the left side anddown. This should be repeated many times at a regular hour each day. The mother should select an hour for the bowels to move, preferablyafter the forenoon feeding, and if the child is too small to sit uponthe toilet chair, a gluten suppository may be placed into the rectumbefore the forenoon feed and some time during the middle of the daythe bowel movement will be found in the napkin. For the older child, before a certain meal each day, a well-vaselinedpiece of cotton may be inserted in the rectum; this often produces abowel movement immediately after the meal. Laxative foods, such asbran, stewed figs, stewed prunes, or a raw apple, should be usedfaithfully--as repeated medication never corrects the difficulty, butusually prolongs it. To immediately flush out the bowel, a soapsuds enema or a plain waterenema may be allowed to flow into the lower colon, or a glycerinesuppository inserted into the rectum will quickly bring a bowelmovement. These methods are only of temporary value; a regular habitshould be formed, if possible, to bring about a natural, normal bowelmovement. When necessary to resort to drugs--such remedies as cascarasagrada, milk of magnesia, or syrup of rhubarb, are satisfactory, aswell as our old stand-by--castor oil. Regular habits must be insistedupon, and if the mother pays attention to regularity at stool in earlychildhood very little trouble will be met later on in adolescence andadult life. Chronic constipation often produces abnormal conditions about therectum such as fissures, hemorrhoids, or prolapse, which may be ofserious import. DIARRHEA Diarrhea is a symptom of an acute illness, or it may be associatedwith a chronic condition such as chronic intestinal indigestion, tuberculosis of the bowel, or may occur alternately with constipationin colitis. It is the most dangerous of all symptoms that babiesdevelop, and in spite of all the instruction given to mothers at thepresent time, in spite of all the welfare stations in large cities, and in spite of all the efforts put forth by the commissioner ofhealth, with his corps of visiting nurses--even yet, more babies dieof diarrhea each summer than from any other single cause. There are usually just two reasons for diarrhea--uncleanliness and badmilk. During the hot summer days flies multiply greatly and all mannerof bacteria and germs grow in warm, moist, shadowy places, so thatusually before the milk leaves the dairy farm it is seriouslycontaminated with disease-producing germs. If the milk is not kept ata temperature of 35 or 40 F. (which is just above the freezing point), these bacteria, particularly the manure germ, grow at such a rate thatby the time the milk gets to the infant it is teeming with bacteria, and diarrhea is the sure result. Another form of diarrhea is cholera infantum, where the stools soonbecome watery and colorless. The vomiting is almost incessant andthere is high fever. Fortunately it is a rare disease, but when onceseen it is never forgotten. One beautiful baby weighing nearly thirtypounds was reduced to sixteen within forty-eight hours, and when deathcame he could hardly be recognized because of the wasting from thismost dreaded of infant diseases. Another form of diarrhea is seen in an acute inflammatory condition ofthe intestine itself. The stools contain more or less mucus and blood. The bowel movements, which are very frequent, are accompanied by agreat deal of pain and straining. This form is often seen in the moresevere types of summer dysentery. We wish to impress upon the reader'smind that these diarrheas may all be avoided if the baby's food isclean and free from germs, if the apple or pear is not only washed, but thoroughly scrubbed before paring during the summer months. If allthe bottles, nipples, water, toys, etc. , are adequately clean, nosummer diarrhea, no dysentery, no other infection due to dirt, willattack the baby. Of paramount importance is the pasteurization of milkduring the summer months, as mentioned elsewhere. TREATMENT OF DIARRHEA Simple diarrhea in the older child of two or three years is treated asfollows: Take away all solid foods. Give a big dose of castor oil, thoroughly wash out the bowel by warm water containing a levelteaspoon of salt and a level teaspoon of baking soda to the pint, andput the child to bed in a quiet room. Boil all milk for ten minutesand thicken it with flour that has been browned in the oven; feed thisto the child at five-hour intervals. After each bowel movement, nomatter how often they come, the colon should be washed out with thesalt and soda enema as before mentioned. Bear in mind that the child is losing liquids, and so, after thebowels have moved, boiled water should be given by mouth, or a cupfulof water can often be retained if it is introduced into the rectumslowly under very low pressure. Twenty-four or forty hours shouldclear up a case of simple diarrhea, and on returning to food it shouldbe dry toast and boiled milk. For the younger baby, withhold all milkand give barley water or rice water for the first twenty-four hours, returning to milk very gradually and slowly. For the more severe types, such as the dysentery containing mucus andblood, everything that has been done for the simple diarrhea should bedone; the baby should be kept very quiet, while castor oil should bepromptly administered. Food is withheld and the bowels are carefullyirrigated after each movement with the salt and soda solutions. Afterthe bowels have moved from the castor oil, then bismuth subnitrate, which has been dissolved in two ounces of water, should be given--oneor two teaspoons every three hours. This will naturally turn the bowelmovements dark. Under no circumstances should any other medicines be given without thephysician's knowledge, as it is at such times as this that many"would-be friends" advise laudanum, paregoric, and other opiates. Theskin must be kept warm, and fluids must replace those that have beencarried off in the many stools. Water may be given by an enema, bywater drinking, and in such rare cases as cholera infantum, when watercannot be retained on the stomach, it often becomes necessary toinject it under the skin (hypodermoclysis) so that it may go at onceto the wasted tissues and perhaps save the baby's life. Give the baby ten days or two weeks to return to normal condition, andunder no circumstances hurry the feeding of milk, as a second attackmay occur much more readily than the first; may more profoundlyovercome the baby and result in death. RUPTURE A protrusion of a loop or portion of intestine through a weakenedabdominal muscle--which grows larger when baby cries and smaller whenhe is lying down in a relaxed condition--is known as rupture orhernia, and is of common occurrence in infancy. It is often seen atthe navel and sometimes in the groin as early as the second week. Hernia is always dangerous and should never be neglected. Thephysician will protect the navel by a special support with adhesiveplaster which is carefully renewed twice a week, and if worn forseveral months usually entirely corrects the condition. A comfortabletruss made from skeins of white yarn will amply protect a groinhernia. The condition should always be taken seriously and receiveimmediate treatment. PROLAPSE OF THE BOWEL Occasionally, as the result of severe straining in constipation, therectum protrudes sometimes one-half inch, and in rare instances two orthree inches. The placing of a young child upon a toilet chair andinsisting upon severe straining sometimes results in such a protrusionof the rectum. This may be avoided by the application of vaseline tothe rectum or by the use of the gluten or glycerine suppositorieswhich cause the hardened masses to make their way out easily. Someonehas suggested that if the buttocks are supported by a board placedover the toilet seat with a two-inch opening so that severe strainingof the rectal muscles is impossible, the prolapse of the rectum willnot recur. The moment the mother observes the slightest protrusion of the rectumshe should quickly put it back and have the child lie down and movethe bowel in the diaper. Very severe cases require a physician'sattention, but if prompt and quick measures are taken on the firstappearance it may be quickly corrected and serious consequences beavoided. In this connection we might mention a condition which sometimes babiesare born with--the absence of the rectal opening. If the baby's bowelsdo not move for the first two days, surgical interference is more thanlikely necessary. Often the external opening alone is missing. Sometimes there is a complete closure or atresia of the lower part ofthe colon. BLEEDING FROM THE NAVEL There should be no hemorrhage from the umbilical stump after it hasbeen properly tied, but occasionally a bit of blood is found upon thedressing and a second tying of the cord stump is necessary. The corddrops off in eight or ten days, and the umbilicus that is left may bemoist or it may bleed slightly; if such is the case, great care shouldbe exercised in bathing this ulcer that has been left behind. Itsimply should be touched with alcohol, a bit of boric acid powderapplied, and a small piece of sterile gauze be placed over it. In thecourse of two or three days it will entirely heal. Care should alwaysbe exercised in washing the umbilicus. Extensive hemorrhage from thisportion of the body is rare, but it does happen occasionally and is asevere condition which demands surgical attention. If the umbilicus remains moist and foul smelling, general bloodpoisoning of the infant may easily follow. Thorough dusting with boricacid powder, with possibly a little oxide of zinc, will usually effecta cure promptly, but should the condition continue, which it does onlyin rare instances, the doctor may have to cauterize it. CHAPTER XXVIII CONTAGIOUS DISEASES Never under any circumstances knowingly expose a child to any of theso-called "childhood diseases. " The old method of "have the child getthem as quickly as possible and get over them, " has laid thefoundation for many chronic disorders later in life. For instance, eyetroubles and running ears are often the sequelae of measles; chroniccoughs, tuberculosis and bronchitis frequently follow in the wake ofwhooping cough; heart disorders follow diphtheria, while kidneydisease often follows in the course of scarlet fever. CATCHING DISEASE Under all circumstances keep the children away from these dangerouschildhood diseases. When a contagious disease breaks out in a schooland the little fellow has, along with the other pupils, been exposedto it, begin at once systematically to keep the nose and throat veryclean with such well-known sprays as the champhor-menthol-albolenespray, which should be used in the nose morning, noon, and night. Throat gargles, such as listerine, or equal parts of alcohol andwater, help to keep the throat in condition to resist the microbicinvasion. During this anxious time of patient waiting the bowels should moveevery day and the food should be cut down at least a third. In otherwords, moderate eating and a clean bowel tract go a long way towardkeeping a child well and preparing him for an attack of disease. Theskin at this time should be kept well bathed and free from theaccumulated skin secretions which clog up the sweat glands andotherwise lower the vitality. Stuffy, close rooms, where the ventilation is poor, not only harbordisease germs, but also lower the vitality of the child. Never takeyour child into a household where there is any form of sickness, forit may turn out to be a contagious disease--no matter how it began, itmust be remembered that many contagious diseases, in their earlierstages, much resemble a simple cold. Measles come on rather gradually, and one might suspect that the childwas simply suffering from a severe cold in the head. Scarlet fever usually begins with a sore throat, while chickenpox hasvery few initial symptoms; usually the first thing noted is the rashitself. Diphtheria begins with a sore throat, while whooping coughbegins very insidiously. The most important thing is to keep children away from people who aresick, and if a contagious or infectious disease is prevalent in theneighborhood discourage the mingling of the children in hot, illyventilated rooms. Put a stop to "parties" and all similar gatherings. Let the little folks have good books, plenty of toys, in awell-ventilated room, and the more they keep to themselves at thisparticular time the better they are off. THE SPREAD OF CONTAGION It is possible to "stamp out" any known disease if only propercooperation takes place and certain sanitary regulations aremaintained. It is within the memory of most of our readers when yellowfever was put to flight and the cause of malaria discovered. Welearned to screen our camps and no longer did our soldiers contractthe fever; while the simple covering of stagnant pools with oil, together with proper screenage, stopped the ravages of malaria. Likewise, many of the woeful tragedies of infant summer diarrhea anddysenteries have been tracked to the so-called "innocent house fly. "We have all learned--only recently--that if we move the manure pileonce in seven days the hatching of the maggots may be prevented, andso millions, yes trillions, of these carriers of disease may never beborn. If there is one sweet morsel above another for this fly pest it istubercular sputum or feces, and from these feasts they go directly towalk over baby's hands, crawl over his cheek, and wash their feet inhis milk. Proper screenage will prevent such contamination of food, such opportunities for carrying disease. Sunshine, hot water, soap, and fresh air, are the best ordinaryevery-day disinfectants. It is possible so to conduct the treatment ofa contagious or infectious disease that no other member of the familymay contract it. A few simple but very important hints are: 1. Door knobs are one of the very greatest avenues ofcontagion--disinfect them. 2. Cleanse the hands both before and after attending to the sick;first, scrub with stiff brush, soap and water, then dip in alcohol. 3. An epidemic of sore eyes may be stopped by absolute "handdisinfection" and using separate towels. 4. Do not go visiting when you have a "common cold. " 5. Kissing is one of the best ways of spreading many diseases. 6. In cases of contagious and infectious diseases completely cover allexcretions from the body with lime. 7. Country homes would be as healthy as city homes if the privies andstables were screened. 8. In the country, the well water should be boiled; one infected wellmay be the cause of the death of a score of beautiful children. INCUBATION PERIODS The incubation period of scarlet fever is from one to seven days. Measles, ten to twenty days. Whooping cough, from one to two weeks. Chicken-pox, fourteen to sixteen days. German measles, seven to twenty-one days. Diphtheria, any time from one to twelve days. Mumps, from one week to three weeks. Of all the diseases, measles and chicken-pox are probably the mostcontagious. In scarlet fever and diphtheria, close contact isnecessary for exposure, while whooping cough can actually becontracted in the open air, young babies being particularlysusceptible. TYPHOID FEVER Typhoid fever is a disease of the small intestine. Typhoid germsaccumulate in the little lymph nodes of the small intestines and thatis the reason why we often have so many hemorrhages from thebowel--actual ulcerations take place--and if an ulcer is situated inthe neighborhood of a blood vessel hemorrhage may result. Typhoid fever begins rather insidiously with a slight debility andloss of appetite, but if a temperature record is kept the fever willbe found to rise from one-half to a degree higher each day. A steadyclimb in the temperature curve is noted until the end of the firstweek, when it remains for a week, possibly 103 or 104 F. After oneweek it begins slowly to decrease and, if all goes well, the earlypart of the fourth week usually finds the temperature about normal. Itis exceedingly important that the child be kept in bed during theentire course of the disease. The bed pan must be used at each bowelmovement or urination. _First Week Treatment. _ During this week the child may feel quitewell, but he should be kept in bed and sustaining treatmentsbegun--such as wet-sheet packs and cold frictions to the skin (duringwhich time there should always be external heat to the feet). The dietmust be full and nourishing, but all pastries and "knicknacks" shouldbe avoided. Abundance of fresh fruit that has been well washed beforeparing, eggs, pasteurized milk, baked potatoes, and toasted bread maybe taken at regular periods--with an interval of not less than fivehours between meals. The bowels should be opened in the beginning of the disease with aliberal dose of castor oil, after which daily colonic irrigationsshould be employed. These enemas should be given at least once a day, the temperature being about that of the body, with a smaller terminalenema about five degrees cooler at the close of each bowel cleansing. _Second Week Treatment. _ The normal temperature at this time is nolonger 98. 6, it is 101. 5 F. This fever is essential to the curativeand defensive processes of the body; and while we do not care to havethe fever fall below 101. 5, at the same time nothing is to be gainedby allowing the fever to go up much above 102. 5 or 103 degrees F. Andso, during the second week, while the disease is at its height, wemake frequent use of the wet-sheet pack, always remembering that theextremities must be kept warm and never permitting the skin to becomeblue or mottled while the cold treatment is being administered. Sincethe real disease is localized in the small intestine, we will nowdescribe a very important treatment for the diseased bowel--and onewhich is also very useful in combating high temperature. _The Cooling Enema. _ The temperature of this enema begins one degreehigher than that of the body (supposing the body temperature to be103, the temperature of the enema would start at 104 F. ). This isallowed to flow into the colon and out again, under low pressure, without disturbing the patient, by means of a glass tube connection(See Fig. 15). The temperature is quickly brought down to 100, then to98, then to 90, usually finishing up at 80 or 85 F. The water isallowed to enter the rectum slowly through a soft rubber catheter (nota hard rectal point), and as it comes out it will be noted that thewater is very warm, sometimes registering 105, and it is needless toadd that if the water goes in at 80 and comes out at 105 F. , much heathas been taken from the body; and so, of all the treatments we have tosuggest for typhoid fever, the one just mentioned is possibly the mostimportant. When it is necessary to keep up this enema for an hour ortwo, the cool water may cramp the bowels, but this may be entirelyobviated by applying hot compresses to the abdomen. Another treatment of great importance in this second week is the coldabdominal compress. Much fever is occasioned in the abdomen because itis the seat of disease, and the much dreaded hemorrhages which oftencause the death of the patient are usually avoided by the use ofabdominal compresses--wrung out of water at 55 F. --the temperature ofordinary well water--and changed every twenty minutes. [Illustration: Fig. 15. The Cooling Enema] I recall one mother in my dispensary practice who was so poor shecould not afford a nurse, her only helper being a son twelve yearsold. A nurse went to the house twice each day and taught this lad oftwelve years to give his mother the cooling colonic irrigation; he wasalso taught to warm up the abdomen by a hot application and afterwardsto apply the cold compresses. The mother made a good recovery. During this second week the diet should be sustaining. It shouldconsist of boiled milk, eggs, fresh fruit and fresh fruit juices, dextrinized grains (hard toast, toasted corn flakes, shredded wheatbiscuits, etc. ). The mouth should be kept scrupulously clean, for inall the infectious and contagious diseases there is always thepossibility of gangrene in the mouth if it is neglected. _Third Week Treatment. _ This is the week we look for hemorrhage fromthe bowel unless the abdomen has been well treated during the secondweek; and even so, the cool compresses to the abdomen will becontinued well into the third week--also the daily or semi-dailyenema. The skin is kept in good condition with soap washing andfriction baths, and a fairly liberal diet is maintained. During thewhole course of the disease the skin is never allowed to get blue ormottled, being quickly restored to the normal red color by the mustardsheet bath, the short hot-blanket pack, or the dry-blanket pack withhot-water bottles. Under no circumstances let the child leave the roomor his bed for at least another week. MUMPS Infants are rarely affected with mumps. It is a disease of thesalivary glands and (as a rule) is usually preceded by pain betweenthe ear and the angle of the jaw, accompanied in a short time byswelling and temperature. It is distinctly contagious even during theincubation period. There is much tenderness on pressure, and chewingis difficult and may be impossible. It usually occurs on the face andonly one side may be affected. The bowels should be kept open, themouth should be kept clean, and the side of the face should beprotected by a layer of cotton held in place by bandages. Hot fomentations may be applied if the pain is severe. The electriclight bulb on an extension cord, that was mentioned in connection withearache, is very comforting in this condition. Isolation should be maintained for ten days or two weeks after allsymptoms have disappeared. SCARLET FEVER Scarlet fever is one of childhood's most dreaded diseases because of, first, its long quarantine; second, its terrible possibilities ofcontagion; and, third, its sequelae. Absolute quarantine is necessary until ten days after the last signsof desquamation have disappeared. This disease is always alarming because of the possibilities of itssequelae--the danger of pneumonia, inflammation of the ears, abscessesof the glands of the neck, and nephritis (inflammation of thekidneys). Scarlet fever is highly contagious at any time during its onset andcourse. Among the first symptoms of the disease are sore throat, swollen glands, fever, etc. Vomiting on a street car or at the moviemay spread the disease to more than one child who might otherwise haveescaped. One child who may have only a very light form of the diseasemay give it to another child in the most severe form. Any such groupof classic symptoms--vomiting, fever, rapid pulse, and sorethroat--should cause any parent immediately to isolate the littlesufferer for several days--awaiting the "rash"--which usually puts inits appearance after three or four days of increasing temperature. This rash has an appearance "all of its own, " unlike any other. Because the fine "meal-like" red points are in such close proximity, the skin assumes a smooth "lobster red" color that is never to beforgotten. After three days of increasing redness, the color beginsslowly to fade, and after four or five days of this fading a peculiarpeeling takes place, whose scales vary in size from a small fleck tocasts of the whole of the soles of the feet and the palms of thehands. During the height of the disease, the throat is very red, the tonsilsare not only inflamed, but covered over with white patches, the headaches and the tongue possesses a peculiar coating through which peepthe red points of the swollen papillae, presenting the classic"strawberry tongue" of scarlet fever. After ten days the fever disappears and the "real sick" stage of thedisease is in the past. Each morning of the ten previous days a small dose of Epsom salts isusually administered and the itching, which so often accompanies therash, is relieved by carbolized-water sponge baths. The nose, throat, and ears receive daily care--sprays to the nose andgargles to the throat, as well as special swabbing to the tonsils. The physician in charge of the case will note the urinary findings, guard the heart and kidneys, prevent the spreading of the scales ofdesquamation by frequent rubbing of the skin with oil, and otherwisework for the future well-being of the patient. MEASLES Measles, one of the most common diseases of childhood, is not to beregarded lightly, for very often its sequelae--running ears, weakeyes, and bronchial coughs--may prove very serious and troublesome. Tuberculosis of the lungs not infrequently follows in the wake ofmeasles. The early symptoms of measles are so mild that often thechild is out of doors, at school, or about his usual play, until thesecond or third day of the fever. He was supposed merely to besuffering from a simple "cold in the head. " On the third or fourth day the patient begins heavy sneezing and wearsa stupid expression; and it is then that the mother ascertains thathis temperature is perhaps 101 to 102 F. He is put to bed and the nextday the rash usually appears. The rash is peculiar to itself, notusually mistaken for anything else, being a purplish red, slightlyelevated, flattened papule, about the size of a split pea. Thecoughing, which is very annoying, usually remains until about theseventh or eighth day--at which time the fever also disappears. The bowels must be kept open; a daily bath be given--in which has beendissolved a small amount of bicarbonate of soda (simple bakingsoda)--after which an oil rub should be administered. The nose shouldbe frequently sprayed with three per cent camphor-menthol-albolinespray, while the throat is gargled with equal parts of alcohol andwater. The feet should be kept warm by external heat, while thephysician in charge may order additional attention to the chest, suchas a pneumonia jacket, etc. Care should be taken to guard against "catching cold, " for bronchitisor pneumonia is quite likely to develop in many cases of measles. Theeyes should be protected by goggles and the room should be darkened;under no circumstances should the little patient be allowed to read. Carelessness in this respect may mean weakened eyesight all the restof his life. Until two weeks after the rash has disappeared, thelittle fellow should be kept by himself, for the desquamation keeps upalmost continuously during this time. The food during the course of the disease is a liquid and soft diet. Children should never be allowed to go to a party or gathering with acold in the head; the mothers of a group of small children will neverforget the time that one certain mother allowed her little fellow toattend a party with "simply a cold in the head. " He laughed, talked, and sneezed during the afternoon and when he went home the rashappeared that night, while eight of the ten exposed children came downwith measles during the next two weeks. CHICKENPOX The incubation period of chickenpox is from ten to seventeen days. Itis a mild disease, with a troublesome rash consisting of widelyscattered pimples appearing over the scalp, face, and body. Thesepimples soon became vesicles (small blisters), which in turn quicklybecome pustular, afterwards drying up with heavy crust formation. Severe itching which attends these pustules may be greatly allayed byeither the daily carbolic-acid-water bath or a baking-soda bath. Theitching must be relieved by proper measures, for if the crust isremoved from the top of the blebs by scratching, a scar usuallyresults. The bowels should be kept open, the diet should be soft. Rigidly isolate, for chickenpox is highly contagious. SMALLPOX This disease occurs oftenest during the cold season. It spares no oneunless vaccinated, attacking children and adults alike. The earlysymptoms are: headache, pain in the back, high fever, vomiting, andgeneral lassitude. In many respects these resemble the symptoms of thegrippe, while on the third day the eruption appears. The pimples arehard and feel like shot under the skin. Within a day or two theseshotlike pimples have grown and pushed themselves beyond the skin intolittle conical vesicles which soon turn to pus. By the eighth or ninthday crusts are formed over the vesicle, beginning to fall off aboutthe fifteenth day. Patients are quarantined usually eight weeks and when a case ofsmallpox in the home breaks out everyone in the family should berevaccinated. The strictest isolation is important from the first ofthe disease. We will not enter into the treatment of smallpox, for medical aid issought at once and usually the patient is removed to a specialisolation hospital. VACCINATION The history of the change brought about in the Philippines sincevaccination has been introduced is an argument of itself which oughtto convince the most skeptical of the value of vaccination. By allmeans, every child in a fair degree of health should be vaccinated. Itis wise to vaccinate babies before the teething period--from the thirdto the sixth month. Babies with any skin trouble or suffering frommalnutrition, but not living in a smallpox district, should bevaccinated during the second year. In young babies, under six months, the leg is the proper place to receive the vaccination. If proper surgical cleanliness is practiced and ample protection isafforded in after dressing, vaccination need not be a taxing process. The child suffers from general lassitude--a little drowsiness withloss of appetite and a small amount of fever--but this passes off in areasonable length of time, especially if he is not overfed and hisbowels are looked after. On the second or third day after vaccinationa red papule appears which soon grows larger, and, after five or sixdays, it becomes filled with a watery fluid. By the tenth day it hasthe appearance of a pustule about the size of a ten-cent piece, surrounded by a red areola about three inches in diameter. At the endof two weeks the pustule has dried down to a good crust or scab, inanother week it falls off, leaving a pitted white scar. If the vaccination does not take, it should be repeated after aninterval of two months. DIPHTHERIA Diphtheria is a disease much dreaded during childhood and adolescence. It may attack any age--even little babies are susceptible. It beginswith a general feeling of heavy, drowsy lassitude with a sore throat. White spots appear on the tonsils which may resemble a simplefollicular tonsillitis, while in a short time white patches spreadover the throat and tonsils. It is not at all uncommon for this membrane to attack the nose, producing a bloody, pustular discharge; and when it does attack thenose, it is none the less contagious and must be regarded just asseriously. A physician is called at once, and, not only to the child, but to the other members of the family, antitoxin is immediatelyadministered. The disease runs a regular course and its most dangerouscomplication is the membrane which forms in the larynx and threatensto suffocate the child unless prompt intubation is performed--theslipping of a silver tube in the larynx to prevent suffocation anddeath. The early use of antitoxin greatly lessens all these seriouscomplications. Care must be exercised to prevent sudden heart failure; and this isdone by raising the child to an upright position with the utmost care;while you insist upon him lying quietly upon his back or his side, long after the disease has left his throat. While the throat or noseis the seat of disease, the toxins from these most dreadeddiphtheritic microbes spread through the lymph channels and the bloodvessels to the heart itself--so weakening that organ that it sometimessuddenly fails, or becomes more or less crippled for life. Theseserious results are to be prevented by the science of good nursing andthe prompt use of antitoxin. In these days the "Schick test" may beadministered for the purpose of ascertaining whether one issusceptible to contracting diphtheria. A physician is always in charge of diphtheria, and he will supplydirections for the bowels, the diet, and the sprays for the nose andthroat, and the general well-being of the suffering child. Isolationand quarantine should continue for two weeks, and in bad cases threeweeks, after the membrane has disappeared from the throat. WHOOPING COUGH A child suffering from a continuous cough, particularly if it isaccompanied by a whoop or a condition which is so often seen inchildren who cough--not able to stop--should not be taken to church, nor to the movies, nor allowed to go to school; neither should he beallowed to leave his own yard. The average duration of the disease isusually six weeks. The child should have an abundance of fresh air, should spend much of his time out of doors, and while in the houseshould avoid dust of every kind; at night he should not be exposed todrafts. Call the physician early in the case and he may attempt tothwart the progress of the disease by certain administrations ofvaccine medication. In very bad cases, where a young child cannot catch his breath andgets blue in the face--which, fortunately, is uncommon--he should beslapped in the face with a towel wet in cold water; or, he may belifted into a tub of warm water, then quickly in cold water, then backinto the warm, etc. Hygienic measures should prevail, such as keepingthe bowels open, the skin clean, and the use of the usual throatgargles and nasal sprays. Do not be misguided by the old-time thoughtthat whooping cough must run its course; for, if medical aid ispromptly secured, the disease may often be cut short and the severeparoxysms greatly lessened. EYE INFECTIONS Not long ago while in North Dakota near Canada, we took a trip one dayjust over the border to visit several villages of Russian peasants. Wefound the boys and girls of nearly the entire village suffering fromtrachoma--a dangerous, infectious disease of the eyes which spreadsalarmingly from one child to another. We saw the disease in all of its varying degrees among the children. Some of them had swollen, reddened lids. A discharge of pus was comingfrom the eyes of others, and they could not look toward a light or thesun. This disease is spread in a hundred different ways--through thecommon use of wash basins, towels, handkerchiefs, tools, toys, doorknobs, gates, etc. , and that is the reason why these isolated villagesof foreign people who could neither read nor write the Englishlanguage were nearly all so sorely afflicted. The ordinary condition of "catching cold in the eye" ("pink eye") isjust as infectious as the trachoma which we have mentioned, althoughit is more of an acute disorder and nothing like so serious. In all such cases a physician is to be called immediately, isolate thepatient, and give strict attention to carrying out the doctor'sorders. Another form of inflammation of the eye which was mentioned in aprevious chapter, is the inflammation of the eye of the newborn. In most civilized districts at the present, especially where the casesare attended by a physician, the eyes of all newborn babies aretreated with either argyrol or silver nitrate. Just as soon asdefective sight is discovered in the child the eyes should be examinedat once and proper glasses fitted. While the glimmer and shimmer ofmoving pictures may seriously interfere with the child's vision, onthe other hand, this very thing often discovers the defect in theeyesight earlier than it would otherwise be found out. RUNNING EARS Inflammation of the ears was fully covered in our discussion ofadenoids and tonsils, but we would like to add at this time that underno circumstances should a running ear be regarded lightly. A chronicmastoiditis (inflammation of the middle ear) often follows measles, scarlet fever, adenoid infection, and inflammation of the tonsils. Theattention of a specialist should be called to it and his instructionsmost carefully carried out; for, when we have a sudden stopping of thedischarge from the ear with high fever and pain behind the ear, sometimes an operation is imperative or the child may be lost. CHAPTER XXIX RESPIRATORY DISEASES Next to digestive disturbances, babies suffer more frequently fromrespiratory disorders--colds, bronchitis, and pneumonia. In fact, during very early infancy, pneumonia heads the list of infant deaths, only to be displaced a few months later by that most dreaded summerdisease--diarrhea. Little tiny babies are so helpless--they are so dependent upon theirseniors for life itself--that our responsibility is indeed great. Weshould put forth our best endeavor to avoid and prevent common colds. Among all the common maladies that afflict the human race "colds"probably head the list; and, in the case of babies and the youngerchildren, the common colds often go on into coughs, croup, bronchitis, and even pneumonia. WHY BABIES CATCH COLD 1. Someone has brought the infection to him. 2. Somebody coughed in his face. 3. Germ-laden hands have handled the baby. 4. He has drunk from an "infected" glass. 5. There was not enough moisture in the air. 6. Somebody wiped his face with an infected towel. 7. Baby was allowed to play on the cold floor. 8. Baby's lowered vitality could not stand the combined strain of overeating and clogged up bowels. 9. Baby was kissed in the mouth by a "cold-germ" carrier. 10. Baby was dressed too warmly--and then taken out. 11. Somebody carelessly breathed in baby's face. 12. He slept in a stuffy room. 13. His extremities got chilled. 14. Baby has adenoids or diseased tonsils. Babies should not be allowed to sit or play on cold, drafty floors. They may play on mother's bed whose open side is protected withhigh-back chairs, or they may play in their own bed whose raised sidesare sheltered by blankets. It is possible for a mother so to disinfect her hands, and so garbherself with clean, washable garments, that, although she may besuffering from an acute cold, she may continue to care for her babyand the baby need not contract the cold. CORYZA--COLD IN THE HEAD This most annoying ailment, a cold in the head, is particularly hardon babies because the obstruction of the nasal passages not only makesbreathing difficult, but renders nursing well-nigh impossible. The throat end of the eustachium tube (the ear tube) is found in theupper and back part of the throat, just behind the nose. The infectionof the cold extends from both the nose and throat and there results aspreading inflammatory process on through these ear tubes into themiddle ear itself. Now if this tube swells so much that it entirelycloses, as so often happens in cases of "cold in the head" as well asin constant irritation from adenoids, then may follow a vast train ofdifficulties--earache, mastoiditis, etc. --with the result that thetiny bones in the middle ear which vibrate so exquisitely may becomeankylosed (stiffened) and deafness often follow. Everything known mustbe done to prevent baby's catching "cold in the head. " If the sinusesbecome infected it may also lead to serious consequences. When the nose becomes clogged it may be opened up by repeatedlydisinfecting the inside of the nose with oily sprays such as simplealbolene or camphorated-albolene spray. The bowels should be quickly opened by castor oil, and the feedingsshould be cut down at least two-thirds or one-half. Public drinking cups should always be avoided and kissing the baby betabooed. GRIPPE The treatment of influenza in infancy and childhood is to avoidcontact with an older person suffering with the grippe. Ordinarily, the so-called "grippe" is a common, mixed infection--not trueinfluenza. Coryza and cough are the chief respiratory symptoms whichattend these widespread epidemics. Often vomiting and diarrhea areseen in the young sufferers. In cases of grippe put the child to bed and call the doctor. In thecase of the older children, the treatment and care to be recommendedhas been fully outlined by the author in the little work entitled _TheCause and Cure of Colds_. Complications from the grippe are very frequent in children--such assevere diarrhea, enlarged glands of the neck, running ears, bronchitis, pneumonia, and sometimes tuberculosis. Every effort should be put forth to isolate and quarantine the firstmember of the family to be stricken with grippe so that the remainingmembers may, if possible, escape an uncomfortable and unhappy siege. SORE THROAT The danger of permanent deafness which so often follows a sore throatas well as a cold in the head, should cause every mother or caretakerearnestly to begin treatment at the very first sign of a sore throat. When a little baby gulps or cries on swallowing, a sore throat shouldalways be suspected and remedial measures promptly instituted. A most convenient article with which to examine an infant's throat isa small pocket flashlight. The pillars of the throat or the tonsils orboth may be much inflamed, and since tonsillitis, diphtheria, andscarlet fever all begin with a sore throat, it is wise early to seekmedical counsel in order that the differential diagnosis may bepromptly made. We urge the mother, as a rule, not to attempt todiagnose severe cases of sore throat. Send for the physician. Tonsillitis is a severe form of sore throat which, fortunately, rarelytroubles tiny infants; but for every sore throat, while waiting formedical help to arrive, lay your plans to empty the bowels, diminishthe quantity of the food, swab or spray the throat, and later closelyfollow the physician's advice concerning the general treatment of thechild. ADENOIDS Adenoid growths appear as grape-like lymphoid formations located inthe upper and posterior-nasal pharynx. These adenoids secrete a verytoxic, thickened fluid, which slowly makes its way down along the backwall of the throat, and reddens and inflames first the anterior andposterior pillars of the throat and then often inflames and enlargesthe tonsils. Adenoids not only obstruct the respiratory passage way to the throatand lungs, but they also exert a harmful influence on the generalphysical and mental development of the child. It is nothing less than criminal for heedless parents to allow adenoidgrowths to remain in the child's post-nasal pharynx. The littlefellow's face is disfigured, more or less for life, his mentalitydulled, while he is compelled to breathe through his mouth. An almost miraculous change often follows the complete removal ofthese obstructive adenoids--the child takes a renewed interest ineverything about him. More oxygen finds its way to the tissues, hisface takes on better color, he gains in weight, in fact, there appearsto be a complete rejuvenation mentally and physically. The signs or symptoms of adenoids are mouth breathing, restlessness atnight, snoring, recurring colds, nasal discharge, swelling of theglands of the neck, poor nutrition, loss of appetite, bed wetting, impaired hearing, lack of attention, and mental dullness. The removalof adenoids is neither a serious or difficult procedure, and they maysafely be removed at any age. DISEASED TONSILS Tonsils which remain permanently enlarged and show signs of diseaseand debilitation--filled crypts--may be removed as early as the fourthor fifth year, if necessary. If proper treatment does not improve thetonsils as the child grows older, their removal should seriously beconsidered. The tonsils may serve some special secretory or defensivefunction during the first few years of life and we think best, therefore, not to advise their removal--except in extreme cases--untilthe child is at least four or five years old. When it is necessary to attack the tonsils, they should be thoroughlydissected out--not merely burned or clipped off. If they are properlyremoved, the danger of heart trouble, rheumatism, and many otherinfections may be considered as greatly lessened. After five years of age the normal tonsils should begin to shrink, andat about the beginning of adolescence they should be no larger than asmall lima bean, hidden almost completely out of sight behind thepillars of the throat. While healthy tonsils may serve some usefulpurpose even in the adult, it is almost universally conceded that thethoroughly bad and diseased tonsil is utterly useless to thebody--only an open gateway for the entrance of infection. BRONCHITIS A very common disorder of early infancy and childhood isbronchitis--an inflammation of the bronchial tubes--accompanied bysevere coughing. Its tendency to pass into pneumonia renders it adisease for skilled hands to treat--a disorder hardly safe for eventhe well-meaning mother to undertake to manage without medical adviceand help. And since bronchitis is usually accompanied by alarmingsymptoms of high fever, weakened heart, embarrassed breathing, mottledor blue skin, green stools, troublesome cough, disturbed sleep, "stopped up nose, " and "choked up throat, " it is of utmost importancenot only to seek medical aid early, but also that the mother, herself, should have definite ideas concerning the proper manner of doing thefollowing things in the line of treatment: 1. Making and applying a mustard paste. 2. The fashioning of an oil-silk jacket. 3. Improvising a steam tent. 4. Flushing out the colon, and a score of other things which the watchful doctor may want given any moment. _Mustard Pastes_ are prepared by mixing one part of mustard and sixparts of flour in warm water and applying to the chest between twopieces of thin muslin. It is left on just seven minutes and thentalcum powder is thickly sprinkled on the moist, reddened skin; thispowder quickly absorbs all the moisture and leaves the skin in a goodcondition--ready for another paste in three hours if it is so ordered. _The Oil-Silk Jacket_, or pneumonia jacket, consists of threelayers--the inside of cheesecloth, an inner thin sheet of cottonwadding, and an outside layer of oil silk (procurable at any drugstore). It should open on the shoulder and under the arm on the sameside. It is worn constantly (change for fresh cheesecloth and cottonevery day) during the inflammatory stage; it is removed only duringthe mustard pastes. _A Steam Tent_ may be prepared by placing a sheet over the infant'scrib and allowing steam to enter from a large paper funnel placed inthe nose of a tea kettle of boiling water kept hot on a small stove ofsome sort. The mattress and bedding are covered with rubber sheeting and theinfant's clothes protected from moisture. The baby should remain inthis steamy atmosphere ten minutes at a time. Another method is to hold baby in arms near the large end of a bigfunnel placed in a tea kettle on the gas stove or range, and then havean assistant help hold a sheet tent over both the mother and babe. Orthe baby carriage may be placed over a small tub of water into whichare dropped several hot bricks. A sheet canopy spread over thecarriage holds the steam in and baby reaps the benefits of the warmmoisture. _Colonic Flushing_ is necessary when green stools accompanybronchitis. A well-lubricated end of a large Davidson's syringe isinserted into the rectum, and with the hips of the baby brought to theedge of a basin (the heels held in the hands of the assistant), wateris forced into the rectum. Not more than one ordinary cup of watershould be introduced at any one time. After expulsion, another may begently injected. _The diet_ in bronchitis is always reduced so that no extra work willbe thrown on the already overtaxed constitution of the child. _Absolute rest_ is necessary and perfect quiet should prevail. Thehumidity of the room should not be lower than 50 at any time, whilethe air should be moderately cool and fresh. Numerous other details which may be necessary in the management ofbronchitis will be directed by the physicians and nurses in charge ofthe case. SPASMODIC CROUP It is believed that children with enlarged tonsils and adenoids aremuch more subject to croup than others. Although very sudden in itsonset and very alarming, spasmodic croup, fortunately, is seldomdangerous. A little child goes to bed in apparently normal conditionand wakes up suddenly with a coarse metallic cough, difficultbreathing, and with a distressed expression on the face. Alternate hot and cold compresses should be applied to thethroat--first the hot cloths (wrung from very hot water) being appliedover the throat, which should be covered with a single thickness ofdry flannel. Then after three minutes of the hot cloths a very coldcloth is applied to the skin itself for one half minute; then more ofthe hot compress, followed again by the short cold, until five suchchanges have been made. A bronchitis tent should be quickly improvisedso that the child can be "steamed. " Vomiting must be produced by kerosene (three or four drops on sugar), alum and molasses, or ipecac (ten drops every fifteen minutes). Someremedy must be administered continuously until free vomiting occurs. Agood dose of castor oil should be given after the spasm. Suitabletreatment should be administered through the day to prevent arecurrence of the attack the next night. The general vital resistance should be raised by outdoor life, improved circulation, good food; adenoids if present, should beremoved. Medical advice should be sought in every case of severe croup, formembraneous croup usually is indicative of diphtheria, and thediagnosis is important, as on it hangs the determination of theadministration of antitoxin. PNEUMONIA Pneumonia is always a serious disease. It is accompanied by highfever, painful, very short cough, and rapid breathing with a moving inand out of the edges of the nose as well as the spaces between theribs. The possibilities of complications are always great--the dangersare many--so that the combined watchfulness of both the mother and aproficient trained nurse are required; not to mention the skill of thephysician. The steam tent, the mustard paste, the oil-silk jacket and the colonicflushing (described earlier in this chapter) may all be asked for bythe physician in his untiring efforts to prevent dangerouscomplications during the course of the disease. Plenty of moderately cool, fresh air (without drafts) is of greatbenefit. Never allow blue finger tips, or cold ear tips to exist; sendat once for the doctor and administer a hot bath, or wrap in a sheetdipped in hot mustard water while awaiting his arrival. No mothershould think of attempting to carry her baby through an attack ofbronchitis or pneumonia without the best medical help available. CHAPTER XXX THE NERVOUS CHILD While each child possesses an individuality all its own, nevertheless, there are certain general principles of psychologic conduct and familydiscipline which are more or less applicable to all children. Theso-called nervous child, in addition to the usual methods of childculture, stands in need of special attention as concerns its earlydiscipline and training. This chapter will, therefore, be devoted tospecial suggestions with regard to the management and training ofthose children who are by heredity predisposed to nervousness, over-excitability, and who possess but a minimum of self-control. HEREDITARY NERVOUSNESS The so-called nervous child--all things equal--is the child who isborn into the world with an unbalanced or inefficiently controllednervous system; and while it is all too true that the common nurserymethods of "spoiling the child" are often equally to blame withheredity for the production of an erratic disposition and anuncontrolled temper, nevertheless, it is now generally recognized thatthe foundation of the difficulties of the nervous child reaches backinto its immediate and remote ancestral heredity. I no longer doubt but that many of these babies with a bad nervousheredity, who are born predisposed to Saint Vitus' dance, bad temper, chronic worry, neurasthenia, and hysteria could be spared much oftheir early troubles and later miseries by prompt and proper methodsof early nursery discipline. These nervous babies are born into the world with an abnormal lack ofself-control. Their "inhibition control" over the natural andspontaneous tendency of the nervous system to manifest its inherentimpulses and passing whims is decidedly deficient. The child is undulysensitive, whines, hollers, or flies into a violent rage when its willis crossed in the least degree. Such a child sometimes keeps itsmother living in constant terror because, when its will is crossed inany particular, it will scream and hold its breath until it turnsblack in the face and sometimes actually goes into a convulsion. In dealing with these unfortunate little ones, fathers and mothers, while they should be firm and persistent in their methods ofcorrection, should also be kind and patient; fully recognizing thatwhatever undesirable traits the little ones manifest they have come byhonestly--these naughty tendencies being the result either of heredityor spoiling, for both of which the parents stand responsible. EARLY TRAINING One of the very first things that a child, especially the nervouschild, should learn is that crying and other angerful manifestationsaccomplish absolutely nothing. The greatest part of the successfultraining of the nervous child should take place before it is three andone-half years of age. It should early learn to lie quietly in itslittle bed and be entirely happy without receiving any attention orhaving any fuss made over it. It should not become the center of acircle of admiring and indulgent family friends and caretakers whowill succeed in effectually destroying what little degree ofself-control it may be fortunate enough to possess. When the little one is discovered to be nervous, fretful, impatient, and easily irritated early in the morning, it should be left alone inits bed or in the nursery until it quiets down. If it has a good, healthy crying spell, leave it alone. Let it early get used to livingwith itself--teach the little fellow to get along with the world as itis--and you will do a great deal toward preventing a host ofneurasthenic miseries and a flood of hysterical sorrows later on inlife. You must not expect to train the nervous child by the simple and easymethods which are successful in the case of a normal child; that is, you cannot repeat a simple discipline two or three times and have thechild learn the lesson. In the case of the high-strung nervous childit requires "line upon line and precept upon precept;" for, whereas anormal child will respond to a certain discipline after it is repeateda half dozen times, the nervous child will require the persistentrepetition of such a discipline from twenty-five to one hundred timesbefore the lesson sinks into his consciousness sufficiently to enablehim to gain control of his erratic and unbalanced nervous mechanism. SPOILING THE CHILD As bad as all spoiling methods are in child culture, they aredecidedly disastrous--almost fatal--in the case of the nervous child;and yet it is these delicate, sensitive, cute little things that arethe very ones who are most frequently the worst spoiled. Nervouschildren simply must not be played with all the time. They must be bythemselves a great deal, at least this is true in their earlier years. The nervous baby must early learn absolute respect for authority, sothat what it lacks in its own nervous control may be partially made upfor by parental suggestion and discipline. Of course, as suggested ina later chapter, the more ideal methods of suggestion, education, andpersuasion should be employed in your efforts to secure obedience andpromote self-control; but, when through either the deep-rootedincorrigibility of a child, or the inefficiency of the parent'sefforts in the employment of suggestion--no matter what the cause ofthe failure of your ideal methods to control temper, stop crying, orotherwise put down the juvenile rebellion, whether the child has beenspoiled on account of company, sickness or through yourcarelessness--when you cannot effectively and immediately enforce yourwill any other way, do not hesitate to punish; spank promptly andvigorously and spank repeatedly if necessary to accomplish yourpurpose. You must not fail in the case of the nervous child toaccomplish exactly what you start out to do. When the little fellow wakes up in the night and cries, see if heneeds anything and administer to him. If you have previously tried themethod of letting him "cry it out, " which is usually entirelysufficient in the case of a normal child, and if such treatment doesnot seem to cure him, then speak to him firmly, give him to understandthat he must stop crying, and if he does not, turn him over andadminister a good spanking--and repeat if necessary to get results. Indealing with a nervous child we must follow the directions on thebottle of the old-fashioned liniment "rub in until relief isobtained. " No "spoiling practices" should be countenanced in the case of nervouschildren. They should be taught to sleep undisturbed in a room in thepresence of usual noises. They should not be allowed to grow up with asleeping-room always darkened by day and a light to sleep by at night. They should be taught to sleep on without being disturbed even ifsomeone does enter the room; they should be taught to sleep normallywithout having to quiet and hush the whole neighborhood. PLAYMATES The early play of nervous children should be carefully supervised andorganized. Under no circumstance should they be allowed exclusively toplay with children younger than themselves. They must not be allowedto dictate and control their playmates; it is far better that theyshould play at least a part of the time with older children who willforce them to occupy subordinate rôles in their affairs of play; inthis way much may be accomplished toward preventing the development ofa selfish, headstrong, and intolerant attitude. When the nervous childis miffed or peeved at play and wants to quit because he cannot havehis way, see to it that he quickly takes his place back in the ranksof his playfellows, and thus early teach him how to react to defeatand disappointment. The nervous child must not be allowed to grow upwith a disposition that will in some later crisis cause him to "getmad and quit. " If the nervous baby has older brothers and sisters, see to it that hedoes not, through pet and peeve and other manifestations of temper, control the family and thus dictate the trend of all the children'splay. Early train him to be manly, to play fair, and when his feelingsare hurt or things do not go just to his liking, teach him, in thelanguage of the street, to be "game. " It is equally important thatthe little girls be taught in the same way how to take disappointmentand defeat without murmur or complaint. TEACHING SELF-CONTROL When nervous children grow up, especially if their parents are well todo, and they are not forced to work for a living, they are prone todevelop into erratic, neurasthenic, and hysterical women, andworrying, inefficient, and nervous men; and in later years they throngthe doctor's offices with both their real and imaginary complaints. These patients always feel that they are different from other people, that something terrible is the matter with them or that somethingawful is about to happen to them. Their brains constantly swarm withfears and premonitions of disease, disaster, and despair, while theirotherwise brilliant intellects are confused and handicapped because ofthese "spoiled" and "hereditary" nervous disturbances--with the resultthat both their happiness and usefulness in life is largely destroyed. The fundamental abnormal characteristic of that great group ofnerve-patients who throng the doctor's office is sensitiveness, suggestibility, and lack of self-control. Sensitiveness is nothingmore or less than a refined form of selfishness, while lack ofself-control is merely the combined end-product of heredity andchildhood spoiling. I am a great believer in, and practitioner of, modern methods of psychological child culture, but let me say to thefond parent who has a nervous child, when you have failed to teach thechild self-control by suggestive methods, do not hesitate to punish, for of all cases it is doubly true of the nervous child that if you"spare the rod" you are sure to "spoil the child. " Let me urge parents to secure this self-control and enforce thisdiscipline before the child is three or four years of age; correct thechild at a time when your purpose can be accomplished without leavingin his subconscious mind so many vivid memories of these personal and, sometimes, more or less brutal physical encounters. Every year you putoff winning the disciplinary fight with your offspring, you enormouslyincrease the danger and likelihood of alienating his affections andotherwise destroying that beautiful and sympathetic relationship whichshould always exist between a child and his parents. In other words, the older the child, the less the good you accomplish by disciplineand the more the personal resentment toward the parent is aroused onthe part of the child. CRIME AND INTEMPERANCE While it is generally admitted that feeble-mindedness lies at thefoundation of most crime, we must also recognize that failure on thepart of parents to teach their children self-control is alsoresponsible for many otherwise fairly normal youths falling into crimeand intemperance. The parents of a nervous child must recognize thatthey will in all probability be subject to special danger along theselines as they grow up. The nervous child, as it grows up, is quitelikely to be erratic, emotional, indecisive, and otherwise easilyinfluenced by his associates and environment. Nervous children are more highly suggestible than others, and if theyhave not been taught to control their appetites and desires, theirwants and passions, they are going to form an especially susceptibleclass of society from which may be recruited high-class criminals, dipsomaniacs, and other unfortunates. It is true that any spoiled child, however normal its heredity, mayturn out bad in these respects if it is not properly trained; but whatwe are trying to accomplish here is to emphasize to parents that thenervous child is doubly prone to go wrong and suffer much sorrow inafter life if he is not early and effectively taught self-control. UNSPOILING THE CHILD If the child of nervous tendencies forms the habit of crying, sulking, or otherwise misbehaving when it is denied its desires, or whensomething it wants done is not immediately attended to, it will befound an excellent plan simply to stand still and let the littlefellow have it out with himself, in the meanwhile kindly reminding himto say, "please mamma, " "please papa, " etc. I well remember onenervous little girl who would yell at the top of her voice and becomeblack in the face the moment she wanted a door opened or anythingelse. A few weeks of patience and firmness on the part of the motherentirely cured her of this unbecoming trait. As a rule, it will be found best not to argue with the nervous child. The moment your commands are not heeded, when you have admonished thechild once or twice without effect, take him quickly to the crib orthe nursery and there leave him alone, isolated, until he is in astate of mind to manifest a kindly spirit and an obedient disposition. It is an excellent plan quietly and quickly to deprive such childrenof their pleasures temporarily, in order to produce thoughtfulness;and these methods are often more efficacious than the infliction ofvarying degrees of pain under the guise of punishment. Nervous children must be taught to go to sleep by themselves. They arenot to be rocked or allowed to hold the hand of the mother or thecaretaker. The nervous baby should not be encouraged to exhibit itscuteness for the delectation of the family or the amusement ofstrangers and visitors. He should be especially trained in early andregular habits, taking particular pains to see that bed wetting andsimilar bad habits are early overcome; otherwise, he may drag alongthrough early life and become the cause of great embarrassment both tohimself and his parents. The control of these nervous habits is somewhat like the management ofthe slipping of the wheels of a locomotive when the track is wet andslippery. The little folks ofttimes endeavor to apply the brakes, butthey are minus the sand which keeps the wheels from slipping. Theparent, with his well-planned discipline, is able to supply thisessential element, and thus the child is enabled to gain a sufficientamount of self-control to prevent him making a continuous spectacle ofhimself. When nervous children do not walk or talk early, let them alone. Ofcourse, if later on it is discovered that they are manifestly backwardchildren, something must be done about it; but if the nervous child isencouraged to talk too soon there is great danger of his developinginto a stutterer or a stammerer. PREVENTING HYSTERIA Every year we have pass through our hands men and women, especiallywomen, who possess beautiful characters, who have noble intellects, and who have high aims and holy ambitions in life, but whose careershave been well-nigh ruined, almost shattered, because of thehysterical tendency which ever accompanies them, and which, just assoon as the stress and strain of life reaches a certain degree ofintensity, unfailingly produces its characteristic breakdown; thepatient is seized with confusion, is overcome by feeling, indulges inan emotional sprawl, is flooded with terrible apprehensions anddistracting sensations, may even go into a convulsive fit, and, inextreme cases, even become unconscious and rigidly stiff. Now, in the vast majority of cases, if this nervous patient, when ababy, had been thoroughly disciplined and taught proper self-controlbefore it was four years of age, it would have developed into quite amodel little citizen; and while throughout life it would have bornemore or less of a hysteria stigma, nevertheless it would havepossessed a sufficient amount of self-control to have gotten alongwith dignity and success; in fact, the possibilities are sotremendous, the situation is so terrible in the case of these nervousbabies, that we might almost say that, in the majority of such, success and failure in life will be largely determined by the earlyand effective application of these methods of preventive discipline. I was recently consulted by a patient whose nervous system was in adeplorable state, who had lost almost complete mental control ofherself, and who really presented a pathetic spectacle as she told ofthe fears and worries that enthralled her. In an effort to get to thebottom of this patient's heredity I had a conference with her father, and I learned that this woman, in her childhood days, had beenconstantly humored--allowed to have everything she wanted. She was adelicate and sensitive little thing and the parents could not bear tohear her cry, it made her sick, it gave her convulsions, it producedsleepless nights, it destroyed her appetite, and so she grew up inthis pampered way. The father recognized the greatness of his mistakeand he told me with tears in his eyes how, when the ringing of theschool bell disturbed his little girl baby, he saw the schooldirectors and had them stop ringing the bell, and he even stopped theringing of the church bells. He was an influential citizen and couldeven stop the blowing of the whistles if it disturbed his preciouslittle daughter. And so this woman has grown up with this nervous system naturallyweakened by heredity and further weakened by "spoiling"; and fortunateindeed she will be if off and on the most of her life she is notseeking the advice of a physician in her efforts to gain thatself-control which her parents could have so easily put in herpossession at the time she was three or four years of age, if they hadonly spent a few hours then, instead of the many months and years thatsubsequently have been devoted to medical attention. METHODS OF DISCIPLINE We run into many snags when we undertake to discipline the nervousbaby. The first is that it will sometimes cry so hard that it will getblack in the face and may even have a convulsion; occasionally a smallblood vessel may be ruptured on some part of the body, usually theface. When you see the little one approaching this point, turn it overand administer a sound spanking and it will instantly catch itsbreath. This will not have to be repeated many times until thatparticular difficulty will be largely under control. It will be discovered when you undertake to break a bad habit in thecase of a spoiled child who is of a nervous temperament, that yourdiscipline interferes with the child's appetite and nutrition. Thedelicate little creature who has perhaps already given you no end oftrouble regarding its feeding, will begin to lose in weight, and eventhe doctor often becomes so alarmed that he advises against allfurther methods of discipline. We think this is usually a mistake. Both the nutrition and discipline should be kept in mind and carriedharmoniously through to a successful finish. It will be necessaryduring such troublous times to conserve both the physical and nervousstrength of the child; it should not be allowed to run about andover-play, as such high strung children often do. It should be givena reasonable amount of physical exercise, and two or three times a dayshould have short periods of complete isolation in the nursery, whereit may quietly play with its blocks and toys, sing and croon or talkas the case may be, but should be left entirely alone. Wise efforts should be put forth to keep the feeding up to the propernumber of calories, and to see, if the child does not gain during thisdisciplinary struggle, that at least it does not lose; and I give itas my experience that I have yet to see a case in which both thechild's nutrition and discipline cannot be efficiently maintained atone and the same time, though it does sometimes require adroitscientific and artistic management. But the game we are playing isworth the effort--the battle must be fought--and it can be fought withthe least suffering and sorrowing the earlier the conflict is waged toa successful issue. I am decidedly opposed to allowing these young nervous children toover-play and thus wear themselves out unduly. This over exhaustionsometimes renders the training of the child much more difficult, as itis a well-known fact that we are all much more irritable and lackingin self-control when we are tired, more especially when we areover-tired and fatigued. Let me emphasize the importance and value of proper periods ofisolation--complete rest and partial physical relaxation. You can takea child who has gotten up wrong in the morning, whose nerves arerunning away with him, who is irritable, crying at everything thathappens, who even rejects the food prepared for him, and who, whenspoken to and commanded to stop crying, yells all the louder--I sayyou can take such a little one back to its crib, place it in the bedand smilingly walk out of the room. After a transient outburst ofcrying, within a very few minutes you can return to find a perfectlittle angel, winsome and smiling, happy and satisfied, presenting anentirely different picture from the little culprit so recentlyincarcerated as a punishment for his unseemly conduct. But let me repeat that while such methods of discipline often worklike magic on normal children, they must be repeated again and againin the case of one who is nervous in order to establish newassociation groups in the brain and to form new habit grooves in hisdeveloping nervous system. RESPECT FOR AUTHORITY There are just two things the nervous child must grow up to respect;one is authority and the other is the rights and privileges of hisassociates. The nervous child needs early to learn to reach aconclusion and to render a decision--to render a decision withoutequivocation--to move forward in obedience to that decision withoutquibbling and without question; that is the thing the nervous man andwoman must learn in connection with the later conquest of their ownnerves; and a foundation for such a mastery of one's unruly nerves isbest laid early in life--by teaching the child prompt andunquestioning obedience to parental commands. At the same time, endeavor so to raise the child that it acquires the faculty of quicklyand agreeably adapting itself to its environment, at the same timecheerfully recognizing the rights of its fellows. It is a crime against the nervous child to allow it to hesitate, todebate, or to falter about any matter that pertains to the executionof parental commands. Let your rule be--speak once, then spank. Neverfor a moment countenance anything resembling dilatoriness orprocrastination, let the child grow up to recognize these as itsgreatest dangers, never to be tolerated for one moment. FALSE SYMPATHY We are aware that many good people in perusing this chapter will thinkthat some of the advice here given is both cruel and hard hearted; butwe can safely venture the opinion that those who have reared manychildren, at least if they have had some nervous little ones, will beable to discern the meaning and significance of most of oursuggestions. Sympathy is a beautiful and human trait and we wantnothing in this chapter in any way to interfere with thatcharacteristic sympathy of a parent for its offspring--the proverbial"as a father pitieth his children"--nevertheless, there is a greatdeal of sympathy that is utterly false, that is of the nature of adisastrous compromise, for the time being making it easy for bothparent and child, but making things unutterably more difficult lateron in life when both (or perhaps the child alone) must face thecalamitous consequences of this failure early to inculcate theprinciples of self-control and self-mastery on the mind and characterof the nervous child. We so often hear "mother love" eulogized. It is a wonderful andself-denying human trait; but, as a physician, I have been led tobelieve that "mother loyalty" is of almost equal or even greatervalue. All mothers love their children more or less, but only a fewmothers possess that superb loyalty which is able to rise above humansympathy and maternal love, which qualifies the mother to standsmilingly by the side of the crib and watch her little one in a fit ofanger--yelling at the top of its voice--and yet never touch the child, allow the little fellow to come to himself, to wake up to the factthat all his yelling, his emotion, his anger, and his resentment areabsolutely powerless to move his mother. Thus has the mother--by herloyalty to the little fellow--taught him a new lesson in self-control, and thus has she added one more strong link in the chain of characterwhich parent and child are forging day by day, and which finally mustdetermine both the child's temporal and eternal destiny. SYSTEM AND ORDER System and order are desirable acquisitions for all children, but theyare absolutely indispensable to the successful rearing of the nervouschild, who should be taught to have a place for everything andeverything in its place. When he enters the house his clothes must notbe thoughtlessly thrown about. Every garment must be put in its properplace. These little folks must be taught a systematic and regular wayof doing things. Nervous children must not be allowed to procrastinate. They must notbe allowed to put off until tomorrow anything which can be done today. They must be taught how to keep the working decks of lifeclear--caught right up to the minute. They should be taught propermethods of analysis--how to go to the bottom of things--how to rendera decision, execute it, and then move forward quickly to the nexttask of life. When they come home from school with home work to do itwould be best, as a rule, first to do the school work before engagingin play. In fact, all the methods which are needful for the properdiscipline of the ordinary child are more than doubly needful for thetraining of the nervous child; while more than fourfold persistence isneeded on the part of parents to make them really effective. EMOTIONAL RUNAWAYS Whether the child be two years of age or ten years of age, when theparent discovers that the nervous system is "losing its head, " thatthe child is embarking on a nervous runaway, or that it is about toindulge in an emotional sprawl, it is best to interfere suddenly andspectacularly. Lay a firm hand on him and bring things to a suddenstop. Speak to him calmly and deliberately, but firmly. Set him on achair, put him in the bed, or take him to a room and isolate him. In the case of the older children, tell them a story of the horsewhich becomes frightened, loses self-control, and tears off down thehighway, wrecking the vehicle and throwing out its occupants. Explainto them that many of the mistakes of life are made during the times ofthese emotional runaways, these passing spells of lost self-control. Tell the little folks that you have perfect confidence in them if theywill only take time to stop and think before they talk or act. Explainto them that since you saw that they were rapidly approaching afoolish climax you thought it was your duty to call a halt, to stopthem long enough to enable them to collect their wits and indulge insome sober thinking. Personally, we have found it to be a good plan not to be too arbitrarywith the little folks, like putting them on a chair and saying, "Youmust sit there one hour by the clock. " They usually begin to indulgein resentful thoughts and a situation is often produced akin to thatof the stern father who felt compelled to go back and thrash his boythree different times during his hour on the chair, because of what hewas satisfied was going through the boy's mind. No, that is notusually the best way. Put them on the chair with an indeterminatesentence. I prefer to carry it out something like this: "Now, son, this will never do; you are running away with yourself. Stop for amoment and think. Now I am going to ask you to sit down in that chairthere and think this over quietly. I will be in the next room. Whenever you think you have got control of yourself and have thoughtthis thing out so you can talk with me, you may get up from the chairand come into the room to me. " Sometimes five minutes, sometimesfifteen minutes, and the little fellow will walk in and talk to you ina very satisfactory manner. He will give you his viewpoint and youwill be able to adjust the matter in a spirit of conference which willbe satisfactory to both parent and child, without doing the leastviolence to the responsibility of the one or the individuality of theother. Very little is to be accomplished, when the child starts to indulge inan emotional runaway, if the parent contracts the same spirit, beginsto talk fast and loud, to gesticulate wildly, grabs the child, beginsto slap and shake it--that is merely an exhibition on the part of theparent of the very same weakness he is trying to correct in hisoffspring. I am afraid it is entirely too true that for every time youshake one demon out of a child in anger, you shake in seven worsedevils. When all other methods fail and you must resort to punishment, do it with kindness, deliberation, and dignity. Never punish a childin haste and anger. THE FINAL REWARD The advice offered in this chapter is not mere theory. It has beensuccessfully used by many parents in the management of their nervouschildren, and while all principles of child culture must be carefullywrought out and made applicable to the particular child in question, nevertheless, the methods of repeated and firm discipline herein setforth will enable you to take many a child who has been born into thisworld almost neurologically bankrupt, and, by this training anddiscipline, enable him in adult life to draw such dividends ofself-control and self-mastery as will far exceed the outward resultsobtained in the case of many children who are born with sound nervoussystems, but who were early spoiled and allowed to grow up withoutthat discipline which is so essential to later self-control anddignity of character. CHAPTER XXXI NERVOUS DISEASES In this chapter we shall consider a number of the more common diseaseswhich are associated with the nervous system of the child. Some ofthese so-called nervous diseases are hereditary or congenital, whileothers are the result of infection and environment. SLEEPLESSNESS--INSOMNIA There are many conditions which cause sleeplessness or insomnia in achild aside from disturbance of the mental state or nervous system. For instance, late romping, too hearty and too late a dinner, lack ofoutdoor life during the day, illy ventilated sleeping rooms, too muchbedding, too little bedding which causes cold extremities, too muchsleep during the day, too much excitement (movies or receptions), intestinal indigestion which is associated with accumulation of gas, and constipation--any or all of these are causes of sleeplessness. Some peculiarly nervous children--those with an hereditary strain ofnervousness--are easily upset or disturbed by any of the conditionsabove mentioned. The treatment of insomnia consists, first, in finding the cause andremoving it. Children with a nervous tendency should be let alone asnearly as possible, and just allowed to grow up as the little lambsand calves grow up. They should be fed, watered, kept clean and dry, and allowed to live their lives undisturbed and without excitement. The medicinal remedies on the market for insomnia are all harmful ifused too long or in excess, and we most earnestly urge the mother notto seek drug-store information concerning remedies for sleeplessness. The neutral bath is beneficial in ninety per cent of these cases. Itis administered as follows: Enough water is allowed to run into thebath tub to cover the child. The temperature should be 99 to 100 F. Itshould be taken accurately--and should be maintained. Bath tubthermometers may be purchased at any drug store. The restless child, after the bowels have been freely moved, is placed in the water, and, without whispering, talking, or laughing, he remains there for atleast twenty minutes, after which he is carefully lifted out, wrappedin a sheet and very gently dried off with soothing strokes and placedat once into his night clothes. As before said, ninety per cent ofrestless children will go at once to sleep after such a treatment. Another method of treating sleeplessness is by the wet-sheet pack. Three single woolen blankets are placed on the bed and a sheet largeenough to wrap the child in is wrung from warm water, about 100 F. Thechild is stripped and this sheet is brought in contact with everyportion of his body, quickly followed by bringing the flannel blanketsabout him and he is allowed to remain there for twenty minutes--if hedoes not fall asleep before the lapse of that time. With witch-hazelor alcohol, the body is sponged off, night clothes are put on and arestful night usually follows. If fresh air is lacking, open thewindows. If there is too much bedding, remove some of it. Talcumpowder the sweaty back and neck and make the child perfectlycomfortable. Give a small drink of water and turn out the light. NIGHT TERRORS Night terrors are probably due to some digestive disturbance, with acoexisting highly nervous temperament. They oftentimes, in olderchildren, follow the reading of thrilling stories or a visit to anexciting moving-picture show. The child goes to sleep and gets alongnicely for two or three hours and then suddenly jumps up out of bedand rushes to its mother with little or no explanation for the act. Inhis dreams the thoughts and the imaginations of his waking moments areall confounded and alarming. We recall one little fellow who constantly feared big, black birdscoming in the window and attacking him--he had been reading aboutSinbad the Sailor and his experiences with the big bird. He so fearedthis big, black bird that he could not go to sleep. For a number ofnights he did not have the courage to tell his parents that it was thefear of the big bird that kept him from going to sleep, but finally heconfided in his mother and told her of his fear. The mother and fatherboth entered into a conversation with him through an open door whichconnected the two rooms, after the lights were out; they laughed andtalked about the big bird, they openly talked of it and allowed theirimagination to work with the child's imagination in planning how hecould combat with the bird, should it really come, asking him how bigit really was and what color he thought its eyes were and how big anobject he thought its feet could carry. They all three planned a fairystory they might write which would rival the fairy stories of theArabian Nights. In a very short time--possibly a week or ten days--thelittle fellow felt quite equal to these imaginary assaults, his fearswere quieted and his slumbers were no more disturbed by visions of thebig, black bird. Everything should be done to relieve the stomach and intestines oflaborious work during the sleeping hours, hence let the evening mealbe light and eaten early enough to be out of the way, as far asdigestion is concerned, by bed time. NERVOUSNESS During the formative period of the nervous system--the first fewyears--under no circumstances should the children be played with lateat night, when they are tired and sleepy, or hungry, for it is at suchtimes that the nervous system is so easily excited and irritated. Whenthe baby is to be played with, if at all, it should be in the morningor after the mid-day nap. Rest and peaceful surroundings are ofparamount importance to the nervous child, and he should be left aloneto amuse himself several hours each day. It is a deplorable fact thatthe nervous child--the very one that should be left alone--is the verychild that usually receives the most attention, the very one who ismost petted, indulged, and pacified; all of which only tends toincrease his lack of self-control and to multiply the future sorrowsof his well-meaning but indulgent parents. HEADACHE Headache attacks old and young alike, and the young infant that isunable to tell us he has a headache manifests it by rolling the headfrom side to side, putting his hand to his head, or by wrinkling uphis brow. Headaches may be occasioned by disorders of the brain andspinal column, such as meningitis. It nearly always accompanies fever, and is often a result of constipation, intestinal indigestion, overeating, as well as eating the wrong kind of food. The treatment of headache in children (aside from removing any knowncause) consists of a hot foot bath, a brief mustard paste to the backof the neck, a light diet--sometimes nothing but water--and theadministration of a laxative. CONVULSIONS--SPASMS In the very young, convulsions are easily produced. That which willproduce but a headache in an adult will often produce a convulsion inthe child. Aside from diseases of the nervous system such as epilepsy, etc. , convulsions frequently accompany gas on the bowels, intestinalindigestion, disordered dentition, an acute illness, intestinalparasites (worms), irritation about the genitals such as the need ofcircumcision, an adherent clitoris, adenoids and enlarged tonsils, inflammation of the ears, and poor nutrition of any sort such asrickets. The convulsion picture is a stiffening of the body--sometimes archingbackwards--rolling or staring of the eye-balls, blueness of the skin, a drooling mouth (often foamy mucus at the mouth), clinched hands, biting the teeth--if there are teeth--and even biting the tongue. There is at first a succession of quick, jerking, convulsive movementsof the body which in a few moments grow less and less violent andfinally cease. The child begins to cry and then soon goes off into adeep sleep, while the body seems more heavy and logy than usual. Inextreme cases, the child relaxes but for a moment of time, when hegoes off into another convulsion, sometimes going from one fit intoanother until death relieves him. Treatment for convulsions must be instituted at once. Do not waitentirely to undress the child--pull off his shoes, place him at onceinto a good warm bath, temperature about 100 to 102 F. An ice capshould be placed to his head (cracked ice done up in a towel), andwhile in the bath or immediately upon taking him out, give a warmsoapsuds enema. The bath that the child is placed in should be alwaystested with the bared elbow. A half cupful of mustard may be added tothe bath. Just as soon as the child is able to swallow, give ateaspoon of syrup of ipecac. Enema after enema should be given untilthe water comes back clear. Undue excitement after the bath onlypredisposes to repeated attacks, and while the mother may be veryhappy that the child is himself again, under no circumstances shouldshe caress and fondle him. Put the little one to bed and allow hisnervous system to calm down; let him rest quietly and undisturbed. NERVOUS TWITCHINGS Habit spasms or "tics" are common in childhood, and are caused by anover irritability of the nerves supplying certain groups of muscles. It is not at all uncommon to see a child nervously blink the eyes, twitch the nasal muscles, shrug the shoulders, constantly open andclose the hand, and execute a score of other minor habit-spasms;which, day by day, wear deeper and deeper paths into his nervoussystem as a result of their constant repetition. These minorhabit-spasms of childhood are but telltales of an unstable nervoussystem, of a nervous heredity lacking poise and balance; and, mindyou, if this nervous system is studied, treated, and properlyharnessed with self-understanding and self-control, much may beaccomplished; the habit may be more or less completely eradicated. Ifleft to itself, unchecked, the habit deepens the "spasm-groove, " andthe "energy-leaks" grow bigger and bigger until finally, in later, adult life, all that is necessary to convert such persons intofirst-class neurasthenics or hysterics is some bad news, a fewworries, or a sudden shock. By all means study to nip all childhood twitchings in the bud;remembering all the while that childhood--the formative period for thenervous system of the child--presents the golden opportunity toprevent and abort the more grave neuroses of later life. There may bea special contraction of one or more muscles of the eyeball whichproduces either a "cross-eye, " when the contraction is convergent, ora turning of one eye outward when the contraction is divergent. It isnot possible for the mother to correct this condition. The oneimportant thing for her to do is to take the child to a skilledophthalmologist early in his life, that treatment may be institutedfor the correction of the difficulty. RETENTION OF URINE Not an unusual condition during childhood is a temporary retention ofurine. It may follow an attack of colic or accompany any acuteillness. Increase the water drinking, and, after seven or eight hours, hot cloths should be applied over the bladder; a large enema (enemabag should be hung low) should also be given, retaining as much as ispossible. These simple measures usually relieve the condition. Ifretention follows circumcision, due to swelling of the parts, thesurgeon should be notified. BED WETTING Nocturnal enuresis (bed wetting) usually is found to "run infamilies. " It is seldom the case to find that both the father and themother escaped bed wetting during childhood when the child is sorelyafflicted. Early bad habits may be the prime factor in this distressing andhumiliating difficulty. A little child that has been compelled to liein wet diapers for hours at a time gradually becomes accustomed to"being wet, " and the desire to urinate is not under the keen controlof a will that has been trained by untiring patience to "sit on achair" at regular intervals throughout the day. This lack of trainingin a child who possesses an unstable nervous system, creates theproper environment for the habit of bed wetting--which often marchessteadily on until puberty. In the treatment of bed wetting giveattention to the following: 1. The urine should be thoroughly examined. 2. The size of the bladder should be determined. 3. The last meal of the day should not be after four o'clock in theafternoon. 4. All during the day, in young children, systematic training shouldbe begun--put the child on the chair every hour, then every hour and ahalf, then every two hours. Let the work be done most painstakinglyand much will be accomplished toward training the bladder to "hold itscontents" during the night. For a time it will be necessary to set analarm clock to ring every three hours during the night, that thebladder may be relieved at regular intervals. 5. No liquids whatever are allowed after four P. M. ; even the fouro'clock meal should be very light. 6. In older children the habit is often broken by appealing to thepride--by requesting or demanding the child to rinse out the bed linenand hang it up to dry himself. Usually at puberty the trouble ends, and while no amount of whippingwill correct the difficulty, the promise of rewards, an appeal to thepride, correction of dietetic errors, the establishment of regulartimes to empty the bladder, the removal of all reflex causes such asadenoids, need of circumcision, worms, etc. --these combinedinfluences--will bring results in the end, if they are faithfully andintelligently applied. MENINGITIS Cerebro-spinal meningitis is not highly contagious. Children oldenough to complain of symptoms usually first complain of an intenseheadache with frequent vomiting and very high fever. Great prostrationis seen, the pulse is weak, the respirations are irregular, the childmay have convulsions, or it may have chills and fever, and rigidity ofthe body may be present. The position of the child is verycharacteristic. It does not want to lie on its back but usually restson one side, with the spine more or less arched. It is a very seriousdisease and demands the early attention of a physician. Some casesare very mild and others are exceedingly grave. If the physician issecured early, and special remedies administered that are known today, many of the children may be saved. INFANTILE PARALYSIS Infantile paralysis is a serious disease of the spinal cord whichcomes on very suddenly and is associated with vomiting, pain in thelegs, and a high temperature. After these symptoms have lasted a dayor two the paralysis is discovered. There may be convulsions. Theparalysis is progressive, and the wasting of the muscles increasesuntil by the end of a couple of months one limb is considerablyshorter than the other. Sometimes the baby goes to bed at night inapparent good health and wakes up in the morning paralyzed. In this disease the attention of the best physician in your communityshould be called to the case at once, for there are being developed inour large research laboratories special vaccines for this condition aswell as for spinal meningitis. But what is done must be done very, very early, so let there be no delay in calling in medical counsel. There are other forms of spinal paralysis which, associated withtuberculosis of the spine and other spinal diseases, result in loss ofpower to one or more groups of muscles. The only treatment that can begiven in the home is to keep all of the paralytic portions of the bodyvery warm by external heat, care being taken to avoid burning, andsecure medical advice. Often, later in the course of the disease, bythe aid of crutches and braces, the child can be taught to go toschool and to get around the house about his little duties. The slight facial paralysis which is so often seen in babies that havebeen delivered with forceps, usually clears up in a few days or at thelatest in a few weeks or months. SAINT VITUS' DANCE Saint Virus' dance (chorea) is a peculiar disorder seen in nervouschildren, and which usually clears up in a few weeks or months underproper treatment. It is characterized by irregular jerkings prettymuch all over the body, so that the child staggers as he walks, dropshis food at the table, and executes many other noticeably abnormalmovements. The child should be taken out of school at once and removedfrom association with children who might make sport of him orotherwise annoy him and thus increase these irregular jerkings. Heshould at once be put under the direction of competent medicalauthority. Simple food, colon hygiene, more or less complete rest, andfreedom from annoying circumstances, will usually bring about a speedyrecovery. CONGENITAL DISORDERS _Water on the Brain_ is characterized by an enlarged head due to anincreased accumulation of fluid within the cranium. While the faceremains small the head greatly increases in size so that oftentimes itmust be braced while the child is compelled to remain in a wheelchair. The mentality is usually fairly normal, but the enormous weightof the head compels the life-long occupancy of a wheel chair. _Deaf-Mutism. _ The child born deaf pays no attention whatever tosounds. An intellectual expression is seen on his face and by sixmonths he is able to do all that a normal baby can do with theexception of hearing. The child should early be taken to an earspecialist in the endeavor, if possible, to correct the defect ofhearing. Such little ones who are destined to a life without sound, should be given every opportunity to learn to read the lips and tosecure a good education--to be taught a vocation where eyesight is ofmore value than hearing. Special institutions are in existence todaywhich can take these deaf mutes when small and so teach them to makeaudible sounds that they can make themselves understood--at leastpartially. Lip reading is a wonderful improvement over the deaf anddumb alphabet, and should be taught early. _Congenital Blindness. _ Perhaps not until the child is six months oldcan the observer distinguish between blindness and idiocy. The blindchild of course will not fix his eyes upon any object; but the generallassitude and the inability to hold up its head, while seen in idiocy, is not present in blindness. _Feeble Mindedness. _ A baby that is born with a weak mind is found tobe very backward in all the normal developmental attainments of thegrowing child. A normal baby holds up its head at four months andshould be able to sit erect at six months. The weak-minded baby willnot do this, and often as late as two years it will not make anyattempt to walk or to talk. There is an unnatural expression--a vacantlook--to the face, while there is often much dribbling at the mouth. _Early Training should be Instituted. _ It is necessary to call theattention of a physician to these facts, that the parents may beinstructed in regard to the early training which is so essential inall these weak-minded little folk. In our opinion it is best to removethese children early to special institutions, where their educationcan be superintended by those thoroughly accomplished and accustomedto dealing with this class. There are varying grades of feeblemindedness--the backward child who requires a longer time to learnthings, and the child who is slow at school and possibly cannot getthrough more than the fourth or fifth grade--but as soon as weakmindedness is discovered, it is best to transfer the child to somespecial institution. CHAPTER XXXII SKIN TROUBLES One of the earliest skin troubles that the average normal childsuffers from is prickly heat--a tiny, red-pointed rash alwaysaccompanied by sweating and usually resulting from over-dressing, stuffy rooms, and other conditions that make the child too warm. Prickly heat produces more or less discomfort but usually little or noitching. Ordinarily, a sponge bath followed by the application oftalcum powder is sufficient to give relief in mild cases; but severeor neglected cases should be treated by means of bran baths, a cupfulof bran being tied up in a gauze bag and suspended in water until thewater assumes a milky color. Soda baths, two tablespoons to a gallonof water, are also very soothing. A baby should never receive anyfriction with a towel after such baths, but should be rolled up in aclean linen towel and simply patted dry. CHAFING Great care should be exercised in the choice of baby's soaps. Among anumber of soaps that might be mentioned castile soap is, perhaps, asgood as any. Frequent sponging is required to wash off the irritatingperspiration; cool clothing, plenty of talcum powder, a dose ofcalcined magnesia, and a regulated diet are necessary to clear up thetrouble. Chafed skin, particularly between the buttocks or in other folds andcreases, should be kept free from soap. Either the starch or bran bathmay be tried, while olive oil should be frequently and lightly rubbedover the chafed part. A bit of sterile cotton placed between the foldsto prevent friction is often all that is necessary to correct thedifficulty. Dandruff or milk crust which is often seen on young babies' scalpshas been described in detail elsewhere. It should early receive thevaseline rub at night which will often loosen up the hardened crusts. It may be gently removed in the morning with soap and water unless thecase has gone on to great severity. In such neglected cases the mothershould not undertake to correct the difficulty alone. Taken early, when the scalp is covered with tiny flakes known as milk crust, it canbe quickly relieved. VULVOVAGINITIS Vulvovaginitis is a very contagious disease, and before the days ofhospital asepsis, which is so perfectly maintained today in our largeinstitutions, this disease used to go right through a children's wardbecause of carelessness in the handling of soiled diapers, etc. Thesign of this disease is a yellow-white vaginal discharge, while thesurrounding skin covering the inside of the thighs and buttocks may bevery much reddened. The baby should be taken at once to the physicianat the first appearance of these symptoms. Only rigid isolation canpossibly prevent other children from getting it--essentials areseparate towels, wash towels, soap (in the case of the olderchildren), and, in the case of the baby, separate diapers and rigidscrubbing of the attendant's hands--in this way only can thisinfection be held in check. The infected child should sleep byherself, and utmost care must be exercised in preventing her fingersfrom first touching the itching vulva and then placing them to theeyes or to the mother's eyes. A vulva pad must be worn as long as thedisease lasts. The physician will give you the proper medicines to beused in these cases, and if no physician is within reach, you areperfectly safe in dropping into the spread apart vulva a few drops oftwenty-per-cent argyrol and then applying the vulva pad. After eachtreatment the hands of the mother or nurse must be most rigidlycleansed. ECZEMA Eczema is a very troublesome disease, particularly in infants; thereare so many forms of it that there is neither time nor space in thisvolume to describe them individually. This disease may be produced inchildren by either internal or external causes--from friction on theskin, from coarse, rough woolen clothes, or from starched garments, orfrom lace or starched bonnet strings which rub into the folds of theskin. Irritating soap, the contact of soiled diapers, cheap toiletpowders, and discharges from the nose and ears may also be responsiblefor the disease. The particular internal causes are over-feeding, digestive disturbances, the too early use of starches which createfermentation in the intestinal tract. In the most frequent form ofeczema the skin becomes red and then there appear tiny vesicles (waterblisters) which soon rupture and "weep. " This fluid which oozes fromthese tiny, ruptured vesicles, in connection with the perspiration andexfoliation of old skin, forms heavy crusts upon the face which areboth unsightly and annoying. Another form of eczema is simply a very badly chafed conditionaccompanied by intense itching, and commonly known as "dry eczema. " Avery disagreeable form is the pustular variety. One poor littlesufferer that was once brought to us had so many pustules on his headthat one could not put a ten cent piece on his scalp without touchinga pustule. The treatment of these cases, in order to be effective andleave the child's head in normal condition, must be administered withthe utmost patience every day for weeks. A doctor's help is alwaysrequired in combating this sort of skin trouble. If the cause isexternal, then the clothes should be changed. All irritation should beremoved--the clothing must not be allowed to scratch the skin. Thechild must not scratch himself. If necessary, little splints may beplaced on the inside of his arms to prevent his bending the elbows ifthe eczema is on the face, while the little sleeves may be pinned tothe side of the dress to resist the movement of the arms. ECZEMA TREATMENT The diet should be most carefully looked into. The nursing mother willearnestly look into every article of food she herself is eating, andcarefully avoid all foods that produce fermentation or decomposition. The mother's urine should be examined and its acidity noted; if it isabove normal she should take some alkalines such as ordinary bakingsoda or calcined magnesia. If it is a bottle-fed baby, any form offlour should be removed from the food and the quantity of the milkreduced. All this, of course, is done under the direction of thephysician. Repeated doses of castor oil may be given. The name of the medicinal agents that have been used in the treatmentof eczema, is legion. Perhaps one of the most widely used is the earlyvarnishing of the affected skin with ichthyol (one part ichthyol, onepart distilled water), which is swabbed on after the skin has beencleansed with olive oil. Allow this to almost dry, and then sprinkleon talcum powder which smooths over the dry varnish of ichthyol. Thisis worn every night and during the day, in bad cases, even when theeczema is on the face. It is renewed each day, and is preceded by theolive-oil bath. No water or soap is ever used in eczema. Fortunately, the Eskimo has taught us that the skin really can be cleansed with oilas well as with water. In the appendix will be found twoprescriptions, number one and number two, that have proved verybeneficial in some of the most severe forms of eczema. HIVES AND FRECKLES Hives, a crop of little raised red papules closely resembling lesionscaused by the sting of a mosquito, may make their appearance upon theskin of the child, remain a few hours, and then disappear. Hives areusually due to digestive disturbances and may be caused by such foodsas strawberries, nuts, pastries, pineapple, certain sea foods, mushrooms, etc. A good cathartic, the taking of alkalines, such asbaking soda or calcined magnesia, with a bran or starch bath, orpossibly a soda bath, will usually correct the difficulty. The sametreatment may be used in nettle rash or prickly heat. Freckles seem to run in families. Broad-brimmed hats or sunbonnets maybe worn, but under no circumstance should a little girl be bidden toremain in the house and shun the beautiful, sunshiny outdoors justbecause she freckles easily. Do not apply any lotions to the freckledface without medical advice, for great harm may be done the tenderskin of the child. RINGWORM Often upon the scalps of young children may be seen circles--rather, patches--which are slightly rough to the touch, and which cause thehair to fall out and the spots to remain bald. They are known asringworms of the scalp. The affection may likewise appear on the bodyor the face, presenting a ring of reddened skin with a scaly border. Ringworm on the scalp is hard to treat and medical help should besecured, for, in spite of all that can be done, the disease often runsits course, leaving round bald spots over the head. Ringworm of theface, taken early, is helped by carefully painting with tincture ofiodine. The mother should constantly bear in mind that ringworm is a"catching" disease, so that all handkerchiefs, towels, and clothes areto be kept separate. The disease known as mange which so often attacksdogs, is nothing more than ringworm, and children often contract thedisease from dogs. Ringworm, whether it be on children or dogs, may begreatly helped by the use of tincture of iodine and other appropriateremedies. BOILS The much poulticing of boils has done an untold amount of mischief. Many children and adults are in their graves today because of impropertreatment of boils. Blood poisoning which so often follows thecareless poulticing, as well as the uncleanly opening of boils, canall be avoided. Before touching a boil, the surrounding skin should bethoroughly washed with sterile cotton and laundry soap and thendisinfected with alcohol. Then, with a scalpel or a surgeon's knifewhich has been either boiled for twenty minutes or allowed to remainin pure carbolic acid two minutes and then in alcohol two minutes, itshould be thoroughly opened down to the core so that the pus may comeout. It is very much better for the trained hands of a physician to dothis than for any member of the family to undertake such anoperation--where the danger of blood poisoning is always present. Theonly treatment of skin eruptions containing pus which is justifiablefor the home folks to undertake is to simply paint them with iodine. Under no circumstance should poultices be used. FEVER BLISTERS It is not at all uncommon for small children to develop a group offever blisters on the lips when suffering with any disease, orexperiencing a high fever. Even a simple cold or a spell ofindigestion may be accompanied by fever blisters. They appear not onlyon the lips but also on the edges of the nose and may even be seen onthe chin. Early in their first appearance they may be treated with spirits ofcamphor or plain alcohol, which sometimes tends to abort them; butthey usually run their course, and when they are fully developed theymay be treated with zinc oxide, simple borated vaseline, or ichthyol. WARTS Very often children's hands are disfigured by warts. They appearsuddenly, develop rapidly, and many times disappear just about assuddenly as they appeared. Every child suffering from warts usuallypasses through the stage of charms and lingoes which are popularlyused to remove these disagreeable growths. We hardly see any efficacyin "bean-ie, bean-ie take this wart away, " or any particular virtue instealing mother's dishcloth, cutting it up into as many pieces asthere are warts on the hand and rubbing each wart with a separatepiece of the cloth; but you will find people in every town or villagewho will assure you that their warts were driven away by one of thesecharms or lingoes. Warts are either better left alone or removed by aphysician with the high-frequency spark or some other reliable method. BIRTHMARKS A red or purplish patch on the skin is the result, as mentioned in anearlier chapter, of an embryological accident in which one or moreembryonic cells slipped out of place in the early days of skinformation. These accidental markings may occur on the face, thescalp, or on any other portion of the body, and they should be letalone, unless they show a tendency to grow, when it may prove best togive them proper surgical attention. A mole is also a birthmark, and if found upon the neck or shoulderswhere it is likely to disfigure, it may be removed by thehigh-frequency spark, or by surgery, in the same way as warts. Nevertamper with moles. Leave them alone or turn them over to the surgeon. ERYSIPELAS Erysipelas is a much-dreaded disease which is the result of infectionwith the blood-poisoning germ--streptococcus. It usually occurs abouta wound, and is due to infection by this microbe. If it followscircumcision, it is due, of course, to infection, and may be veryserious, even causing death. It attacks persons of any age and isoftenest seen on the face. In appearance, the skin is a bright andshiny red, with a definite line of demarcation slightly raised at theedges because of the swollen tissues underneath. On pressure, theredness disappears but reappears immediately upon relieving thepressure. The inflammation, pain, and fever often continues a numberof days, during which the child should be isolated from all othermembers of the family. The bowels should be freely opened, and thediet should be liquid and soft; while local treatment is cared for bythe physician who should always be called. Should erysipelas developon a very young baby it is very important that he should be removed atonce from the mother. As stated before, the disease is produced by theblood-poisoning germ which is very much to be avoided in any and allstages of obstetrics. One attack in no way renders the patientsimmune. They may have repeated attacks of erysipelas. The treatmentsshould be started early and kept up most rigidly. SCABIES AND LICE In thickly settled districts among the poor and uneducated, wherefilth and untidiness reign, the "itch" is a very prominent disease. Itis caused by the itch mite, a parasite which burrows underneath theskin leaving behind its eggs in little irregularly shaped, bluishtinted ridges. Such a profound itching is set up by this burrowing anddepositing of eggs that the child cannot resist scratching, and alltaken together produces the typical itch-rash. The common site forthis rash is on the sides and between the fingers and toes; on armpits and buttocks of the child, as well as at the waistline. Thetreatment is usually beyond home remedies. A physician should havecharge of the case who will conduct a line of treatment which, ifdiligently followed, will rid the body of this scourge within a weekor ten days. Along with the itch are often found parasites of the head, or lice(pediculi). It is not at all infrequent to find them in the heads ofuncared for children; but if a much-cared-for child is brought incontact with an infected head he will probably "catch" the infection. A most intense and disagreeable itching is set up at once. Thetreatment consists in getting the head clean by the use of a very finecomb, thus endeavoring to remove the adult parasites as well as theeggs or "nits. " However, great care should be taken to avoid injuringthe scalp. Perhaps the simplest and most effective treatment known isthe kerosene bath which should be applied at night, the hair beingdone up in a bandage until morning, when the kerosene is washed offwith soap and water and then the hair given a vigorous vinegar shampooin order to destroy the "nits. " Tincture of larkspur, or an ointmentmade from the seeds, may also be used. It is applied several days insuccession and then washed out. CHAPTER XXXIII DEFORMITIES AND CHRONIC DISORDERS Reference has already been made to certain accidents of embryologyduring the very early days or weeks of the formative period of theembryo. Common illustrations of such deforming developmental accidentsare harelip, cleft palate, and club foot. HARELIP AND CLEFT PALATE In the case of a partial or complete failure of the two sides of theface to come together in the median line, a deformity results which isknown as harelip--a partial or complete cleft of the upper lip. It maybe a single or a double cleft, exposing the teeth, or the cleft mayeven extend up into the nose. This deformity may seriously interferewith nursing, making it necessary to resort to feeding with a medicinedropper and later a spoon. The success of the operation for the reliefof harelip, which should usually be performed during the early monthsof life, is often very remarkable. Should this failure to unite be in the deeper structures of the head, then cleft palate is the result. This, too, may be partial orcomplete: partial as seen in a cleft of the soft palate only; andcomplete, when the hard palate also is involved. In such an instanceit is the floor of the nose that is defective; hence the nose andmouth are one cavity. A specially devised apparatus which assists the child in nursing maybe found on the market, for nursing is well-nigh impossible withoutthe closure of the roof of the mouth. The operation for cleft palateis usually successful when performed at the proper time and bycompetent hands. In tongue-tie the weblike membrane underneath is attached too farforward, so that the child is quite unable to protrude his tongue, andthis condition greatly interferes with sucking. The operation for therelief of this condition is slight, and should be performed as soon asthe defect is discovered. DEFORMED HANDS AND FEET Occasionally there is a webbing of one or more fingers of the hand, and there are sometimes seen too many fingers or a double thumb. It isneedless to allow such a deformity to continue; the operation forrelief is often remarkably successful and should be performed veryearly. Clubfoot results when short tendons or contracted tendons pull thetoes inward or outward with raising of the heel. Treatment must beinstituted early; braces or splints are applied; and untiring effortsare put forth in massage and other lines to prevent a lifelonghandicap of clubfoot. An inward rotating of the legs presents the deformity of pigeon-toe. The normal foot naturally inclines toward "pointing in, " and such acondition should not be discouraged. Many flat feet (broken arch) aredue to shoe lasts which compel the toes to slant "out, " and thebunions which so often follow such mistreatment may be exceedinglypainful. By all means place shoes on the pigeon-toed child that possessstraight lasts with flexible arches, and which admit of the exerciseof many muscles of the foot which otherwise remain inactive. As the child grows older the toenails thicken, and often in theirtrimming they are cut so closely at the corners that sometimes acondition results known as ingrowing nails. Such are very painful andmust receive special attention. First of all, the nail is cutsquarely, and after scraping it thin the corner is lifted and cottonso placed under it that the nail's downward and inward growth isstopped. SPINAL CURVATURE Curvature of the spine is more common than is usually thought. Themost frequent variety of it is the lateral curvature. One shoulder islower than the other, and the hips are therefore uneven. Rickets, during infancy, is the most common cause of spinal curvature. Improper sitting at school--sitting on the edge of the seat--orcarrying heavy loads are often contributing factors to the productionof lateral curvatures. Only the muscles and ligaments enter into thisdeformity, hence the treatment should be started early and shouldconsist of: 1. Stretching exercises. 2. Hanging from the rounds of a ladder securely fastened to the wall. 3. Certain applications of hot fomentations to the spinal muscles fortheir relaxation. 4. Firm cushion placed under one or other of the hips to encourage there-establishment of muscular poise. 5. Special supervision of the case. POTT'S DISEASE Pott's disease, or tuberculosis of the bone, often results in anangular spinal deformity. This curvature, unlike the lateralcurvature, is a sequela of an actual disease of the bones. It isalways very serious and demands early treatment from skilled hands. Early in the disease there is a peculiar stiff, tottering gait. Thelittle child holds the spine rigidly, and in picking up objects fromthe floor bends the knees instead of the spine. If the trouble is inthe upper spine, the shoulders are held high and the head is stifflypoised, it is never rotated; in looking about the entire body turns. Medical aid should be secured early. The X ray not only locates thedifficulty but also determines the extent of the process. If the spinebe put to perfect rest, outdoor life begun, a diet rich in fatsestablished, the results are often wonderfully successful. Another tubercular condition is seen in the much dreaded hip-jointdisease which parents should always be on the lookout for. Theearliest symptoms are crying out in the night suddenly, unnaturalstanding on one leg (to relieve the strain on the diseased hip) andso-called "growing pains. " Call in a physician very early andinstitute proper treatment. A posterior curvature of the spine isoften associated with a bad case of rickets. It is of temporaryduration, and usually clears up when the symptoms of rickets have beeneradicated. It involves only the back muscles--not the vertebralbones. The young mother is often very much concerned over the misshapen headof the child as a result of a prolonged labor; and it does seem quitemiraculous to see a head, more nearly resembling an egg than anythingelse, become beautifully round and shapely by the end of two or threedays. Protruding ears may be encouraged to lie more flatly by the wearing ofa specialized bonnet at night. When the babies are too young to turnthemselves they should be turned first to one side and then the other, while care should always be exercised in properly straightening out acurled under ear or an overlapping ear. RHEUMATISM While we so often regard rheumatism an adult disease, nevertheless, children do suffer its aches and pains as well as the fever which sooften attends the inflammatory type. The so-called "growing pains" areoften of rheumatic origin. Diseased tonsils not only are often--very often--the avenue of entryof infectious microorganisms that cause one type of rheumatism, butmany forms of valvular heart disease are also directly traceable tothese same diseased tonsils. The treatment consists in giving properattention to the tonsils, even removal if necessary--and if the childis old enough. All other possible causes should be located andremoved; the child should have absolute rest in bed with briskcathartics and a liquid diet (no meat broths). The diet should consistmore of alkalinizing foods as shown in the special table in theappendix. Medicinal alkalines are often given when the urine shows avery high acid reaction. SCURVY Scurvy, seen in children who subsist on "prepared foods, " ismanifested by tender legs and swollen gums which have a tendency tobleed easily. Pallor, loss of appetite, and insomnia accompany thecondition. The treatment of scurvy is change of diet from "patentfoods" to fresh cow's milk, with the addition of orange juice, daily. In older children the food must be very nutritious; out of door life, salt glows, friction baths (see appendix), and the taking of largeamounts of fats are all essential to the cure. ADENITIS--ENLARGED GLANDS Enlarged glands, or what our grandmothers used to call "kernels" inthe throat are often the result of inflammation in the mouth orthroat, and occur in connection with many of the childhood diseases, notably diphtheria, scarlet fever, and scarlatina. Glands appearing in the back of the neck may be occasioned bypediculli (lice), ring worm, or eczema, while those seen in the neckjust back and below the ears may come from mastoiditis (inflammationof the middle ear) or adenoids. Glands felt under the arm enlarge because of trouble or infection inthe breast, hand, or arm; while glands in the groin are usually due tosome infection of the feet, legs, or abdomen. These glands usually disappear when the general health and well-beingof the child is improved by: 1. Outdoor life. 2. Morning dry-friction rub to the skin. 3. Good liberal diet, including plenty of fats. 4. No feeding between meals. 5. The salt glow and general tonic treatment (see appendix). 6. The oil rub at night. RICKETS Rickets (a disease of the bones) often follows in the wake of faultyfeeding and unhygienic surroundings. The bones lack a proper amount oflime salts and other elements. Development in general, especially thatof the bones, is greatly interfered with. Bowlegs, prominent square brow, enlarged perspiring head, weakness, and often tenderness of the flesh, are notable signs of the disease. The treatment varies little from that of scurvy, and will be providedin detail by the attending physician. MALARIA Children often suffer from malarial parasites. Sudden rise of fever onregular days (sometimes daily, every two days or every three days)should demand a careful medical examination including the examinationof the blood where the offending organism is seen in the red bloodcells. We recently saw a little girl who happened to have an earacheand was about to be operated on for ear trouble, when examination ofthe blood revealed the fact that she was suffering from malaria. TUBERCULOSIS In the routine examination of adult patients, the X ray observationsof the lungs often reveal deposits of lime salts which tell the storyof a successful fight against tuberculosis (Fig. 16). And while it mayseem surprising, we believe beyond a doubt that most of us have hadsome varying degree of tuberculosis while young--the unrecognizedbattle has been fought--and these small monuments of lime salts aloneremain to tell the interesting story. The pity of it is that whole armies of little folks fall in thisstruggle against disease, for it is one of the common and fataldiseases of childhood. Fresh-air schools, playgrounds, and free schoollunches are saving hundreds of children from the ravages of thisdisease each year. Tuberculosis is strictly a house disease, hence the little tubercularpatient must seek outdoor life. All avoidable exposure to the diseasemust be denounced, and public sentiment must continue to be aroused tothe hygienic betterment of the tenement districts and basement homes. The sanitary drinking cup and the bubble fountain must be encouraged, as must also the proper ventilation of all places where crowdsassemble, be it the schoolroom, the theater, or the church. SYPHILIS While tuberculosis is known as the "great white plague, " syphilis andgonorrhea constitute the "great black plague, " which seen in thelittle folks is pitiable indeed, leading us to realize that surely"the children's teeth have been set on edge" because of the carelesseating of sour grapes by the parents. Syphilitic parents who have notbeen properly treated, should think many times before they take uponthemselves the awful responsibility of bringing into the world atainted child. Proper mercurial treatment should be instituted at oncenot only for the child but also in the case of both parents. [Illustration: Fig. 16. X ray Showing Tuberculosis of the Lung] CHAPTER XXXIV ACCIDENTS AND EMERGENCIES In this chapter we wish to instruct the mother or the caretaker indoing the one thing needful for every one of the more common householdaccidents and emergencies while waiting for the doctor. In every household there should be found an accident and emergency"kit" of necessary paraphernalia for the quick application of the onenecessary medicine, dressing, etc. This "kit" should contain bakingsoda for burns, bandages and sterile gauze for cuts or tears, togetherwith adhesive plaster, needle and thread, etc. INSECT BITES AND STINGS Far greater harm is often done the skin by the subsequent scratchingof the insect bite with dirty finger nails than by the bite itself;and so it is very important that we remember to allay quickly theintense itching by the application of ammonia water or camphor. Almostinstantly the itching is stopped, and the added "scratching"irritation to the already injured skin is thus avoided. By the aid of a magnifying glass, and often by the naked eye, we maydetect the stinger which has been left behind by the greedy guest, andwhich should be removed by a pair of tweezers. Ice-water compresseswill stop the swelling and even an old-fashioned mud dressing, whichwas used and appreciated by our great grandmothers, is a thing not tobe despised. If the much admired shrubbery be removed one hundred feet away fromthe porch, mosquitoes would trouble the household less. It has beendemonstrated in many localities that clearing away the near-by clumpsof shrubbery permits the family to sit on unscreened porchesunharmed. Mosquitoes multiply rapidly in stagnant pools of water, butif oil is poured over these stagnant waters the increase of mosquitoesis abated, and their total extinction is not unheard of in swampydistricts receiving such care. Whenever baby is out of doors where mosquitoes, flies, or otherinsects are to be found, he should be properly protected from suchpests by mosquito netting stretched over a frame eighteen inches abovehis face, for we can think of nothing more uncomfortable than amosquito netting dragging over a sweaty baby's face. The fact thatmosquitoes, flies, roaches, and other insects are carriers oftuberculosis, infantile paralysis, typhoid fever, cholera, yellowfever and malaria, as well as a host of minor ailments, should make usthe more anxious for either their extermination or the protection ofour children from their greedy bites and stings. DOG BITES AND SNAKE BITES Dogs, cats, rats, or mice bite at any time of the year, and provisionshould always be made for ample protection against such accidents. Such a wound should always be squeezed or sucked until it has bledfreely, and then be cauterized by a red-hot iron or touched with anapplicator that has been dipped in sulphuric acid or nitric acid. Asubsequent dressing of Balsam Peru is healing. The dog should bewatched, and if it shows signs of hydrophobia the bitten child shouldbe promptly taken to the nearest Pasteur Institute for treatment. In the case of snake bites the same sucking and cauterizing treatmentis indicated, with the additional tying of a handkerchief or cord afew inches above the wound to stay the progress of the blood and tokeep the poison out of the general circulation. A solution oftwenty-per-cent permanganate of potash should be used to wash thewound. The popular administration of large draughts of whiskey is of nobenefit, for the secondary depressant effect of alcohol increases thebody's poison burden, and those who survive do so in spite of thewhiskey, and not because of it. SWALLOWING FOREIGN BODIES Small articles such as buttons, safety pins, thimbles, coins, etc. , are often swallowed by little folks, and if they lodge in the throatand the child struggles for his breath the treatment is as follows:grasp him by the heels and turn him upside down while a helper brisklyslaps him on the back. The foreign body generally flies across theroom. If it is lodged high up in the throat it may often be dislodgedby the thumb and finger. If it cannot be reached and it will not godown, lose no time in seeking an X-ray laboratory where its exactlocation may quickly be discovered and proper measures instituted forits removal. A troublesome fish bone is easily dislodged by swallowing ahalf-chewed piece of bread which carries it down to the stomach. Cathartics and purgatives are not to be given; in due time the objectwill appear in the stool. In all instances it is well to locate itsexact position by the X ray--that there may be assurance that it willdo no harm. It is surprising what large objects can be swallowed. One oldgentleman swallowed his false teeth, and a six months old babyswallowed, or at least had lodged in its throat, a silver dollar. All detachable parts should be removed from toys that are given tobabies, such as the whistle from rubber animals, the button eyes ofwool kittens and dogs, and other such removable parts. FOREIGN BODIES IN THE EYE To begin with, do not get "panicky, " but carefully, painstakingly, andpatiently do the following: 1. Rub the well eye until the tears flow plentifully in both eyes. 2. Blow the nose on the injured eye side, closing the other side. Thisoften encourages the tears to wash the foreign speck down through thetear duct, into the nose and out into the handkerchief (in case thechild is old enough to follow such instruction). If the foreign bodybe sharp, as a piece of steel or flint is likely to be, it may bedriven right into the eyeball. Seek a physician who will dropmedicine into the eye to deaden the pain and then if it cannot begently rubbed off the eyeball, a magnet will promptly remove it. An eye bath of warm boracic acid is always comforting and never doesharm, so that may be given while waiting for the doctor to come, ifthe object seems to be beyond the reach of family help. If an alkaline, such as lime, be blown into the eye it is verypainful, but much relief may be obtained by gently pouring into theeye, by means of a medicine dropper or eye cup, warm water to whichhas been added a little vinegar or lemon juice. Likewise, acid in theeye produces much pain. In this instance, an eye bath of a weak sodasolution is indicated. FOREIGN BODIES IN EAR AND NOSE Insects that have crawled into the ear may be suffocated by droppingsweet oil or castor oil into the ear, which, after twenty minutes, should be washed out by gentle syringing with warm water from afountain syringe, hung one foot above the child's head. Peas, beans, shoe buttons, or beads are sometimes put into the ear andnose by adventurous or experimenting children. The shoe button or bead will not swell as does the pea or the bean, and may often be safely washed out. If it is causing no pain and willnot drop out in case of the ear, or will not be easily blown out incase of the nose, see your physician at once. He has in his possessionjust the necessary instruments for its immediate removal. Peas and beans swell, and consequently cause greater discomfort thelonger they are in; do not poke at any foreign body lodged either inthe nose or the ear, for the ear drum may thus be injured, while inthe former case it may be pushed into one of the accessory sinuses. EARACHE One of the most comforting and highly effectual forms of heat for anaching ear is a four-candle-power carbon electric light on anextension cord that permits the light to come in close contact withthe ear. A shade is made from a piece of stiff letter paper that fitsthe socket snugly and flares out to a three inch opening, which shouldextend below the point of the bulb one inch. This shade holds all theheat and light and directs it into the aching ear. In every well-ordered household there will be found a three-per-centsolution of carbolic acid and glycerine of which one drop should beput into the aching ear, and then the external heat, mentioned above, should be applied. A bag of warm salt, a hot water bag, or a warmplate will provide external heat if an electric light is notavailable. Do not put laudanum or other remedies into the ear, otherthan are herein suggested, without your physician's knowledge. Earache is always serious, and since it is usually indicative oftrouble which, if left untreated, may cause deafness, it demandsthorough treatment from skilled hands. Running ears invariably need medical attention and should never beneglected. NOSEBLEED If the nose bleeds whenever it is cleansed, more than likely there isan ulcer on the septum which will continue to bleed if left untreated. The physician should heal the ulcer, and the child should be taughtalways to vaseline the nostril before cleansing it. In case of persistent nosebleed, put the child to bed with the headelevated. Pressure should be put on the blood vessels going to thenose by placing two fingers firmly on the outer angles of the nose onthe upper lip, while a helper may put firm pressure at the root of thenose at the inner angle of each eye. An ice bag may be placed at theback of the neck, and another piece of ice held on the forehead at theroot of the nose. If these measures do not stop the flow of blood afew drops of adrenalin may be put into the nose and repeated in fiveminutes if necessary. As the bleeding begins to stop, as well asduring the bleeding, all blowing of the nose is forbidden as it willonly cause the bleeding to start afresh. It sometimes helps to hold apiece of ice in the hands. CUTS AND TEARS A cut with smooth edges, if deep, should be allowed to bleed freely, should be washed in boracic acid solution, and its edges held togetherby a stitch which is usually put in by a physician; but if treatmentis to be given at home, the hands of the nurse must be thoroughlywashed and the thread and needle boiled for twenty minutes. If thephysician has been sent for, make firm pressure over the wound bybandaging tightly with a dressing of sterile gauze dipped in boracicacid solution. In case of a slight cut, make it bleed freely, then wash inboracic-acid solution and apply sterile gauze held in place by abinder. If no odor or pain follows, let alone for two or three days, when a new dressing is applied. A physician should be called in case of ragged wounds or tears, assuch usually leave bad scars. Cleanse carefully, leaving no dirt inthe wound, cause it to bleed, if possible, and apply a sterile gauzecompress wet in boracic-acid solution, bandaged on as directed above. Zinc ointment may be applied to surfaces that have been skinned. Alldressings on dirty wounds should be changed daily. Blood poisoning may readily follow a wound, hence the utmostcleanliness should prevail. The hands of the attendant, the dressings, the surrounding skin, must all be clean. The bowels should be keptopen, and under-feeding rather than over-feeding is indicated. If a needle be needed to open a sore or boil, always disinfect thepart and surrounding area by painting with tincture of iodine, andheat the needle to red heat through a flame before it touches thesore. In case of cuts or wounds of the eyeball apply a compress of sterilegauze wet in boracic acid, held on by a bandage, and go immediately toa good eye specialist. PUNCTURED WOUNDS AND SLIVERS Wounds made by pins, needles, fishhooks, tacks, and splinters arealways very painful and great care must be exercised to force bleedingfreely, which helps to wash out infection, as more than likelymicrobes entered with the instrument or sliver when the wound wasmade. Fishhooks are exceedingly troublesome, as they often occasion theenlarging of the wound to get them out, especially if they have gonein beyond the barb. Slivers are easily broken off, so great care is needed in theirremoval. A pair of tweezers is convenient for seizing the protrudingportion, while all side movements are avoided lest it break off in theflesh, in which case it may be gotten out with a needle that has beensterilized in a flame. All puncture wounds should be dressed with the wet, sterile compress, covered over with wax paper and bandaged loosely; this encouragescleanliness and favors healing. BRUISES If left untreated, bruises swell, become highly discolored, and in theprocess of healing pass through the dark blue, green, and yellowstages. The treatment is as follows: Apply hot and coldalternately--the heat should be as hot as can be borne and left onvery hot for three minutes, then ice water compresses should beapplied for one minute, then hot again--these changes should continuefor an hour, and if carried out immediately after the injury alldiscolorations and most of the swelling may be avoided. Witch-hazelcompresses are comforting. If discoloration has taken place, theapplication of hot compresses will often hasten its disappearance. FRACTURES AND DISLOCATIONS While there is very little a member of the family or a non-medicalfriend can do in case of a fracture, and while it is unwise to offersuggestions relative to the setting of bones, yet it is highlyimportant that both the family and friends know how properly tosupport a broken leg while carrying a disabled person into the houseor to near-by medical aid. For instance, in the case of a fractured leg below the knee, if acouple of flat boards three inches wide be tied about the leg with twopocket handkerchiefs, the ends of the fractured bone will not rubagainst each other and the pain will be much less in carrying. Inthis way all danger of causing the broken bones to protrude and thus"compounding" the fracture is also avoided. And also, if there is nonear-by ambulance, a good emergency stretcher may be improvised out oftwo or three buttoned vests with two poles, rakes, or brooms runthrough the armholes--one vest under the shoulders and one under thehips and still another under the fracture. An injured person may inthis way be carried for miles quite comfortably. Two people may fashion a seat out of their four hands on which thedisabled child may sit with his arms about the necks of his twofriends. If the fractured end of the bone penetrates the flesh it isthen known as a compound fracture and the utmost cleanliness mustprevail--as in dressing other wounds. An X ray laboratory shouldalways be sought, where convenient, to ascertain if the ends of thebones are in good position. In dislocations, the bone has slipped out of place at the joint. Medical aid should be called to replace the bone, while hotapplications may be used in the meantime. SPRAINS All sprains (a twist or straining of a joint) should promptly be putinto a very hot bath and held there for thirty minutes. If this isimpossible, then a rubber tube or a handkerchief is tied snuglybetween the sprain and the trunk of the body. Almost instantly thepain, which is often intense and severe, is very much lessened. Thehot-water bath is very hot, and the joint should be very red on takingit out. Immediately following the bath the injured joint is wrapped ina very cold wet compress, which is next completely covered by silk, gutta-percha, mackintosh, or many thicknesses of newspaper--anythingthat will hold all the heat in--as the cold compress is quickly heatedup. Lastly, a bandage of heavy flannel completely covers thewhole--compress, impervious covering, etc. The joint is now elevated for three hours, when it is again immersedin a very hot bath and then again the cold compress is applied. Thisis continued every three hours, except during sleep, for two days, after which it may be done morning and evening. Massage is nowadministered every three hours, first four inches below the injurythen four inches above it, while in a day or so the joint itself maybe gently rubbed with well-oiled hands. By the end of one week thepatient begins to use the injured member. In the case of a sprained ankle a properly applied adhesive strapbandage will give no end of relief and support. Various liniments maybe applied, but usually the good obtained is from the thorough rubbingwhich always accompanies their use according to directions. Sprains treated as above directed will often liberate the child inone-third the usual time generally allotted for its healing. FROST BITES AND CHILBLAINS Keep the child who has frozen some part of his body in a cool room, and rub the frost-bitten part with snow or ice water, or wrap it up incold water compresses. The return to heat must be slow indeed, else much pain may beexperienced; blisters followed by discoloration, and evenmortification, may set in. You may be surprised some morning onawakening to find your child's hand twice its normal size and veryred, because it was out from under the cover a good share of the nightexposed to Jack Frost. Do not bring it to heat quickly but immerse itin cold water, gradually and slowly raising the temperature of thebath until it is warm and comfortable. The intense itching and burning of a chilblain may often be relievedby painting with iodine or triple chloride of iron (Monsel'ssolution). Soap liniment has also been suggested, as well as alternateapplications of hot and cold water. Chilblains are troublesome, painful, and their yearly recurrence is often very annoying. SWALLOWING POISONS Poisons of an acid nature, such as hydrochloric, sulphuric, nitric, oroxalic acids, are neutralized by alkalines, such as magnesia, chalk, soda, and soap, followed by soothing drinks or sweet oil. Remember that carbolic acid is not an acid, and is not antidoted withalkalines. The swallowing of carbolic acid should be quickly followedby diluted alcohol, and if this drug is not ready at hand many of thenumerous alcoholic patent medicines will do just as well. Epsom saltsshould be given in abundance. Poisons of an alkaline nature, such as lye, washing soda, ammonia, etc. , are antidoted with vinegar or lemon juice, followed by soothingdrinks or sweet oil. A complete table of poisons and their antidotes will be found in theappendix. Poison ivy, as soon as detected, should be treated as follows:Thoroughly scrub the affected part with tincture of green soap and hotwater, which often prevents the trouble developing. Clean pieces ofgauze may be wrung out of lime water and placed over the inflamed andmuch swollen surface, keeping them very wet. At night an ointment ofzinc oxide may be applied over a painting of "black wash" (to beobtained at drug stores). Poison (trifoliolate, or _three-leaved_) ivyresembles Virginia Creeper, and all nurses and caretakers should beable to recognize it. Another treatment for poison ivy which is said to be very efficient isas follows: Moisten a bit of cotton with a ten-percent solution ofcarbolic acid and apply to the affected area--then immediately (aboutone-half minute) wipe off this carbolic acid with another piece ofcotton saturated with alcohol. Matches, roach powders, fly poisons, washing fluids, lye, paris green, antiseptic tablets, and pieces of green paper, should all be kept outof the child's reach; and, in case of accidental swallowing of any ofthem, the physician should be sent for at once, and with the message"Come!" should be given the name of the poison swallowed--if it isknown. After the antidote is given, soothing drinks are usually administered, such as raw white of egg, milk, flaxseed tea, slippery elm, etc. Complete rest in bed is always essential, and external heat isnecessary for the body chills easily as the child grows weak. Toothache may be temporarily relieved by applying an ice bag below thejaw, thus diminishing the flow of blood to the tooth, and a hot-waterbottle to the cheek, which causes the skin vessels to fill with blood, thus relieving the tension in the vessels of the tooth. If there is a cavity, a small piece of cotton moistened with oil ofcloves and packed well into it may give much relief. Children and adults should make a bi-annual pilgrimage to the dentist, who seeks out beginning cavities, early treatment of which willprevent these dreadful aches and later ill health. BURNS Burns and scalds are not at all uncommon with children, whoseeagerness to explore and desire to investigate often leads them intotrouble. 1. The simple reddening of the skin--slight burns and sunburn--simplyneeds protecting oil, or equal parts of oil and lime water, and is tobe covered with sterile gauze. 2. The burns which destroy the outer layer of the skin, producing ablister, are treated much as a wound would be treated. The blister, iflarger than a half dollar, should be opened near the edge with aneedle which has been passed through a flame. The serum should bepressed out and the parts protected by a piece of gutta-percha thathas been disinfected with some antiseptic solution; this coveringkeeps the dressings from sticking, thus avoiding the destruction ofthe new-forming tissues. 3. When the tissues are injured in the more severe burns, thesurrounding flesh is carefully disinfected with boracic-acid solution, and the same dressing applied as described for the "blister burns. "Balsam Peru is a healing balm for burns of this classification. If a child's clothes catch on fire he is instantly to be thrown on thefloor and any heavy woolen fabric, such as a curtain, table spread, blanket, or rug, is to be thrown over him (beginning at the neck) andthe flames thus smothered. The clothing is now cut off, and if morethan one-third of the body is burned the child should be taken to thehospital for constant care; and if more than one-half of the body isinjured recovery is doubtful. Great care should be taken in keepingthe unburned portion of the body warm, as there is a great tendencyfor the child to become very cold as he weakens from both the nervousshock and from the absorption of toxins. Acid chemical burns are treated with baking soda, except in the caseof carbolic acid (misnamed), which is treated with alcohol; alkalinechemical burns are dressed in vinegar or lemon juice compresses. Methods for restoring the drowned should be understood by every man, woman, and youth. These methods are more fully taken up in worksdevoted to emergencies and will not be discussed in detail at thistime. FAINTING Consciousness is quickly restored to the fainting child by loweringthe head--laying him flat on the floor--while an assistant raises thelegs perpendicularly. Cold dashes of water may be slapped on the chestwith a towel, while the face is bathed or sprinkled with cold water. Consciousness is usually quickly restored by the above suggestions, inconnection with plenty of fresh air. A sudden blow on the head occasionally results in a severe conditionknown as concussion of the brain. There is a partial or complete lossof consciousness lasting from a few moments to an hour or two. Pallorof the skin and a sense of bewilderment accompany concussion of thebrain. Rest, quiet, and darkness should prevail until the physician arrivesand makes an examination. External heat to the extremities may beapplied, but no stimulants are to be administered until so ordered bythe physician. It is wise to seek medical advice in the case of odd or unusualbehavior after a fall on the head. CHAPTER XXXV DIET AND NUTRITION Most interesting is the study of the food as it passes through theprocesses of digestion, absorption, assimilation, and oxidation--alldefinite and important parts of the great cycle through whicheverything we eat passes on its way from the table to the tissues. Elimination is the last step in nutrition, and is the process by whichthe body rids itself of the broken down cells and other poisonous anduseless wastes. These various phases of bodily nutrition may beexpressed in a single term--metabolism. What we eat and how much we eat must be carefully planned, for ourbody temple is really made of what we eat. If you were erecting abeautiful mansion you would not think of allowing cheap, trashy, andinferior building materials to enter into the construction of yourhome. Neither should you permit unfit and inferior materials to becomea part of the daily dietary of your little boy or girl, thus to becomea part of their bodily structure. ASSIMILATION OF FOOD Following the process of digestion in the stomach and intestine, thenutritive food elements are absorbed through the wall of the bowel bythe wonderfully adapted little villus, and distributed by variousroutes to the uttermost parts of the body. The sugars (all starchesare changed into sugar) are carried in the portal blood stream to theliver, where they are actually stored away in the form of glycogenwhich, in a most intelligent manner, is dealt out to the body fromhour to hour as it is needed for fuel. If all the sugar, after ahearty meal, were poured into the circulation at once, the bloodstream would be overwhelmed and the kidneys would be forced toexcrete it in the urine. This unnecessary waste is avoided by theliver's storing sugar after each meal and dealing it out to the bodyas required. Likewise, the proteins also pass through the liver on their way to thebody. Just what action the liver exerts upon proteins is not whollyknown at the present writing. The digested fats are absorbed at onceby the lacteals, the beginning of the intestinal lymphatic system, bywhich they are carried to the large veins at the root of the neck andthere emptied into the blood stream. We have now traced our variousfood elements through the processes of digestion and absorption in thealimentary tract, some going through the liver, and others through thelymphatic system, until they circulate in the blood stream itself. It is from these food substances, circulating in the blood stream, that the various cells of the body must assimilate into themselvessuch portions as they require for purposes of heat and energy and forthe repair of their cell substance. This specialized work of cellassimilation converts the dissolved watery food in the blood intosolid tissues, exactly reversing the process of digestion. With a most profound intelligence, each of these body cells andtissues, bone and nerve fiber, muscle and organ, selects from theblood stream just its supply or portion of the food elements requisiteto its upbuilding and maintenance. The mysteries of assimilation areeffected by means of chemical substances called "enzymes, " similar tothose found in the digestive organs, but acting in an entirelydifferent manner, in that they build up solids out of liquids insteadof converting solids into liquids. ELIMINATION OF BODY WASTES Metabolism consists of a twofold rôle--an upbuilding and a tearingdown process. After the food is all digested, absorbed, andassimilated, having become a part of the bodily organ, bone, muscle, and nerve fiber, then begins the work of tearing it down--ofliberating its heat and energy--to be followed by its eliminationfrom the body through the sweat glands, uriniferous tubules of thekidneys, etc. The carbohydrates (starches and sugars), together withthe fats, are completely burned up in the body and are then eliminatedin the form of water (thrown off through the sweat) and carbonic acidgas given up by the lungs. The proteins, or nitrogenous foods, are not so completely burned up inthe body. The ashes which result from their combustion are not simplesubstances like the water and CO_{2} of the carbohydrates. Thisprotein ash is represented by a number of complicated substances, someof which are solid (protein clinkers), which accumulate in the bodyand help to bring about many diseases, such as gout, headache, fatigue, biliousness, etc. These protein ashes and clinkers are further acted upon--split up andsifted--by the liver, and are finally eliminated by the kidneys in theform of urea, uric acid, etc. The body being unable to store upprotein, is often greatly embarrassed when one eats more of thissubstance than is daily required to replenish the waste of the body, for it must all be immediately split up in the system, and theover-abundant and irritating ashes must be carried off by theeliminating organs. Now, the overeating of sugars, starches, or fats, is not such a serious matter, as they may be stored in the liver andsubsequently used; and even if they are eaten in excess of what theliver can care for they accumulate as fat or add extra fuel to thefires of the body, their ashes being carried off in the form of suchharmless substances as water and carbon dioxide (CO_{2}); but theovereating of protein substances is always a strain on the body andshould be avoided. ELEMENTS OF NUTRITION There are seven distinct elements entering into the composition ofhuman foods--protein, starch, sugar, fat, salts, cellulose, and water, not to mention enzymes, vitamines, and other little-known chemicalprinciples. These elements are all variously concerned in thenourishment, energizing, and warming of the body. PROTEINS The proteins are the structure builders of the body. While starches, fats, and sugars may be compared to the coal that feeds thelocomotive, the proteins represent the iron and steel that are usedfrom time to time to repair the engine and replace its worn parts. Theessential chemical difference between starch and protein is that thelatter contains nitrogen and a small amount of sulphur and phosphorus. The most common forms in which protein is used for food are theglutens of the grains, the legumes, nuts, cheese, the white of egg, and lean meat. STARCHES The starches are by far the most abundant of all elements in humanfood. They enter largely into the composition of nearly all plants andseeds. Under the influence of the sunlight, the green-colored plantsgather up the CO_{2} of the air and, with the water absorbed from theground, build up starch. The plant takes all the carbon from whichstarch is made from the air, but while the atmosphere contains almosteighty per cent of nitrogen, the plant is unable to use it; it mustsecure its nitrogen from the decaying refuse of the soil. Thus theplant utilizes the waste products found in air and earth in thebuilding of its food substances. Starch exists in the form of small granules. Since each little starchgranule is surrounded by a woody envelope of cellulose, it becomesnecessary to cook all starches thoroughly in order to burst thiscellulose envelope and thus enable the saliva to begin, and othersecretions to continue, the work of digestion. FRUIT SUGARS The sugar of fruits represents a form of food requiring practically nodigestion; while the sugar found in beets, the cane plant, and themaple tree, must be acted upon by the digestive juices of theintestine before their absorption can take place. During the winter, the maple tree stores its carbohydrates in its roots in the form ofstarch. With the advent of spring Mother Nature begins the digestionof this starch--actually turns it into sugar--and in the form of thesweet sap it finds its way up into the tree trunk to be deposited inthe leaves and bark in the form of cellulose, a process very similarto that performed by digestion in the human body, where starch bydigestion is first turned into sugar, and afterwards deposited inanother form in the liver and muscles. Dextrine is a form of sugar resulting from thoroughly cooking orpartially digesting starch. There are about twenty-five stages orforms of dextrine between raw starch and digested starch or fruitsugar. Dextrine is found in the brown-colored portions of well-toastedbread. FATS Fat is a combination of glycerine and certain fatty acids. As a food, it is derived from both the animal and the vegetable kingdom. Animalfat consists of lard, suet, fat meat, etc. , while fat of animal originis represented by cream, butter, and the yolks of eggs. The vegetablefats are found in nuts, especially the pecan, cocoanut, Brazil, andpine nuts; also in the grains, particularly oats and corn. The peanutalso contains a considerable amount of fat. Of the fruits, the bananaand strawberry contain a trace of fat, while the olive is the onlyfruit rich in fat. As a food, fat is used in three forms. The emulsified form isrepresented by cream, olive oil, and nuts. When the tiny globules offat, which are each surrounded by a little film of casein, arecrushed--united into a solid mass--we have a free fat. This form isrepresented by butter and other animal fats. Another form is friedfat--fat which has been chemically changed by heat with thedevelopment of certain irritating acids. MINERAL SALTS The mineral elements comprise but a small part of human food asregards weight, but they are extremely important to the health of thechild as well as the adult. As found in the food, they are not in theform of mineral salts, like common table salt. The salts of food areliving salts, organic or organized salts, such as are found in thegrowing plant. These salts are of great value to the various fluidsof the body, and also as stimulants to nerve action, but moreparticularly in the work of building up the bones. Salts are found largely in the cereals. A small amount is also foundin vegetables, particularly the potato, as well as in most fruits. CELLULOSE Cellulose represents the great bulk of all vegetables and fruits. Itis digested by most animals, but in man it is digested only to theextent of about thirty per cent. The presence of a large amount ofcellulose in the food enables us often to satisfy the appetite withoutinjury from overeating. It serves to give bulk to the food, andthereby possibly acts as a preventive to constipation. WATER Water fills an important place in the nutrition of the body. The foodchanges in connection with digestion, assimilation, and elimination, can take place only in the presence of water. Water constitutes fromfifteen to ninety-five per cent of the various foods. The wateryjuices of vegetables and fruits consist largely of pure, distilledwater, in which fruit sugar is dissolved, with added flavoringsubstances. Water is absolutely essential to the performance of everyvital function connected with human metabolism. ANIMAL HEAT The source of heat in the animal body was the subject of muchsuperstitious speculation on the part of ancient scientists. It is nowknown that animal heat is derived from the food we eat by means of apeculiar process of vital oxidation--effected in the presence ofoxygen--by the action of water and enzymes upon the food elementsabsorbed by the living cell. This process of oxidation liberates theheat and energy stored by the sun in the food, and thus the body iskept warm by this constant combustion of the digested foodstuffs. Thestarches and sugars, together with the fats, represent food elementswhich serve as the body's fuel. By this means we are able to maintaina constant body temperature of almost one hundred degrees. The average human body produces enough heat every hour to raise twoand one-half pounds of water from the freezing point to the boilingpoint. This is equivalent to boiling about seven gallons of ice-waterevery twenty-four hours. Differently expressed, the body gives offeach hour the same amount of heat as a foot and a half of two-inchsteam coil. This is the same amount of heat which would be produced byburning about two-thirds of a pound of coal. FUEL VALUE OF FOODS Expressed in terms of English weight, the fuel value of the threedifferent food elements would be: 1 ounce of carbohydrates 127. 5 calories 1 ounce of proteins 127. 5 " 1 ounce of fat 289. 2 " It will be observed that fat contains more than twice as much heat asthe carbohydrates. This is due to the fact that fat contains morecarbon than either starch or sugar. Next to fats, starches and sugarsare the most important fuel elements. Protein is a very extravagantform of food for fuel purposes. Proteins are the most expensiveelements of human food; they are incompletely burned in the body, andinasmuch as they leave behind distressing and disease-producing ashes, it is clearly evident that only sufficient amount of proteins shouldbe eaten each day to supply the demand of the body for repairs. Weshould depend more largely upon the carbohydrates and fats for heatand energy. A large part of our food is required to furnish heat to take the placeof that lost by radiation from the skin, and this is why childrenrequire more food than adults--they have a larger skin surface inproportion to their weight, and therefore lose more heat by radiation, and it is for this reason that the food for the growing child must bewisely and carefully selected. DIET FOR CHILD TWO TO THREE YEARS OLD _Breakfast_, 7-8 A. M. : Fruit; cooked or toasted cereal served withthin cream; a soft boiled or coddled egg; bread (two or more days old)and butter; plenty of milk. _Dinner_, 12-1: Soups; creamed vegetables--tomato, corn, peas, andcelery; any two of potatoes--creamed, mashed, or baked--carrots, beets, spinach, peas, cornlet, squash, cauliflower, asparagus tips, string beans; protein dish--the puree of dried beans, peas, orlentils; macaroni or carefully selected meats; dessert--apples, bakedor sauce--or other fruits, junket, custard, milk. _Supper_, 5-6 P. M. : Fruit, bread (bran bread if constipated); milk;porridge, with rich milk or milk toast; sweetened graham crackers. FOODS ALLOWED CHILDREN OF FOUR YEARS AND OLDER _Protein Dishes_: Purees of dried peas; lentils; beans; macaroni;eggs--soft boiled, poached, scrambled, or omelette; meats--steak, chops, chicken, turkey, broiled fish. _Cereals_: All the toasted-flake foods; toasted and not too freshbread, including both graham and bran; hominy; corn meal; oatmeal;farina; rice; barley; tapioca; sago, etc. _Soups_: Creamed vegetable soups of all kinds and broths. _Vegetables_: Potatoes; all the small green vegetables; lettuce;stewed celery; beets; squash; cauliflower, etc. _Fruits_: All, if stewed or baked. Raw fruits--pears, peaches, ripeapples, berries, oranges, persimmons, grape-pulp without seeds, etc. _Desserts_: Custard; jellos; junkets; home-made ice cream; spongecake; baked fruits with whipped cream, etc. FOODS TO BE AVOIDED BY YOUNG CHILDREN 1. _Doughy breads_, griddle cakes, insides of muffins, hot biscuits, etc. 2. _Fried meats_, such as sausage, oysters, pork, ham, veal, saltfish, corned beef, dried beef, etc. 3. _Foods that are hot when they are cold_--such as catsup, horseradish, mustard, highly spiced pickles, sauces, etc. 4. _Rich pastries_, puddings, unripe fruit, salted peanuts, and highlyconcocted dishes. 5. _Certain salads_, containing coarse but easily swallowed foods, with highly seasoned sauces. 6. _Tea, coffee, and all alcoholic beverages. _ 7. _Soft candies_, chocolate creams, bon-bons, patties, etc. Average normal children crave sweets, and since their normal food isabout seven per cent sugar it is not to be wondered at. There are manyforms of pure, hard candies which may be taken by the three-year-oldchild. They are stick candy, fruit tablets, sunshine candies, andother varieties which may be sucked. All soft candies, such as chocolate creams, bon-bons, patties, etc. , are to be avoided. Hard candies, taken along with the desserts at mealtime, in no wise injure the normal stomach of the healthy child. The other members of the family should set a correct example bysucking the hard candies rather than chewing them; for if the hardcandies are allowed to dissolve slowly in the mouth they produce aweak solution of sugar, which does not interfere with digestion as dothe strong and concentrated sugar solutions which result from chewingchocolate creams, bon-bons, etc. Candy, cookies, sandwiches, or bits of cake should never be allowedbetween the meals. EATING BETWEEN MEALS Children who do not eat well at the breakfast table, if given a"piece" at 10 A. M. , will not be ready for the 12 o'clock meal; andthen another "piece" at 2 P. M. Interferes with the normal appetite at6 P. M. Digestion is disturbed, the nervous system irritated, and a"puny child" is often the result. Bring the three-or-four-year-old to a well-selected breakfast sometime between 7 and 8 A. M. Then nothing--absolutely nothing--but watermust pass the lips between that breakfast hour and the 12 o'clockmeal, which should be a good one. Then the interval until 5 or 6 P. M. Is passed in the same manner. At the evening meal the appetite isagain whetted: and a good appetite always means good gastric juice todigest the meal. And so, good mother, guard carefully the intervalbetween meals if you would have good digestion and good health for thelittle folks. DAILY FOOD REQUIREMENT The following table, taken from _The Science of Living_, [B] shows theminimum of calories or food units required by boys from five tofourteen years of age and girls from five to twelve: BOYS Skin Daily Age Height in Weight in Surface in Calories or Years Inches Pounds Sq. Ft. Food Units 5 41. 57 41. 09 7. 9 816. 2 6 43. 75 45. 17 8. 3 855. 9 7 45. 74 49. 07 8. 8 912. 4 8 47. 76 53. 92 9. 4 981. 1 9 49. 69 59. 23 9. 9 1043. 7 10 51. 58 65. 30 10. 5 1117. 5 11 53. 33 70. 18 11. 0 1178. 2 12 55. 11 76. 92 11. 6 1254. 8 13 57. 21 84. 85 12. 4 1352. 6 14 59. 88 94. 91 13. 4 1471. 3 GIRLS Skin Daily Age Height in Weight in Surface in Calories or Years Inches Pounds Sq. Ft. Food Units 5 41. 29 39. 66 7. 7 784. 5 6 43. 35 43. 28 8. 1 831. 9 7 45. 52 47. 46 8. 5 881. 7 8 47. 58 52. 04 9. 2 957. 1 9 49. 37 57. 07 9. 7 1018. 5 10 51. 34 62. 35 10. 2 1081. 0 11 53. 42 68. 84 10. 7 1148. 5 12 55. 88 78. 31 11. 8 1276. 8 [B] Sadler, William S. , _The Science of Living; or, The Art of KeepingWell_. A. C. McClurg & Co. CHAPTER XXXVI CARETAKERS AND GOVERNESSES Because of her versatile adaptability to the management of details, woman, all through the ages, has willingly and happily sacrificedherself upon the altar of service. It is not in the province of thischapter to go into the details of the tribal life of the early hordesand clans that came from the north and from the east to establishcivilization in the cities of Rome and Britain--space forbids. In thischapter we wish to hold up a picture to the mother, a picture whichmay speak volumes to her soul; one which perhaps she may ruthlesslythrow away--nevertheless, we propose to exhibit it. HOMEMAKING VS. HOUSEKEEPING A newspaper woman in my office recently told me a story of a motherwho finished her high-school education, took some work in auniversity, and who yielded to the earnest pleas of herlover-classmate through grammar school, high school and college--andmarried him. To this happy family there came a number of beautifulchildren. The mother willingly, lovingly, cared for them during theirhelpless infancy--made their clothes, managed their meals, opened thedoor for them as they came home from school, met them with a cheerystory, listened to their problems, helped them with their lessons--butall through it, first, last and all the time, she also managed theentire home. She dusted the furniture, changed the curtains, lookedafter the linen, mended the clothes, and even pressed the trousers ofher "rapidly rising" husband that he might go out into his "club life"and enjoy the evenings with his associates. The duties of the day sowearied her, and the night vigils with the sick child, --looking afterthe little coughs, the uncovered shoulders, getting the drinks ofwater and performing a dozen other details--that she was too weary toaccompany her husband to the dance, to the theater, to the socialgathering or to ladies' night at the club; and so, in the course of adozen years, the mother had grown old, and quite naturally she hadgrown "home centered. " Her world's horizon was the walls of her home. She was happy and quite contented in her children's smiles, in thecheery "how do you do" of her husband, in the fact that that gravy wasgood or that steak was fried to the king's taste. She was happy and contented until one day when the awakening blowcame. In the attic she and her thirteen-year-old son, who was justentering high school, were looking through an old chest when she drewforth some examination reports and some old school cards--holding themup side by side. One set of the cards bore the father's name and theother set the mother's maiden name. In great surprise the boyexclaimed, "Why, mother, I never knew you studied algebra and Latin;why, mother, I never knew you were educated. " Her eyes wereimmediately opened, the scales fell off, she was awakened to the factthat her own son was coming to regard his mother as somewhat inferior, in intellectual attainments, to the father--that she was considered inthat home as a mere domestic. True, the steak had been broiled well, the pudding was exquisite, the children's clothes were always inorder, the husband's trousers were always beautifully pressed, histies were cleaned as well as a cleaner could clean them; but where didshe stand in her boy's mind and where was she in her husband's mind? "Do you notice how trim and nice Mrs. Smith always looks? Her clothesare always in the latest style, and she combs her hair so becomingly. "Such remarks as this from the well-meaning husband cut keenly, and itis well that they do, for often it is only such remarks that wake upour "home mother. " Dear reader, I want you to ponder this story. I wish to say to themother who has started out upon a career in life, who has preparedherself for teaching school, for a business career, for story writing, for millinery, for lecturing, or has perhaps graduated in a domesticscience course, that she makes the mistake of her life in settlingdown, just because she has taken another's name, to be perfectlysatisfied with becoming the household domestic, the household mender, the household cook. MOTHERS IN THE PROFESSIONS I have in my acquaintance scores of mothers in the professions, newspaper women, women who have carved out brilliant careers forthemselves, women who have taught school for twenty years while theirchildren have been growing up, women physicians who have risen in theesteem of all their professional brothers and sisters, women who haveconducted cooking schools, who have occupied positions of trust inhospitals and in every walk of life, and who have successfully rearedchildren at the same time. You will pardon me for being personal when I say that since our ownlittle fellow was six weeks old his clothes have been washed andmended and his food has been prepared by earnest and honest women whohad not fitted themselves for the career which this boy's mother hadchosen. His mother went to her office, cared for her patients, kept upby the side of her husband in the battle of life. All the time therewas a woman at home just devoted to that little fellow. A newspaper woman recently told me her story--a story which shouldimpress everyone of my readers as it did myself, and she, like manyother mothers in the professions, leaves her home as the little fellowgoes to school. His hands have been washed, his bowels have moved, hishair has been combed, his breakfast has been eaten by the side of hismother--she has directed it all. He goes forth to the schoolroom andshe goes forth to her profession. All through the day she lovinglykeeps in mind these children that are growing up. She works theharder, real love entering into everything she does, because she isnot merely earning the bread that goes into their mouths, but isforming a character not only for herself but, because of her broadenedhorizon, is instilling into their little minds the possibilities oftheir own career, their own opportunity to enter into the world's workas real world workers. I contend that the mother in a profession has many blessings that themother who remains at home never has. The mother who remains at homehas a viewpoint that is often quite likely, wholly unconsciously, ofcourse, to become small, to become narrow, to become focused uponsmall details; on the other hand, the mother whose mind and whoseheart are so full of the affairs of the office, of the newspaperarticle she has just written, or the lecture she has just given or isabout to give, or the meeting that she is to preside over, is quitelikely to become somewhat irritated sometimes if the little fellowdoesn't stand quietly to have his hair combed, she is quite likely to"feel rushed;" but under all circumstances, dear reader, whether thismother be a home mother or in a profession, never, never must sheallow mental panic to seize her. Ever must we keep in mind that theselittle ones are just children--children that are still in thedevelopmental stage. WORK OUTSIDE THE HOME And now for the home mother. I believe it is necessary and ofparamount importance that she get away from her children (if possible)several hours each day; that she provide for them a caretaker who canrelieve the children of her or relieve her of the children, whicheverway you may look at it, for we are inclined to think that the childrenoften tire of the mother just about as often as the mother tires ofthe children. I would have the woman who remains at home, whosehusband is able to provide outside help for the heavy work of thehouse, enter into some uplifting neighborhood work, social settlementwork, church work, wholesome club work--anything but bridge and whistand gambling games. I would have them bring into the nursery a womanwho is cheery, who is capable of teaching games, of entertaining andamusing these little folks under their own roof. The woman who has graduated from high school, who has a diploma toteach, I would have take a school or, at least, do substitute work. She will be happier--far happier--continuing along the lines for whichshe has prepared herself, even if all the money she earns be used topay the help. Some women are especially fitted for the important workof mother and homemaker, and such wives will find for themselves aworthy career in the home and its neighborhood activities. Each womanmust find a field of action suited to her own temperament, education, experience, talents, and opportunities. SELECTING A CARETAKER For a caretaker, the professional or business woman should not selectan ignorant servant girl; that would be a great mistake--a crime--aviolation of the law that should govern the training of these littlepeople who have come to us to be reared and cared for and fitted tooccupy their place among the world's workers. As a rule, one soul doesnot possess the qualifications for scrubbing and laundry work and alsothe firm but gentle ministering qualifications necessary for asuccessful caretaker. They do not combine as a rule. It has been myexperience, as a mother with a profession, and that of many others ofmy acquaintances, that an art student or a music student makes asplendid caretaker. There are hundreds and hundreds of genteel women, with winning manners and beautiful dispositions, who may be obtainedto sew on the buttons, wash the faces, and change the clothes of ourdarlings while we are carrying forward in the world the great work forwhich we have fitted ourselves during the long struggles of our teensand early twenties. The young woman who is brought in to care for the child should beabove the usual "servant" class. She must eat in our dining-room, sheshould be welcome in the living-room or sun parlor, and be treated asa respected member of the family. Her salary is usually not large forshe realizes that she is given something in that home--something thatmoney cannot buy. THE UP-TO-DATE MOTHER Now this young woman (the caretaker) wants to hold her position, andso she is very anxious to carry out in detail the laws and rules thatare laid down by the mother. Mother can keep abreast with the world, mother has time to read periodicals that keep her in touch with thegreat, wide, pulsating affairs of life. She is able to meet morewomen worth while, and with her husband attend lectures, musicals, theaters, and other places for intellectual culture. Anyone of my readers need not look four blocks from her home to find amother who is run down at the heel, whose dresses are calico, whosehat is five or six years old, whose black silk dress (the only one sheever had) is worn shiny or threadbare, who works and saves every pennythat she can that her children may look well; and, even when thehusband does invite her to go out with him, he will often beconfronted with this remark: "John, I would like to go, but really myclothes are a little bit shabby. " The world is just full of suchwomen, with their very hearts being eaten out of them for the want ofa beautiful gown, a beautiful hat or a pretty pair of evening shoes, and they might have them every one if they would be willing to allowthe duties of the household to be presided over by a woman that cannotdo the things the mother can do, while she goes out and accrues anumber of dollars each week which will more than provide for thethings that her soul desires so that she may go well dressed by theside of her husband in quest of that very necessary intellectualculture and social diversion. The wife of a prominent judge, in my office just this week, said to methat she believed that most of our social and domestic uneasiness wasdue to the fact that fathers and mothers and children went outtogether so seldom. The father goes to his club, the children go totheir little gatherings, and mother usually stays at home; although oflate, she is beginning to realize the value of the women's clubs. QUALIFICATIONS OF THE GOVERNESS The caretaker should not be too old. It is a very great blessing ifthere is an older sister in the family who can come in and assist withthis work, or if there is an aunt. If one is to be selected from theopen market, then we suggest a woman in her late teens or earlytwenties whose heart is full of play, whose face is sunny, and who isyoung enough to appreciate and like the becomingness of youthfuldress. It is needless to say she should be free from tuberculosis andother diseases. She should be trustworthy enough not to administersoothing syrups because the children won't sleep, or to give candywhen mother has forbidden her, or to teach the children bad habits ofany sort. It is impossible to exercise too much care in the selection of thissubstitute mother, and when you do find one it is often wise not tokeep her too long. A year or so is plenty long enough for any personto be with our children. It is only necessary for anyone to walk outinto the public parks and casually listen to the conversations of manyof the "chewing-gum caretakers" to discover with what carelessnesssome people select caretakers for their children. The language theyuse is not only ungrammatical but oftentimes both slangy and profane. The flirtations carried on with many of the park policemen andbystanders lead us to feel that many people arrive at the idea thattheir little folks "will grow up some way. " If the caretaker is astudent, a young woman of culture, and is kept with the family, shewill be found to be more circumspect and dependable. Her gentlemanfriend, if she has one, should be allowed to come to the home. Shedoes not have to meet him out in the park any more than a sister wouldhave to go away from home to meet a friend; and, to my mind, everything centers around the viewpoint of the mother as she selectsthis caretaker, for if she is her social equal it puts her in adifferent place entirely to the well-meaning but ignorant servant girlto whose care is often intrusted the lives of the little people. HINTS FOR THE CARETAKER There are a number of hints we wish to bring together in this chapterfor the mother to suggest to the caretaker. For instance, here is agroup that one author gives us: BABY IS HAPPY BECAUSE He is dry. He is healthy. His food is right. He has sleep enough. His meals are on time. He is dressed properly. He is bathed regularly. His habits are regular. His bowels move regularly. He has fresh air day and night. He is not dosed with patent medicines. He is not excited by frequent handling. He is not annoyed by flies or other insects. THINGS BAD FOR BABIES Candy. Pacifiers. Thumb-sucking. Soothing syrups. Patent medicines. Waterproof diapers. Moving picture shows. Sucking on empty bottles. Being kissed on the mouth. Play of any sort after feeding. Sleeping in bed with the mother. Whiskey or gin for supposed colic. Sneezing or coughing in the face. Irregular or too frequent feedings. Sleeping on the mother's breast while nursing. Spitting on handkerchief to remove dirt from baby's face. Allowing a person with a cough or a cold to hold the baby. Violent rocking, bouncing, and rollicking play at any time. Dirty playthings, dirty nipples, dirty bottles, dirty floors. Allowing any person with tuberculosis to take care of the baby. Testing the temperature of the baby's milk by taking the nipple in the mouth. THINGS TO REMEMBER Keep baby out of dust. Don't cover his face. Don't rock him to sleep. Keep baby away from crowds and sick people. Don't neglect a sore throat or a running ear. His health, growth, and happiness depend largely upon _you_. Cats and dogs have no place about a baby. They carry disease. The baby is not a toy or a plaything, but a great responsibility. Don't wipe out baby's mouth. It tends to cause ulcers and thrush. OVERCOMING BAD HABITS There are a few bad habits which older children fall into such aslip-sucking or thumb-sucking or finger-sucking which not only narrowand deform the upper jaw, but likewise deform the hand itself. Theyshould be stopped at the earliest opportunity by pinning the sleeve tothe bedding or putting mittens on the hand or putting a slight splinton the anterior bend of the elbow. Some children suck theirhandkerchiefs, or bite holes in their aprons and neckties. Children often bite their finger nails, and a habit of this kind fullydeveloped during early childhood often remains with them throughoutlife; whenever a nervous spell seizes them they instantly begin tobite their finger nails. Other people pick their nose when nervous, soduring very early childhood these habits should be discouraged. Onemother helped her little son by beautifully manicuring his nails forhim each week. Another child was cured by old-fashioned spanking. Thefinger tips may be painted with tincture of aloes, or dipping the tipsof the fingers in strong quinine water will sometimes help. I know ofnothing better for the adolescent child than to teach him how properlyto manicure his own nails. Another bad habit that children often getinto is stooping or allowing the shoulders to become rounded. Shoulderbraces are not indicated in these cases. The children should beallowed to enter the gymnasium or the father should take off his coatand vest and go through gymnasium stunts with the boy. The mother cando the same for the girl. It is often the case that round-shoulderedchildren are near sighted. The child really has to stoop to seethings. When a child holds his head to one side constantly on lookingat objects, astigmatism, an error of eyesight, is usually indicated. An eye specialist should be consulted, the eyes examined, and properlyfitted eye glasses should be worn. Just as early as possible in the life of the little child he should betaught to blow his nose, to spit out the coughed up mucus from hislungs, to hold out his tongue for inspection and to allow his throatto be examined. He should be taught to gargle, and to regard thephysician as one of his best friends. Attention to these minoraccomplishments will make it very easy indeed for the physician incase of illness. CHAPTER XXXVII THE POWER OF POSITIVE SUGGESTIONS A child is the most imitative creature in the world. Before he is outof pinafores he tries to talk and act just like his elders. It isbecause of this inherent tendency to say and do those very thingswhich he hears others say and do, that, if faith-thoughts are earlyand constantly suggested to the unfolding mind of the child they willassist greatly in evolving a character of joy, confidence, andcourage. On the other hand, if fear-thoughts are continuously sown inthe young mind they will eventually distort the emotions, deform theconceptions, and wholly demoralize the health and life activities ofthe growing child. Within the limitations of the possibilities ofhereditary endowment, and in view of this wonderful imitative nature, we are able to make of a child almost anything we desire; not "anangel, " in the ordinary acceptation of the term, but a child who knowshis place and possesses the power of normal self-control. EARLY FEARS From two to six years of age, when the imagination is most plastic andvivid, when the child's imitative instinct is so unconsciouslyautomatic, is the most effective and opportune time to initiate goodhabits and lay the foundations for the later development of a strongand noble character. "Baby's skies are Mamma's eyes" is just as trueas it is poetical. While a tired and worn-out mother, exhausted by amultitude of harrassing household cares, may be pardoned for heroccasional irritability, nevertheless the little one unconsciouslypartakes of her spirit. When the mother is happy the child is happy. When Mother is sick and nervous the child is impatient and irritable. It is unfortunate that this very time of a child's life, when we cando practically anything we choose with him, is the very time when somany parents fill the child's mind with the unhealthful fear-thoughts. "The bogie man'll get you if you don't mind Mamma, " or, "I'll get theblack man to cut your ears off, " or, "the chimney sweep is around thecorner to take bad little boys, " are familiar threats which are sofrequently made to the little folks. These efforts to terrorize theyoung child into obedience never fail to distort the mind, warp theaffections, and, more or less permanently, derange the entire nervoussystem. The arousal of fear-thoughts and fearful emotions in the mindof the growing child is very often such a psychologic and aphysiologic shock to the child that the results are sometimes notwholly eradicated in an entire lifetime. Just see how far we carry this unwholesome introduction offear-thoughts--even to the Almighty. Thousands of us remember beingtold as a child that "God don't like naughty boys, " or, "God will sendthe bad man to get you if you don't be good. " Thus, early in life, anunwholesome fear of the Supreme Being is sown in the mind of thechild, and, as time passes, these false fears grow and come so topossess the mind and control the emotions that in adult life thisearly teaching comes to mold the character and shape the religiousbeliefs of the individual. To the child who has been reared to dread God, who has come to lookupon the Creator as an ever present "threat, " how is it possible toconvey the beautiful teaching of His fatherhood? FEAR OF NOISES How frequently some unusual noise leads a parent to say: "Keep still!What was that? Did you hear that noise?" The little folks of thefamily are startled, their eyes grow large and their faces pale, whilethey cling to the frightened mother. Of course, investigation usuallyshows that the strange and alarming noise was merely the slamming of acellar door, the rattling of a curtain in the wind, some one walkingabout downstairs, or the action of the new furnace regulator in thebasement. But meantime the harm is done to the children--fear, theworst enemy of childhood, has been unconsciously planted in the mindby the thoughtless and nervous parent. FEAR OF DARKNESS Consider for a moment the thousands of children who are early taughtan abnormal fear of the dark. Even when the child is absolutely freefrom such a fear, when sent into a dark room some member of the familywill thoughtlessly remark, "Do you think it is quite right to sendthat child into that dark room? Suppose something should happen. " Thechild quickly catches the suggestion that something is supposed to beor happen in the dark, and in his mind is sown the seed of fear. When our boy was about two years old he was carried one night to thewindow by a caretaker, and as they looked out into the darkness theyoung woman said, "Boo! dark!" The little fellow shuddered, drew backand repeated, "Boo! dark! Boo! dark!" That night, as was our custom after the evening story, we tucked himin his little bed, turned out the light, and saying, "Sweet dreams, Darling, " closed the door. Imagine our surprise to hear, "Mamma, Mamma, Willie 'fraid of dark, Willie 'fraid of dark, " and it was withdifficulty that he was induced to go to sleep in the dark. Immediateinquiry revealed the occasion of his fears, and the next night we setabout to eradicate the fear of darkness from the little fellow's mind. For ten successive nights we took his hand, and, leading him into adark room, said, "Nice dark, restful dark; we go to sleep in the dark;we're not afraid of the dark, no. " Each night, save one, we were metwith, "No, no, naughty dark. Willie 'fraid of dark. " On the tenthnight as we entered the room as usual, repeating, "Nice dark, restfuldark; we go to sleep in the dark; we're not afraid of the dark, no, "his little mind responded. Suggestion had at last routed fear andgiven birth to faith. We had won! But it had taken ten nights ofconstant work to undo one moment's work of a thoughtless girl. Everynight since he has gone to sleep in the dark without a murmur. THE FOLLY OF MAKING THREATS Threats only show weakness on the part of the disciplinarian. Mostschool teachers early learn the folly of making threats. When I wasteaching school I recall that a number of slate pencils had beendropped on the floor one afternoon. Thoughtlessly I threatened, "Nowthe next child that drops a pencil will remain after school andreceive punishment!" My fate! The weakest, most delicate girl in theroom was the next to drop her pencil, and she was a pupil with aperfect record in deportment. The reader can imagine my embarrassment. I had threatened punishment, and so had to get out of the predicamentas best I could. This experience effectually cured me of making suchfoolish threats. Most of us live to regret the threats we make. "Your father willthrash you when he comes home tonight, " or, "You'd better not let yourfather see you doing that, " or, "You wouldn't behave that way if yourfather was here, " etc. , are common threats which we hear directed atheadstrong and willful boys. What is the result? Do such threats causethe love of the child for his father to increase? They make the childactually afraid of his father. "I'll 'bust' your brains out, " said a four-year-old to his pet lion, because it wouldn't stand up. Now it should be remembered that thesethings do not originate in the minds of the boy and girl. They onlyrepeat the things they hear others say. It betrays both cowardice andignorance to undertake to secure obedience by such threats as "I willbox your ears if you don't mind, " etc. Obedience that is worth anything at all is only secured by suggestionand love, never by promises of reward or threats of punishment. CHILDREN WHO ARE CALLED "COWARDS" Recently we overheard a little fellow say, "Father says I'm the onlycoward in the whole family. " Looking him straight in the face we saidto him: "You're not a coward. Such a fine boy as you couldn't possiblybe a coward. " The boy was greatly amazed, and, as we left him, he wassaying over to himself, "I'm not a coward. She said I'm not a coward, "finally adding, "She said I couldn't be a coward. " This one thought, repeated to him several times and turned over and over in his mind, eventually overthrew the false fears instilled by his father. A short time ago the daily papers contained the story of theten-year-old son of a New York business man who drew his few dollarsfrom the savings bank, boarded a train for Chicago, and, after threedays of amusement and loneliness, his money all gone, was found in ahotel bitterly weeping. His identity was revealed, the parents werenotified at once, and the boy was sent on the first train back to hishome. On the way to the station he sobbed out through his tears, "Well, my brother can't call me a coward any more, anyway. " Who knowsbut that this everlasting taunting of the child with the accusation ofbeing a baby or being a coward has much to do with many such escapadesand other daring exploits on the part of the juveniles who are chafedby such unjust insinuations? Those of us who are acquainted with thevice and crime of a great city can imagine just what might havehappened if this boy had been a little older, if his heredity had notbeen so good, if his money hadn't run out, if he had been able toremain in the big city long enough to make undesirable acquaintances. Many criminals have confessed behind prison bars that when they werechildren they were called cowards. After a while they actually came tobelieve that they were cowards, and in their efforts to acquirecourage and demonstrate their bravery they were led to desperate andeven criminal acts. They prowled around the dark alleys just toconvince themselves that they were not afraid, that they were notcowards, and there they made the acquaintance of the criminals who ledthem into new and dangerous paths. Even if a child enters this worldhandicapped by heredity, let us not lessen his chances of success byadverse suggestion. Faith-thoughts, thoughts of bravery and of courage, may just as easilybe instilled into the mind of the normal child as thoughts of fear andcowardice. A child should never have suggested to him that he isafraid. He should be constantly assured that he is brave, loyal, andfearless. The daily repetition of these suggestions will contributemuch to the actual acquirement of the very traits of character thatare thus suggested. This does not mean that a child should not betaught caution and forethought. THE GIRL WHO WOULD "TURN OUT BAD" Parents do not begin to realize how fearfully dangerous is this habitof constantly reiterated negative suggestion. Let me illustrate by anactual incident: A beautiful girl in a near-by state grew up quietlyin the little village until she was eighteen years of age, whensuddenly she decided to run away from home, declaring she was oldenough to do as she pleased. She confided in one of her girl friendsthat she was going to Chicago, and had made all arrangements to loseherself in the "redlight" district. All that this girl friend said hadnot the slightest influence. As the train bore her away to the cityand to ruin, a social worker in Chicago was wired to meet her at asuburban station. The girl was met, taken from the train and whiskedin a cab to the home of a Christian woman. So possessed was this girlwith the idea of throwing herself away that the captain of police wasasked to talk to her; but the combined efforts of the police captain, a magistrate, and several Christian people could not persuade her torecall her threat. She declared she would kill herself if her parentswere notified. This siege lasted for ten days. Then she finally brokedown, saying: "I simply can't help it. All my life my mother has toldme that I was going to turn out bad. No matter what would happen athome, if I broke a dish or went out with the young people and remainedaway ten minutes later than I was told to, it would always be thrownup to me. 'Oh, some day you'll turn out bad. ' I have heard it until Iam sick of it, and something within seems to push me on and on, telling me I must turn out bad. " Of course the girl was persuaded to believe that these were onlyfear-thoughts; that she was a beautiful, virtuous girl, that shesimply had received the wrong training, that she couldn't possiblyturn out bad. She was thus saved by the sympathy and advice ofunderstanding friends, was subsequently married and is today themother of a splendid boy. WHAT HEALTHY FAITH-THOUGHT WILL DO Here is another story which illustrates what healthy faith-thoughtwill do. A young man was not long ago selected for the highestposition within the gift of a large religious organization. When hewas a lad his parents held this thought constantly before his mind:"David, if you will be a good boy, if you will do what is right, youmay some day be President of the General Assembly. " He became aminister of the Gospel, a very successful one, and subsequentlymarried a young woman who was also much interested in religious work. She continued to encourage him in this ambition, saying: "David, preach the best sermons you can; make an effort to bring many souls toChrist, and some day I believe you will be President of the GeneralAssembly. " The man presided over the General Assembly of hisdenomination, not one term, but term after term. He kept his eye longfixed on that particular aim, and by faith he won it. THE POWER OF SUGGESTION To see how powerful suggestion may be in a child's life take thisincident that every parent knows: The little one trips and tumbles. Mamma says, "Oh, did you fall? Well, never mind; come here, I'll kissit. There, now it's well. " Immediately the child goes back to his playperfectly happy. One little fellow was taught that when he fell heshould get up at once, rub the bump, and say, "That didn't hurt. " Allthrough his career the bumps and the hardships of life were met withthe same pluck. On the other hand, a thoughtless caretaker willexcitedly jump and catch up the slightly injured child, coddle it, rock it, pet it--and the crying continues indefinitely. This earlytraining in meeting minor hurts and obstacles lasts throughout thelifetime. Pluck and grit are lacking. The behavior of the man in theface of difficulties is foreshadowed by the attitude of the childtoward his petty trials and bumps. Successful child training follows in the path of positive suggestion. Impatient words and careless threats of punishment can only contributeto the wrong training of the young mind. When is the best time to suggest to the child? Catch the little fellowwhen he is happiest, when he is overjoyed and filled with glee; for itis at such times that the suggestions offered will meet with the leastresistance. Teach the children through the spirit of play and through the mediumof the story. The boy or girl in the story always can have a cleanface, always close the doors quietly, and otherwise so conduct himselfor herself as to constitute a powerful positive suggestion for good. The story-child always says, "All right, Papa, " "All right, Mamma, "when corrected. BEDTIME A GOOD TIME TO SUGGEST The "going-to-bed time" is the time _par excellence_ for suggestion inearly childhood. After the play time, the study time, and the eveningstory, when all is quiet, in the peacefulness of the darkness, whileyou are seated in a low chair close beside the little bed, with yourhand in his, repeat over and over again the positive suggestions whichyou desire to take root in the mind and bear fruit in the character. Again and again tell the little fellow that he is the noblest andbravest of boys, that he loves truth and hates deceit. No matter whatdisturbs him, if it is the lessons at school or a wrong habit, firstthink out exactly what you desire him to be or to do, and firmly, butquietly, tell it over and over to him. As a concrete example: Suppose Henry, at three-and-a-half years of agehas to be coaxed or almost forced to eat. Say to him: "Now, Henry, youare a good little boy. Papa and mamma love you dearly. If you aregoing to grow up to be a big man you must not forget to eat; sotomorrow when you go down to the table you will eat everything mammaor nurse puts before you. It won't be necessary for papa to feed youat all; you will eat the potatoes, the gravy, the toast, and thecereal, and drink your milk. You will make mamma very happy, and papawill be proud of you; and then after dinner we will have a good romp, and you will soon grow up to be big enough to have a velocipede and awatch. " After two or three evenings of this suggestion you will besurprised to see there is a great difference in his eating. Take the timid little girl who is unable to recite well at school, whois shy, and has great difficulty with her lessons. At thegoing-to-sleep time sit by the side of her bed and tell her thattomorrow she will have her lessons better, that she will not any morebe afraid, that she will get up and recite without the least fear inher heart. By constantly repeating these suggestions she will be givenconfidence, and in most cases it will result in effecting thedeliverance of the child from her bondage to fear. Never tell her thatshe is shy or that she cannot do things. Constantly tell her that sheis a successful girl with a strong character, and that she is going tomake a very useful and courageous woman. Hold high aims and idealsbefore her. Suggestion cannot atone for all the defects of characterwhich may be inherited, but it can do much to help such unfortunatelittle ones gracefully bear their burdens. NEVER ACCUSE CHILDREN OF DISHONESTY Never tell children that you suspect they are dishonest or untruthful. Be very slow to accuse and suspect them of falsehood or theft. Tellthem over and over again they are the best boys and girls in theworld; that they are going to make the noblest of men and women; thatthey love honesty and truth. Even when you discover them in minorfaults do not make the mistake of unduly magnifying and emphasizingthe error. As soon as possible direct the thoughts and attention ofthe wrongdoer away from his error, and focus his thoughts andattention on the high goal you expect him to reach. This will not beconstrued as doing away with proper punishment for persistent faultsafter the more ideal methods seem to have failed. A patient recently called us to see her little girl, and as we madeready to make the examination the mother said: "Now, Mary, stop yourplaying and come and be undressed and let the doctor look at you. " "I don't want to stop playing, " murmured Mary. "But you must come. You know you don't feel well at all, your cheeksare so red. Now swallow and see if it don't hurt. Now try again. Iknow you don't feel well. " By the time we had begun our examinationMary began to succumb to her mother's suggestions, and began to feel atrifle indisposed. She was being made temporarily ill by the unwiseand unfortunate suggestions of the overanxious mother. Theexamination revealed that there was nothing whatever the matter withher. IT IS EASY TO FORM GOOD HABITS Let us get the truth firmly into our minds as parents that it is justabout as easy to form a good habit as a bad habit, just about as easyto acquire helpful, happy thoughts as those that are injurious; and wecan do it, if we will but see to it that our children early formcorrect and proper habits of thinking and acting. While the childrenare taught proper respect for authority, let fear be an unknown wordto them. Don't let a thought of the fear of insanity, of hauntedhouses, of drafts, of this and of that enter into your home. Instead, live in the glorious sunshine of strong, healthy, faith-thought, and asupreme happiness will come into your life, and you will give a legacyto your children for which they will "rise up and call you blessed. " CHIVALROUS SPIRIT The love of mother and sister can naturally and happily be turnedearly to a chivalrous attitude toward all women when it is developedby suggestion and other training. In giving up a chair or bringing onefor a guest, in lifting the hat, in noticing ways to be polite andattentive to mother, a lifelong conduct may be ensured. Each day gives us trying and sometimes shocking revelations of theprevalent lack of courtesy, or even humanity, on the street carsduring the "rush" hours. The indifference to the comfort of women, even the aged, on the part of many men and boys in the matter ofgiving them seats or other care, indicates a dangerous socialcondition. The mother, instead of exercising selfish concern for her boy, shouldmake it her duty very early to suggest that he give his seat to awoman or girl, as he would be glad to have someone do for his motheror sister. Such unselfish service will become a habit of pleasure, andhelp the boy become a pure-minded, manly gentleman with that respectfor womanhood without which a nation is doomed. CHAPTER XXXVIII PLAY AND RECREATION There are a number of theories advocated by late authors on the"psychology of play, " in which they connect the free and easy play ofthe modern child with the more serious and sober pursuits of ourancestors--our racial parents of prehistoric and primitive times. Wequote from _Worry and Nervousness_: And so we are told that the spectacle of the young infant suspending its weight while holding on to some object, and the early instincts so commonly shown to climb ladders, trees, or anything else available, are but racial mementos of our ancestral forest life. The hide and seek games, the desires to convert a blanket into a tent, the instinct for "shanties"--which all boys universally manifest--we are told that these forms of play are but the echo of remote ages when our ancestors sojourned in caves, lived in tents, or dwelt in the mountain fastness. In this same way the advocates of this theory seek to explain the strange and early drawings which the young lad has for wading, swimming, fishing, boating, and other forms of aquatic recreation. [C] In this chapter we purpose to discuss the play of the child, whosecareer we will divide, for convenience, into three stages: 1. The age from three to six--juvenile days. 2. The age from six to twelve--the "going to school" child. 3. The age from twelve to twenty--the adolescent youth. [C] William S. Sadler, _Worry and Nervousness_, p. 377. JUVENILE PLAY DAYS As nearly as is possible the little child should be out of doors thegreater part of his waking hours: To our mind it is nothing short ofcriminal to keep the little folks in the house when the weatherpermits outdoor life. Of the outdoor games which we have to suggest, perhaps the sand pilestands at the head of the list. Clean white sand should be placed inan inclosure just low enough for the child to climb over. Many, manyhappy hours may be spent in this sand pile, at the same time thelittle fellow is in his own yard and the watchful mother knows thedrift of the conversations which take place. In a previous chapter we called attention to the fact that the littlegirls' frocks should be provided with knickerbockers, so that she mayrun and jump, or sit as comfortable as the little boy, without aconscious reproof ever ringing in her ears, "Mary, do keep your dressdown. " OUTDOOR PLAY Tree climbing is another source of enjoyment to these little peopleand they should early be taught how to climb. Instead of suggestingfear to the child let the mother go into the yard and talk with hersomething like this: "Now, Mary, put your foot in that fork, now catchhold of that upper limb, hold on tight, you will get there yet;"instead of the following conversation, which all of our readers haveheard: "John, do take care or you will fall and break your neck; becareful, you will fall. There, I knew you'd fall!" etc. Both mothersare trying to accomplish the same thing--one mother suggests"fore-thought, " while the second mother thoughtlessly suggests"fear-thought. " These little people should be provided with rakes, spades, and hoes, and a portion of the yard should be given them in which they are atliberty to dig and rake and have a royal good time. We have yet to seethe child who is not interested in flower-bed making, and the mothershould think of the virgin opportunity to instill the story of lifeinto the child's mind as he plants the seed, and day by day watchesits development and growth. A pen of rabbits may be a good thing, if proper measures are taken toprevent their burrowing out of the pen, destroying the lawn, causingmuch sadness of heart to their little keeper, and no end of annoyanceto the neighbors. Roller skating and hoop rolling, as well as sledding, are all valuablerecreations. The snowman, snowballing, and the sled riding all bringthe ruddy glow of health to the cheek, and are wonderful producers ofgood appetites and restorers of "tired out nerves. " INDOOR GAMES There is no end to the number of things that can be done when theweather shuts us in, but before we take up these games let us neverforget that every child thoroughly enjoys going out in the rain wellprotected with rubber boots, raincoat, and umbrella. It is not extravagant to burn plenty of electricity or gas on cloudydays, for the artificial sunlight helps to cheer the heart. Suchindoor games as those which may be had from blocks, puzzles, cuttingout of pictures, darning of cardboard, soldier games, dolls, housekeeping, etc. , are all splendid means of recreation for thelittle ones. Let the mother or caretaker join with the little folks inthese pleasant games. For the older children, checkers and dominoesare most excellent indoor games. THE "GOING TO SCHOOL" CHILD First of all we must decide upon the bedtime hour, as well as the hourfor rising. Between the ages of six to twelve, the bedtime hour shouldbe eight o'clock, or not later than eight-thirty, and the rising hourat seven, or seven-thirty in the morning, for children of this agerequire eleven to twelve hours sleep. Again, there must be taken into consideration the home work that thechildren at school are asked to do by their teachers. While this homework is not usually taxing, yet the time spent in doing the work mustbe taken account of. In our opinion the best time for home work is anhour and a half to two hours after the little fellow gets home fromschool. He should be allowed to relax for one and a half or two hours, to play out of doors whenever the weather permits, and then witheither his mother or his caretaker from one-half to three-quarters ofan hour should be spent on the lesson for the following day. Followingthis, the dinner hour is enjoyed with the parents, and after thatthere should always be provision in the daily duties of the father andmother for at least a half hour for the evening romp; so that play andrecreation during the school age occupies possibly not more than twoor two and one-half hours a day outside of school hours. The playgrounds of schools are of inestimable value, and we quiteagree with one who said: "If we can only afford one of the two--theplayground or the school--have the playground first and afterward theschool. " The small parks and playgrounds of the cities are a greatblessing to the little folks. COMPANIONS The companions of the school child are usually his playfellows atschool, and we urge the throwing open of the home during inclementweather to allow these school friends to come in and make trains outof our chairs and tents out of our couch covers, steamer rugs, afghans, etc. We do suggest that caution be used in allowing children to playindoors who are suffering from colds in the head, running noses, running ears, tuberculosis, or other chronic disorders, which areoften highly contagious. Running noses and running ears, as well astuberculosis, may be contracted by susceptible children when the playat recreation time takes place indoors; while such disorders are muchless dangerous in connection with outdoor play. We are well aware of the fact that some playmates may choose thebathroom, requesting that doors be locked, or wish to play in abedroom securely away from mother and the caretaker. Under nocircumstances should this be allowed. Let the child early learn thatgood wholesome play in the open is better than secretive misdemeanorbehind closed doors. THE "IN THE HOUSE" HOUR It is a pitiful fact that many mothers apparently are whollyunconcerned as to the whereabouts of their little folks, even afterdusk; this is unwise to say the least, for a boy or girl under twelveyears of age should be found under the parental roof at dusk. The citymother should impress upon her child that when the street lamps arelighted his first duty is at once to come into the house. During thewinter months this lighting of the street lamps occurs anywhere fromfour to six. During the summer months another rule should be laiddown, depending upon the neighborhood, the character of the friends onthe street, the surroundings, etc. By all means let us see that ouryoung people are in the house by dusk. PARTIES Every mother who reads these lines has had to meet this question:"Shall I let my little one begin to go to parties?" and every motherwill have to answer that question for herself. We personally feel thatthe social life extended by the school, together with the meeting ofthe companions at Sunday school, in the park, or on the playground, isquite enough; and we deplore the fact that many children grow into theidea that much time must be spent at "parties" in the drawing-roomunder unnatural surroundings, in dressed-up clothes, eating ice creamand cake, etc. Outdoor gatherings of children are wholesome andhygienic, but most of these indoor gatherings of groups of children weconsider decidedly unhygienic. One child coming down with scarletfever, measles, or whooping cough can infect twenty others at anafternoon party. The eating of so much ice cream, candy, and cake isdeplorable in that it upsets the digestion, and all this is irritatingto the developing nervous system of the child; and not infrequentlybrings on a lot of other symptoms, resulting in discomfort anddisease. We believe in outdoor picnics but not in too frequent indoorparties. PICNICS Groups of children gathering in the park, on the beach, in the woods, when well chaperoned, are among the pleasant and profitable pleasuresof childhood. It is just such gatherings that mothers and childrenshould indulge in--and once a week is not too often during the longvacation. The mothers, too, should enter enthusiastically into thejoys of a day's outing, where the enormous intake of oxygen, thehearty laughter, the races, the games, etc. , all create a wonderfulappetite, which can be so delightfully satiated from the well-filledlunch baskets; and while the children are thus playing together what awonderful opportunity for the mothers to engage in an exchange ofhelpful ideas. Each mother has her own way, which is "the best way" tomake this cake or that salad; or has met this particular difficulty inchild training in a carefully thought out way; a neighborhood women'sclub can thus be held out in the open, while the children are havingthe time of their lives in the frolic of the picnic. "MOVIES" The movie is an institution that has come to stay, and today motherseverywhere are perhaps discussing this particular institution morethan any other. The movie affords a wonderful opportunity to see thesights and scenes of other lands, of feeding the imagination of thechild on travel pictures and nature pictures. It is a most deplorablefact, however, that this wonderful institution which is fraught withso many opportunities to educate and enlighten the mind of the growingchild has carefully to be censored. Women's clubs have done much topurify the movies for the school-age child; many theaters are nowshowing on certain days a special afternoon movie for the children;and while many of these movies have great possibilities for good, wemost earnestly urge that the school child see the movie that he is tosee before dinner, and not have his mind excited and his nervoussystem "thrilled" just before going to bed. Someone asked me severalyears ago, "Are you going to let your little fellow go to movies?" Iinstantly answered, "No, but I shall take him. " If the mother or thefather sits by the side of a growing child and carefully, thoughtfully, and, yes, prayerfully, points out the good and explainsthe evil, then even the questionable movies will prove the means ofbringing father and son and mother and daughter, into closercompanionship. Under no circumstances should children under twelve years of age betaken to long lectures, entertainments, or concerts, which will keepthem out until eleven. VACATIONS Let the vacation be well planned. This is the opportunity "de luxe"for the child to earn a few pennies to enlarge his bank account. Allowhim a truck garden, guinea pigs, chickens, anything remunerative, which will enable him to become one of the world's workers and one ofthe world's savers. Let him start a bank account when he is six, andwatch him as he puts the dime in the bank, instead of taking it to theice-cream-soda cashier. Some time during the vacation, if possible, mother and father shouldaccompany the little folks to the camp, to the beach--somewhere, anywhere--to get back to nature and live like Indians for a shorttime. Each member of the family will come back rested, happier, andmore ready for the next year's work. In the summer time learn to eat on the porch--it is great sport forthe children. Many meals can be served on porches that are so oftenserved in hot, stuffy rooms. The "home" does not consist in the furniture, the rooms, thebric-a-brac, or the curtains. The home is the mother and the fatherand the children and the spirit of good fellowship which shouldpossess them. Make the companions of the little folks very welcome, letting them learn the early use and abuse of the different articlesof furniture in the house. It is all right to play tent with thebeautiful couch cover; it is all right at certain times to dress up infather's best clothes and mother's beautiful gown, but while they arethus having a good time let them learn that all these things are to beused and not abused. ADOLESCENT DAYS The homely boy or the homely girl usually grows up free from theflattery and undue attention which are sure to be heaped upon thegood-looking boy and the popular girl. Way back in the early days offive or six, and all the way up to the ages of twelve to twenty, children should be taught that it is altogether natural and correctto do things well and to look well; parents should stop, and causetheir acquaintances to stop, "making over" the boy or the girl justbecause they have done something well, or have beautiful curls, orbecause their eyes are a magnificent brown, etc. If a girl should beespecially endowed with a charming complexion, a wonderful chin, andif she does possess a beautiful nose or neck, let her early realizethat she has been made the custodian of goodly features and that shemust give an account for this particular blessing, and under nocircumstances must she become self-conscious about it. Ofttimes a goodfrown to an unwise friend is all that is necessary to stop this "lipservice" flattery. The "chewing-gum girl" is just a thoughtless girl, that is all; sither in front of a mirror and compel her to chew gum for one-half hourand watch herself do it, and it will often suffice to cure her. Youngladies should be taught that chewing gum should be done in thebedroom, but never in the living-room or on the streets. It is notonly a disgusting habit, but it often creates an occasion forcriticism as to the quality of one's home training. ICE-CREAM PARLORS The mother who cares will not allow her lovely daughters nightly, oreven semi-weekly, to frequent the ice-cream parlors and secluded sodafountains. She had far better arrange group dinners and groupreceptions in her own parlor; with ice cream served in her own dishesand eaten with spoons that she has supervised the washing of. Young women and young men in their late teens crave companionship, andthey should have it; but let it be under wise chaperonage at home orin public rooms, and not in the solitude of a lonely bench in thepublic park, or the seclusion of an out-of-the-way, ice-cream parlor. This "running the streets" which is so freely indulged in by theadolescent youth in the early teens need not occur, if wise provisionis made for the assembly of small groups in the home. Some elders think it pleasing and cute for young men and youngwomen--fourteen to sixteen, or even seventeen--to wrestle and rollaround on the floor like two huge kittens; but it is unwise andindiscreet and should be discouraged. DANCING We hesitate to speak of dancing for we realize it is a very popularindoor recreation of today, but we most earnestly urge that if dancingmust be done, it be done under proper chaperonage, and if young peoplemust meet in public dance halls let them be municipal dance halls, where motherly matrons are in charge. Many of the social dances whichbring the participants into such close physical contact are to bediscouraged and stricken off the list; and while dancing is a splendidform of exercise--let us add that it is also sometimes a dangerousone. QUESTIONABLE PLAY After the boys and girls graduate from grammar school they may comeinto contact with such agencies as secret societies--which nine timesout of ten are questionable--and while we realize that there is acontention both for and against these organizations, we may dismissthe subject here by simply adding that we have known little specialgood to come out of these societies. While it may not be any more wrong to hit a ball from the end of astick--as in billiards--than it is to hit it from a mallet in croquet;or from a stretched tendon, as in tennis; or from a bat, as inbaseball--we do not feel that we have to argue the point, when weremind the reader that billiards and pool, especially in the publicparlors, do assemble questionable companions, who use questionablelanguage; while these games are often accompanied by betting, which isalways to be deplored. And so with card playing, we see no greaterharm in playing a game of euchre, than a game of authors, as far asthe cards are concerned, but your boy and girl, as well as mine, as arule, have cleaner and purer minds at the home game of authors than isprobable in a game of cards in a public place. In closing this chapter we have to announce a group of wholesomerecreations which may be entered into by our lovely young people--theman and the woman of tomorrow--whom we one and all wish to keep cleanand good and pure; all the while helping them to develop the sense ofhumor and the element of play. Such recreations are tennis, golf, croquet, roque, boating, sledding, skiing, bicycling, motoring, horseback riding, and a host of others too numerous to mention. Let usnot forget that ofttimes pursuits such as garden-making and helpingthe parent in the office or in the home, may be made a great source ofenjoyment to the adolescent youth, if they are allowed to earn a smallamount of money each week, which they may deposit in the bank. We close this chapter "Play and Recreation" with the wish that all, old and young, would develop a greater sense of humor, a greater lovefor play and recreation, which will increase the health of both mindand body and prevent many nervous disorders such as neurasthenia. CHAPTER XXXIX THE PUNY CHILD In every neighborhood there is to be found the delicate child, andeverywhere anxious mothers are putting forth every effort to improvethe condition of their puny boys and girls. In carefully looking overthe puny child, we see an underweight little creature with pale skin, and as he comes to the table everybody notes that he refuses more orless food. DIET AND HYGIENE As we give the child a closer examination we find that certain lymphglands are enlarged, possibly adenoids are present in the post-nasalpharnyx, and, in many instances, there are badly diseased tonsils. Usually the puny child is constipated, hands and feet are cold, and hejumps and starts at any unusual noise, thus showing a tendency tonervousness. One of the first things necessary is to take this littleone to a good specialist and if necessary have the adenoids andtonsils removed. This having been done, the diet should be carefullylooked into. There should be served him for breakfast a generous bowlof dextrinized grains with a good portion of diluted cream, a glass ofrich milk, a baked potato, and fruit. For lunch at twelve o'clock heshould be given a glass of malted milk with egg, or eggnog, six oreight dates or three or four figs, a handful of pecan kernels, andperhaps a lettuce sandwich. For dinner at half past five, anothernourishing meal of baked potatoes, a protein dish of either cheese andmacaroni or eggs or meat, a generous fruit salad, a glass of richmilk, and bread and butter, should be enjoyed. There is no class of little folks who eat between meals more oftenthan do these delicate children, for mothers painstakingly endeavorto feed these children all they can possibly take; so one motherthoughtlessly went about it something like this: the half past sevenbreakfast having been only touched--nibbled at--with the ten o'clockhour came this request: "Mother, I am so hungry, I want something toeat. " Eagerly the mother prepared either a meat sandwich or a jellysandwich and possibly a glass of milk. When it was time for the twelve o'clock dinner hour, or lunch hour, again the well-filled plate was refused, the appetite having beensatisfied at ten o'clock. Having taken very little nourishment atnoon, by half past two the plaintive plea again came to the motherears: "May I have a piece?" and again the well-meaning mother gave himthe desire of his heart. So the day passed, the dinner making thefifth time food was taken into the stomach, and in all probabilitythere was eaten a cookie in between. The reader can readily see thatthe digestion was consequently very much disturbed, fermentationoccurred, decomposition of food took place in the digestive tract, with its result--constipation. IMPROVING THE APPETITE Not a morsel should pass the lips of any child, and particularly ourdelicate child, between meals. Let him come to the table at half pastseven or eight o'clock, and if he does not want to eat tell himfrankly that that is all he is to receive until twelve--and stick toit. Nothing more than water or fruit juices should be taken betweenmeals. It may be necessary to create an appetite for the three meals we havejust described, and as we now take up the outdoor hygiene we would notforget that some simple treatment should be instituted each day in awell-heated bathroom or bedroom. Roller skating or ice skating, hoop-rolling, rope-skipping, and Irish mail, or a coaster, all furnishsplendid exercise for the delicate child. Under no circumstancesshould he be allowed to remain all the time in the house; and sopleasing recreations must be provided for him out of doors. The sandpile should not be forgotten, flower-bed making, raking the lawn, apolished coasting board fastened in a slanting position to an uprightwhich can be mounted by means of a ladder, create splendid outdoorsports for these children. THE DAILY PROGRAM Take the child into a warm bathroom each morning and let him stand insix inches of well-warmed water. With a rough mitten made out ofeither mohair, crash, or turkish towel, the entire body should now berubbed until it is pink. This procedure is known as a dry-frictionrub. Do not stop until the skin is pink, particularly the arms andlegs, for the back and chest usually get pink quickly. Then withsimply a cold dash of water to the feet, dry them well and allow himto dress. Twenty minutes before the meal hour, let him get out of thehouse and roller skate around the square as many times as he can intwenty minutes, or let him race and have a royal good time in thefresh morning air and then after this forced oxygen intake let himcome in to breakfast. And now for school, and as we say "school, " we regret that there arenot more "open-air schools. " Some day the American people, moreparticularly the American mothers, will awaken to the fact that weneed more schools with simply window space rather than so many closedglass windows. Some day we will send our children with sweaters, leggings, stockinet caps, mittens, even in the cool days of spring andfall, to "open-air schools, " and in the cool fresh air they will thinkbetter and work faster and make wonderful progress in both studies andappetites. The particularly delicate child, under treatment, will not spend thewhole day in school. In all probability the forenoon session only willbe attended, after which the half-past-twelve or one-o'clock meal thathas been previously described will be given him. Now if the appetiteis variable, arrange a little surprise for him by serving this meal onthe porch or in the living-room by the open grate, or out under thetrees. In all probability such a meal will be taken eagerly, particularly if the mother will read a pretty story. Now the afternoonis to be spent in doing a number of different things. We would like apleasant walk, a visit to the park, hoop-rolling, roller-skating, rope-skipping, ice-skating, outdoor sliding, anything that will takeour little fellow out of doors to increase his oxygen intake untilpossibly the half-past-three hour is reached, when he should come intothe house and lie down and prepare for the treatment for thatparticular day. TREATMENT SUGGESTIONS Twice a week he should be given a salt glow (described in theAppendix). Twice a week he should be given a thorough soap shampoo(also described in the Appendix). After each of these baths a specialrub should be administered to the spine, and as there is so oftenspinal curvature in these children, certain stretching movements ofthe spine are valuable, together with hot fomentations (see Appendix)over the spinal centers. These are wonderful stimulants to thedelicate child and should precede the salt glow twice a week. Everyafternoon a hot-and-cold foot bath may be given to create a bettercirculation. The feet are put in hot water from three to five minutes(as hot as can be borne), and then they are quickly plunged into thecoldest water obtainable for three seconds, then back into the hotwater, and vice versa, until three changes have been made, alwaysfinishing the treatment with the cold dip. On the three remaining daysof the week at half past three, the child will simply relax in thehammock or on the porch couch while the mother aids in the relaxationby a pleasant story. We would suggest that on Monday the salt glow beadministered; Tuesday a rest is taken; Wednesday the soap shampoo isto be administered; Thursday another rest; Friday a salt glow;Saturday another rest, and Sunday the shampoo, etc. Before going to bed at night, with the mother's hands well oiled witheither olive or sweet oil, the circulation is again stimulated by theheavy friction rub. Constipation is taken care of along the same lines as mentionedelsewhere in this book. It is surprising to see how often these delicate children are infestedby worms, and while a great deal of dependence cannot be put in thatsingle symptom "grinding the teeth at night, " or "pallor around themouth, " yet we do believe that many a delicate child continues tosuffer from worms many years. It is a very simple procedure to obtaina specimen of the stools. A cathartic should be given and after usualfree-bowel movement, the second time the child desires to go to stoolthis should be saved and taken to the laboratory for a careful searchfor worm eggs which are usually in evidence if worms infest the child. The treatment for worms is described elsewhere in this work. We have seen scores of young people between the ages of eight andeleven who, before treatment, were pale, listless, under weight, irritable and cross, after three months of such treatment as has beenoutlined gain six to ten pounds and look as ruddy as their healthiestneighborhood friends. It is perfectly marvelous to notice how a childwill put on from six to eight pounds in a short period, at the sametime overcoming his irritableness and fretfulness. I am more and moreinclined to believe that most bad children are sick children--areundernourished children--and it behooves us American mothers andfathers to give proper attention to this undernourished child, call ahalt, and devote three months to giving him the help that he needs. Hedid not ask to come into this world; and it is "up to us" to give thischild what he deserves--for every child in this world has a right tobe well born, to be well fed, and to be well reared. CHAPTER XL TEACHING TRUTH We confidently believe that most of the sex immorality seen in youngpeople is more or less the result of ignorance and curiosity;therefore we most earnestly desire in this chapter to portray sointerestingly the beautiful story of life as seen in the vegetable andanimal world, that our mother-readers will be seized with the greatdesire wisely to convey to the young child's mind this sublime andbeautiful story. The questions most naturally arising in the mind ofthe reader at this time are: When shall we begin to tell this story?How shall we tell it? Where shall we begin? Where shall we stop?Realizing full well that the subject is usually handled prematurelyand with unpreparedness, we will attempt in this chapter to discuss itwith courage and candor, believing that there is a right way, a righttime, and a right place to impart this information. A LESSON FROM NATURE When the little folks are about three or four years of age, whenconfidence and trust are at their height, they often come to usbegging for a "story;" and this is the golden opportunity for theparent or caretaker to tell them the story of Mr. And Mrs. Corn, andall their little babies; or Mr. And Mrs. Morning Glory and theirlittle folks. There are a score of other equally interesting andinstructive botanical stories which are just as beautiful in theirsublimity, and fairy-like in their personality. The little children'seyes grow big with wonder as you tell the story of a whole township offamilies by the name of Corn (See Fig. 17), who have their residencesout in the wide country fields. [Illustration: Fig. 17] [Illustration: Fig. 18] We will first introduce the child to Mr. Corn, the tassel, wavingproudly and majestically in the breezes, and seeming to say: "I ammaster of all I survey. " The little fellow is filled with wondermentas he learns how the clouds give up their drops of water to quench histhirst and how the sun smiles upon him to yellow his beard; and howthe wonderful all-important _pollen_ is developed and ripened. Often the child eagerly asks, "And where, mamma, is Mrs. Corn?" and tothat interested upturned face we relate the pleasing story of thebeautiful silken tresses of Mother Corn. Early in her life she is abeautiful shade of green, and as she thus gracefully hangs out fromthe ear of corn, day by day the smiles of sunshine turn this mothercorn to brown, and then to a still darker shade. "And where, mamma, are the babies?" the child next inquires; and, aswe take the ear of corn, removing the outer clothing--the husks--wefind the underclothing, a much lighter shade of green, and here now weare in close contact with the babies themselves--the kernels--and toeach little kernel or baby corn we find mamma closely clinging. Hereis a beautiful opportunity to teach mother-love and motherwatchfulness, as also the opportunity to draw lessons from the babykernels sitting there in even rows, with their faces clean, silentlycontented--just doing their duty. The stories that may be told arelimitless, and possibly as interesting as are the myths andfairy-tales, yet all the while as true as truth itself, with nofakery, no legends--just simple truth. THE ALL IMPORTANT POLLEN Now on a second trip into the cornfield, another story may be told ofthe important work of the pollen. This "father part" of the plantfalls upon the silken tresses of the "mother part, " by which thepollen is carried down to the sleeping corn-baby seeds--the kernels. And when the "corn dust" does reach the sleeping seeds a great changebegins to take place. This change is known to the adult as"impregnation;" to the little child it may be presented as "anawakening" of the sleeping seeds, so that they begin to grow, todevelop, to expand and push out, until we have the full-grown seedsseen in the delicious and juicy roasting ear. Sometimes, in the case of the larger plants and trees, Father Tree maybe miles and miles away from Mother Tree and so this all importantpollen must be carried by the wind or by the bees, and as it blowsagainst the mother part of the plant-flower she catches it and pushesit downward to the seed babies. The wind scatters the pollen of theoak tree, the hazlenut, the walnut, the birch, the willow and manyothers; for, without the good kind wind or the bees, the pollen wouldnever find its way to many a mother flower, and the "fertilization" ofthe seed could not take place. THE MORNING GLORY FAMILY Perhaps the story of life can be told as beautifully from themorning-glory as from any other flower. Here the beautiful flower cupis the home of Father and Mother Morning-Glory and all their littlebabies. (See Fig. 18). As we carefully take away their little home, the flower cup, we haveleft a little green cup, and coming up from the center you will seefive little stems, every one of them wearing a hat of powder or pollenand this--if you please--is Papa Morning-Glory. Look closely and youwill see coming up from the center of these five stems (stamens) onecentral stalk without a hat, Mother Morning-Glory, known in botany asthe "pistil"; and as you follow down this pistil you will find anenlarged part at the base, which is known as the cradle-nest--the homeof the seed babies. Little was known about this wonderful fertilization of the seeds bythe pollen two hundred years ago, and a whole century passed beforethe secret of the blossom and the bees was discovered; and even thenit was not fully realized how great was the work of the bees incross-fertilization. Nor was it understood that the beautiful blossomof the flower, with its sweet nectar, was an exceedingly importantfactor in attracting the bees. Another century passed before Darwingave to the world the story of the great work performed by the bees incross-fertilization--in carrying the pollen from flower to flower, for it is now a well-known fact that all of the blossoms visited bythe bees produce better fruit and better flowers. In the flower where the father and mother part matures at the sametime, self-fertilization is the rule. Cross-fertilization occurs ininstances where either the father part or mother part ripen atdifferent times, in these cases the pollen is carried from plant toplant by the wind or by the nectar-seeking bees. These busy bees, withtheir fluffy little feet and fuzzy coats, become completely coveredwith this all-important flower dust, and in seeking nectar from otherflowers they leave the "awakening dust" behind, and thuscross-fertilization takes place; new types of babies are produced, newgenerations of fruits and flowers. HOW MOTHER NATURE WORKS Dr. Chadwick, in her _Blossom Babies_, gives us a beautiful recitalconcerning the fertilization of plants, which provides an endlessnumber of interesting stories. The water plants are very interestingin that the pollen is just light enough to float on the exact level ofthe mother part of the flower, otherwise fertilization could nevertake place, and there would be no more lovely lilies. Long throatedblossoms are fertilized by their attraction for certain moths orhumming birds who have long tongues. Mother Nature is exceedinglycareful to reproduce her children, and in every conceivable way shesees to it that her plant-seeds are fertilized and distributed. We areall familiar with the dandelion and the thistle and a host of otherswhich fly through the air with actual plumes, some seeds fly withwings, such as the maple; other seeds travel by clinging or sticking, such as the cockle burr; still others float and shoot; while we allknow about a lot of seeds that are good to eat, such as the nuts andfruits, as well as many of the grains, such as corn, etc. An incubator about hatching time is a wonderful object lesson inteaching the story of life. Take the children to visit one and letthem actually see the live baby chicks coming forth from theseed-shells. Other wonderful lessons may be drawn from the motherhorse or the mother cow; and it is impossible to portray the closecompanionship, the sublime trust and confidence, which exists betweenthe mother and the child who have been bound together by these tiesand sentiments of truthfulness, trustfulness, and frankness. THE SALMON FAMILY The little fellow is daily learning that everything that grows comesfrom a seed, even the salmon which was eaten at lunch yesterday wasthe text for an impressive story about Papa and Mamma Salmon. In thebeautiful Columbia river Mother Salmon is swimming about quietlyseeking a shallow place in the stream where she may deposit hercluster of baby seeds, which looks very much like a mass of tapiocapudding as they gently sink to the bed of a shallow spot in the river. There they lay "sound asleep" until Father Salmon, swimming by, isattracted to the spot and, hesitating, talks something like this tohimself: "Why the idea, here are some helpless fish-baby seeds, theycan't grow and develop without me, here they are sound asleep;" and, nestling over them, he contributes the self-same and all important"something"--comparable to the pollen of the plants--which wakes themup. In the case of the fish the "awakening" substance is not in theform of a powder as in the plant world; but is in the form of asemi-liquid mass, much resembling the white of an egg. The littleseeds soon begin to tremble--begin to wake up--and then begin to swelland grow and develop. In a few days what do you suppose happens tothese little bulging baby seeds? The very same thing that happened tothe chick seed--they burst and out come hundreds of cute little fishminnows. In just a few hours they are all swimming about in a mostwonderful fish-like manner. EARLY QUESTIONS Some day you will be surprised by your little child suddenly askingyou some such question as this: "Mother, where did I come from?" whilein the same frank manner you reply: "Why from your mamma, of course;where do you think you could have come from? Everything that growscomes from its mamma--oranges, apples, radishes, cabbages, cats, dogs, and chickies--everything that grows has to have a mamma andpapa, " and they are often satisfied with this answer for a long time. No child should go to kindergarten without knowing that he came fromhis mother, and this knowledge should come to him from his ownmother's lips. These are different days than those in which ourgrandmothers lived. The spirit of investigation and of inquiry is inthe air. The moving-picture show makes it necessary for children ofnine or ten to understand these things--to have a knowledge of certainof the conventionalities of life. Twenty years ago this may not havebeen so necessary--the youth of that day might have waited severalyears longer for certain phases of his sex instruction. It is highlyimportant that this knowledge be obtained from a wise and pure andsympathetic mind--from the child's own parents. One mother put her little girl's questions off week after week, saying: "I will tell you when you get older, dear--no, not now, dear;run away, you are not old enough to know such things, you must forgetabout them. " Thus the unprepared mother sought to gain time in whichto consult the doctor or the library. Finally the day came when themother felt that she was sufficiently wise to answer the query, "Wheredid I come from, " and so with her heart in her throat she approachedher daughter, saying: "Come, Mary, mother is going to tell you allabout it. I am now ready to answer your question. " Imagine hersurprise and astonishment when Mary said: "Oh, you needn't mind, mother, Kate told me all about it last week. " Now the question in mymind is: how did Kate tell her? How much unnecessary information didthis older and experienced Kate put into the pure mind of thisinnocent little girl? ONE MOTHER'S AWAKENING One mother in a western state--a county superintendent ofschools--told us the following interesting story of her ownexperience, which we think may be of help to some of our motherreaders. One morning her seven-year old son rushed into the house exclaiming:"Oh, mother, there is a new calf out in the barn, and I know where itcame from; I saw a wagon load of calves come by here yesterday, andone of them must have dropped off, for it is right out there in thebarn with old Bess this minute. " The mother was very busy with her papers and her reports, and she letthe incident pass with a smile, thinking it was a very pretty littlestory. A week later the six-year old brother came in saying: "Mother, I think there must have been another wagon load of calves passed by, and one must have been lost off, for old Nell is cleaning up a littlecalf out in the barn for all she is worth, " while the older brotherpiped up: "Sure, it was another load of calves; that is just exactlythe way the other calf got here;" and the two little fellows went offto school. About a month later that county superintendent suddenly became a muchwiser mother than she was before, although her heart was made to ache. Both boys came home from school one day and the older one met her withsomething like this: "I am mad! I've been lied to; all the fellows atschool say I have, and they are making sport of me, too, " and with aglare in his reddened eye he continued, "You know that new calf didnot come off that wagon; you know that calf came from old Bessherself; all the fellows say so at school, and they are making allkinds of fun of me, and I don't want to go back. I'd like to run awayfrom home. " The mother quietly drew the boy to her side and remindedhim that she had simply listened; that she had not opened her mouth;that he came into the room and told about the incident himself, butthis did not satisfy him. He turned to her wounded and crushed, saying: "Well, you let a fellow believe it, and that's just as bad;"and this educated mother--this trusted custodian of a county full ofschool children--beseeched me to warn mothers everywhere to teachtheir children the truth, and to never let a child go to school with asex misunderstanding. She told me that it took her six months to getthat boy's confidence back again. DON'T GET SHOCKED I believe that many mothers make the sad mistake of showing the childthat they are shocked by trivial sayings and trifling experiences oftheir little people. If we could only get it into our heads for onceand for all that our children are born into this world veritablelittle thieves and falsifiers, as well as adventurers and explorers, we would then cease being so shocked and outraged by their frankstatements of what they have heard or have done. Let the mother listento all these things with calmness, while she seeks to direct thechild's mind in pure and elevated channels--to help him upward byimparting "precept upon precept; here a little and there a little. " Children will come in with stories that at first thought do greatlyshock the parent; but under no circumstances should the boy or girldiscover that the parent is shocked, for if he does he will not likelycome again with another such "shocking" difficulty. One mother told methat her seven-year-old boy, beginning third grade, came into herbedroom one morning saying: "Mother, I am just busting to saysomething, " and this mother very wisely said, "Well, say it; certainlyI don't want you to burst, " and she told me that this boy whispered toher three of the filthiest words that he could possibly have heard onthe streets. In relating this experience to me she said: "Do you know, doctor, that I really did not know what to think at first, but Iremembered that you had taught me never to be shocked, and so I lookedup and asked: "Do you feel better?" whereupon he breathed a big sighand exclaimed: "What a relief! I have just been busting to say that tosomebody. " Mother, to whom would you rather he would say these things?to you, or to some little girl out on the street, or to some olderboy? Think what trouble and possible mischief were avoided bywhispering into the sympathetic ear of mother. This wise mother turnedto that little boy and said: "Son, that ear is always waiting for justsuch things and whenever you feel like saying something--like gettingit off your mind--you just come to me;" and he came repeatedly. Onetime he came in saying: "I don't know whether you want me to play withHarold or not; he does some of those things you told me about theother day. " And the mother thoughtfully and wisely looked up and said:"Did he do it in front of his mother? Why of course he didn't. Did heask you to go into the bedroom or bathroom and lock the door?" and thelittle fellow quickly answered: "Why sure he did; how did you guessit?" and added "now I suppose you are not going to let me play withhim any more, " and this wise mother, knowing that if she denied himthis privilege that it would quite likely be frequently sought, said:"Why, certainly play with Harold in the open, but whenever he suggestssecrecy--" she did not have time to finish the sentence, the boy said:"I am wise; whenever he gets to doing that 'funny business' I'llskiddoo. " The confidence between that mother and son, to my mind, waswonderfully sublime--all the while practical and helpful in his dailytraining. DON'T REPULSE THE CHILD A little older child sees the fowls, the dogs, or the cats, "mating, "and then, rushing into the house, inquires what it is all about; andunless the mother is on her guard some older member of the family mayshow surprise and thus thoughtlessly convey to the child's mind thathis question is improper and entirely out of place. To the question, "What are they doing, mamma?" quietly answer, "Just mating, dear, justas the flowers mate; everything that lives or grows comes as theresult of mating. " Suppose that you were repulsed every time you approached a dearfriend, your husband, or some other member of the family? Take, forinstance, the matter of a caress or an embrace--how would you react torepeated rebuff? And so with the little child; he comes into thisworld full of confidence and trust, full of wonder and curiosity;possessed with the spirit of exploration and investigation--everywhereand all the time he asks questions. Usually, his questions areanswered thoughtfully and without hesitancy, except along the line ofone thought--that of sex. Do not think for one moment that he issatisfied by your evasive answers. You have but to recall your ownchildhood experiences, and remember that today the moving pictureshow and general public sentiment has placed the age for suchknowledge from one to five years earlier in this generation than inthe past. I do not care what the child comes into your presence with, be it the most shocking thing in this world, do not under anycircumstances let it disturb your mental poise, or raise your ire orshock you; for if you do, then and there--at that moment--occurs abreak in the sublime confidence which the child reposes in you. NECESSARY MORAL TRAINING While we are using the plant and animal world as object lessons inteaching our children the facts of sex and the secrets of life; whilewe face the commonplace sex matings of the animals about us withoutcringing, without appearing to be shocked when our children callattention to these things; nevertheless, when the child is old enoughto take cognizance of these phenomena, he is old enough to begin toreceive some definite instruction from his parents regarding the moralphase of these great biologic problems. We cannot safely andindefinitely utilize the animal world as an object lesson in sexeducation, without at the same time emphasizing the moral differencebetween man and the beast. Many parents treat these sex problems so lightly and endeavor to actso naturally and unconcerned about these questions, that the childcomes to look upon the promiscuous sexual relations of the animalworld as something altogether natural; and, unless proper moral andreligious training is carried on at this time, he stands in danger ofcoming to regard lightly the moral standards of modern society. At the same time of life that Mother Nature fully develops the sexinstincts--at adolescence--she also awakens the religious emotions;the one being so necessary for the proper and adequate control of theother. Let parents take a cue from old Mother Nature, and at the sametime the sex relations of animals are freely discussed with thegrowing child, let the mother or father wisely call attention to thefact that but very few of the animals live family lives as do humanbeings. In this connection valuable use--by way of illustration--canbe made of the ostrich and some of the ape family who are loyal andtrue to their chosen companions. Moral and religious instruction must accompany sex-hygiene teachingjust as soon as you leave the realms of botany and enter the sphere ofzoology. We could here relate many a tragic experience which ourpatients have passed through as a result of volunteering too much sexknowledge and at the same time neglecting this very necessary moralinstruction. SANTA CLAUS AND THE STORK We must bear in mind that the child believes what we tell him; hetrusts us implicitly and we owe it to him to teach him the truth inanswer to his numerous questions. We must keep his confidence. Takethe matter of Christmas, for instance. How many confidences have beenbroken over the falsehood of Santa Claus and the chimney. Two littlefellows hesitated in their play in the back yard, and the followingconversation was heard: "You know that story about Santa Claus is alla fake. " "Sure it is, I know it isn't so, I saw my father and motherfilling the stockings. You know that stork story is all a lie too, there's nothing to it, babies don't come that way, and now I'minvestigating this Jesus Christ story, I suppose that's all a faketoo. " The fact of the matter is, that while these children havediscovered the truth of the first two stories, for a long time theywill query the third story, for to them, that too is mysterious andfairy-like. They hadn't seen Santa or the Stork and had only heardabout Jesus. STORY OF THE HUMAN BABY The story of the human baby may be told to any child of seven to tenyears. Each mother will have to decide in her own mind the right timeto go into the details of the human baby seed. The child should havehad an opportunity to have planted some seeds in the ground, to havevisited an incubator, or to have visited the farm and observed thefamily groups of babies--the chicks, pigs, calves, etc. --with theirmothers. Let me see now how many different baby seeds do we know? Yes, we doknow the radish seeds, many flower seeds, chicken seeds, bird seeds, corn, potatoes, and many others, and we can tell them all apart. Theboy and girl baby seeds are too tiny to be seen with the eye. They areso small that it takes about two hundred of them in a row to make oneinch. We can only see these human baby seeds with the aid of amicroscope. It is such a precious seed that it cannot be intrusted tothe ground or to a tree nest for development. The great Wise Fatherdecided that a mamma would love and care for it better than anythingor anybody in all the world. So, just as there is a cradle bed in themamma flower, so there is in the human mother's own warm body, tuckedfar away from the cold rains and the hot sun, a little bed, for theboy and girl baby seeds. Right near to this little seed bed MotherNature has prepared a little room, which holds the tiny "waked up"seed for nearly a year as it slowly grows into a little baby girl orbaby boy. THE MATING STORY You remember the story of how Bob Robin found Jenny Robin, don't you?You remember mamma told you how Bob came up from the southland earlyin the spring and asked Jenny in lovely bird song to come and be hisvery own wife? How he promised her he would feed her on cherries, andcurrants and the fattest of worms? And that she told Bob she loved himand went to live with him, and how they built that cute little nest tohold the eggs; and how Jenny Robin sat on the nest until the littlebaby robins were all hatched out. Well, one day papa found mamma. He met her and loved her dearly andtold her he wanted her to come and live with him, and they built theirhome nest and were very happy together, because they decided theywould always love each other more than any one else in the world. After mamma and papa built their home and lived together, one day awonderful change came to one of the baby seeds and it awakened andbegan to grow. Mother Nature whispered to it, and told it how to findits way into this little room and there it clung to the wall and grewfor nearly a year. Papa brought mamma nice things to eat, just as BobRobin did Jenny. Papa did everything he could to make mamma happy andcomfortable. For nearly five months this little seed just grew and did not letanybody know it was there, until one day it began to tap against thesides of the walls of this little room, and every time it did mamma'sheart just bounded with joy as she thought of the precious seedgrowing to be a darling baby--and all inside of her very own body. Andone day, after nearly a whole year had passed, the door to the roombegan to open, and, very soon, a lovely baby found its way out of thisspecial room into the big, big world. Mother Nature then told thislittle baby that it might still remain close to the mamma it had beenwith so long, and so she taught it how to get its food every day frommamma's breast. At this point the child usually breaks out by saying, "Now, mamma, I know just why I love you so much. " UNFOLDING THE TRUTH I shall always remember with pleasure my own son, not quitetwo-and-a-half years old, who sat at the table one day asking numerousquestions such as, "Mamma, what is that? Mamma, where did that comefrom?" etc. He picked up a navel orange, and pointing to the navel said, "What isthat?" I frankly said to him, "Why, my dear, that is the baby orange. " "Why, Mamma, " he exclaimed, "do oranges come from oranges?" "Certainly, dear child; where else could they come from?" "But, " he says, "Mamma, do potatoes come from potatoes?" "Why, honey, " I said, "Orange babies come from orange mammas, potatobabies from potato mammas, grapes come from grape mammas, littlekitties from kitty mammas, and little boys from their mammas. " We simply mixed all the babies up, just as you would mix up adelicious fruit salad. We took from the mind all question of mysteryand surprise by quickly and honestly answering his question. Thus, hisfirst knowledge of his origin, if he is able to recall it, will everbe associated with oranges, grapes, potatoes, kittens, etc. We did not tell the whole story for some two or three years later, butday by day we simply answered the questions as he asked them. One day, when he was about three, he burst into my bedroom, saying, "Mamma, dear, I did come from you, didn't I?" "Why, yes, darling, from nobody else; just from your own mamma andpapa. " "Say, mamma, was my hand in your hand, my foot in your foot, my headin your head?" "No, dear, " I replied, "You were all curled up as snug as a littlekitty is when it's asleep, and you slept for nearly a year in a littleroom underneath mamma's heart. " It was a wonderful story. He threw his chubby arms about my neck, hislegs around my waist, and said: "You dear, dear, mamma. I do love youand papa more, just awful much. " THE DOCTOR'S PART In my private sitting-room, where William and I have had manyconferences, there hangs my medical-class picture with classmates andfaculty. A member of my family was one day answering the boy's queriesas to who this one or that one was, etc. Finally, on pointing to oneparticular face, the answer came to his inquiry, "That's Dr. P. Youwouldn't be here if it wasn't for him. " That evening the littlefellow, just past three years, came to me and asked, "Mamma, didn'tyou say I came from you?" "Yes, dear, " I replied. "Well, Auntie says I wouldn't be here if it wasn't for Dr. P. What didthe doctor have to do with it?" "Why, simply this, dear. The door to the little room in which you grewin mamma's body wouldn't open, and so kind Dr. P. Came and helped openthe door. " "And let me out?" exclaimed the eager child. "Oh, I want to go and seeDr. P. And thank him for helping me out!" And this little fellow was neither shocked or surprised, any morethan he was over finding out that orange babies came from orangemammas. In the same frank manner in which the simpler questions are answered, strive to answer these important ones. If we seek to evade, topostpone, to wrap in mystery these sex questions, the little ones willnot forget but will ponder and worry over them, and seek to obtaincertain knowledge from others who oftentimes tell too much or toolittle, and such information is usually mixed with much unnecessarymatter which may or may not be foreign to this particular subject. Onthe other hand, if we frankly and honestly answer the question athand, curiosity is avoided and the child feels he understands it all. The subject drops into the background of his mind--into the marginalconsciousness--with the countless other facts he has accumulated. Asense of "knowledge possession" is as comfortable to the child as itis to the adult. TRUSTING YOUR CHILD Often the question arises: "Will they tell to other children thisnewly found knowledge?" If the wise mother makes them feel they are apart of a "family, " and reminds them that such matters as the secretsabout Santa Claus, the stork, and the baby nest are only discussed in"family groups, " they are often seized with the normal pride whichaccompanies confidence, and often keep secrets as well or even betterthan do most adults. One day a little man, three-and-a-half years old, was posing for aphotograph. The photographer said: "My little fellow, you pose well. We've had such a good time together. Where did they get such a lad asyou?" The mother's heart stood still. From her hiding place behind a largecurtain at the back of the studio, she listened, wondering what wouldbe his answer. At first he hesitated, but after a moment's pause, said: "Really, Mr. W. If you don't know I feel sorry for you, and I'd really like to tellyou, but I can't, it's a secret between me and my mamma. " Children enjoy secrets. If possible, isolate a group of subjects thatare not to be discussed with playmates, such as Santa Claus facts, thestork story, and the baby story; often the very isolation of onesingle fact stands out so big in the child's mind that he is manytimes tempted to mention it, when, if it were associated with a wholegroup of "family secrets" he would seldom be led to talk about it. Aswe have said, children can keep secrets much better than most adults;and just suppose they _should_ tell something--what harm? Withtwenty-five false stories in the neighborhood, suppose one story oftruth should escape! No particular harm would result; but I find theykeep these secrets well. Numerous questions will arise which should be met with open frankness. No blush, no shame, should even suggest itself, for we are dealingwith a wonderful truth, so let us give out our answers with cleanhearts and pure minds. The Great Father will bless us and surround ourloved "flock" with a garment of confidence in mother and father thatwill protect from much of the evil which is in the world, and, eventually, our little ones will grow into men and women whose verylife of purity will cast its influence into the social circle. Onlythe company of the good and the true and the pure will be sought whenassociating with the opposite sex; while, in the end, better mothersand better fathers will be developed for the work of the nextgeneration. TEN POSSIBLE CAUSES OF SECRET VICE 1. The attention of the little folks is often drawn to the sexualorgans by a sensation of itching which accompanies a state ofuncleanliness and filth. The genitals must be kept scrupulously clean. Elsewhere in this book we paid our respects to the rubber diaper, andwe wish to reiterate at this time that it is in all probabilityresponsible for a great deal of masturbation. The constant moistureand heat keeps the genital organs in a state of congestion which ismore or less accompanied by itching sensations. 2. A long or tight foreskin in the male child favors the accumulationof secretions which not only occasion itching sensations butoftentimes are the cause of convulsions in early infancy. In the caseof the female, a tight foreskin over the clitoris will retainsecretions which also cause an itching sensation. 3. Unscrupulous nurses sometimes actually teach these little fellowsto masturbate. 4. Lying in bed on the back with a full bladder, in the case of theboy, often produces an erection of the penis, and this is usuallyaccompanied by a feeling of fullness which serves to direct the mindto the genital organs. 5. Lying in bed alone with nothing to do but to investigate oftenresults in secret vice. 6. The unwise practice of allowing children to visit each other overnight and sleep together, is often productive of mischief. 7. Constantly telling a little girl to keep her feet down, to keep herdress down, makes her over conscious of sex and otherwise causes theattention to be directed in unhealthy channels. 8. Teasing a child unnecessarily about a little sweetheart oftenproduces an emotional reaction which is not altogether desirable. These suggestions are especially bad in the older children. 9. Unwise sex knowledge is usually productive of curiousinvestigations, which if not properly followed up, particularly inthose children who are temperamentally secretive, and who do not fullyconfide in mother and father, often results in moral misdemeanors. 10. Do not allow two young children habitually to isolate themselvesin their play. Direct their play away from the attic, the basement, and other places remote from direct observation. There is no use telling a child not to touch that part of his body, particularly if it is a boy, for it is going to be absolutelyimpossible for him to carry out such instructions. One motheroverheard her caretaker say, "Don't put your hand there, it isn'tnice. " Immediately the wise mother called the caretaker to her andreminded her that most children usually continue to investigate eventhough they are told not to, and so the caretaker received thisinstruction: "When you see Harry putting his hand to that particularpart of his body, just gently draw it away and divert his attention tosomething else, and when he goes to sleep in his little bed teach himto lie on his side and bring his little hands up under his chin or theside of his face and remain near him telling him a beautiful storyuntil the eyes begin to get sleepy and pick him up immediately onawaking in the morning. " This mother was quite unlike the mother who once came to my office, saying: "Doctor Lena, I have done everything to prevent my boy'shandling himself, why every time he wakes up at night I am alwaysawake and I instantly say to him, Charlie where are your hands? Yousee Doctor, I am doing the best I know how. " Very likely it isunnecessary to call the attention of the reader to the fact that thismother was doing more harm than good in constantly calling hisattention to the fact that he did have a sexual side to his nature. TRUTH VS. EXAGGERATION And just here let us add that while masturbation is an unclean habit, an impure habit, and a thing altogether to be shunned, we would not behonest to ourselves and to our readers if we did not explain thatunder no circumstances does it make foolish minds out of sound mindsor insane minds out of sane minds. If your boy or your girl is goingto grow up to be foolish or insane he had a through ticket for thefeebleminded institution or the insane asylum when he was born intothe world. The time when masturbation does affect the mind of thechild is when the mind awakens to the fact that it is allowing anabnormal, unclean, or filthy habit to dominate mind, soul, and body, and then, and usually not until then, does this bad habit begin tocause mental depression and a host of other symptoms that so oftenaccompany masturbation. In our worthy efforts to combat the evils of secret vice let us not goto the other extreme and create such a condition of mind in the youthof our generation as to lay the foundation for sexual neurasthenialater on in life, as a result of the protracted worry, constantbrooding, and conscientious condemnation, which they so oftenexperience following some brief or trivial indulgence in early secretvice. Let us fight this vice with the truth, and not resort toover-exaggerated pictures which can only serve to blight the hopes anddestroy the courage of over-sensitive boys and girls after they havegrown up--as they look back on their lives and recall perhaps a singlemisstep in their childhood. In this way we can hope to do good todaywithout mortgaging the child's happiness and mental peace in years tocome. APPENDIX APPENDIX BATHS USED TO REDUCE FEVER 1. _The Sponge Bath. _ The child, completely undressed but looselywrapped in a wool blanket, is placed on a table so that the mother ora nurse may conveniently stand while administering the bath. Close athand have a number of soft linen towels and a large bowl of tepidwater which may or may not contain a small amount of alcohol, witch-hazel, salt, or vinegar, according to the doctor's directions. The upper portion of the body is partially uncovered and the tepidwater is applied with the hands to the skin surface of one arm. Thehands may be dipped in water from one to four times, thus makingrepeated applications of the water to the arm. These are followed bycareful drying--patting rather than rubbing. The other arm is nowtaken, then the chest, then the back and last the legs. 2. _The Wet-Sheet Pack. _ Two light-weight wool blankets are folded tofit the child; they should extend eighteen inches below the feet andshould be wide enough to lap well in front. A sheet just large enoughto envelop the body is then wrung out of cold water and spread outover the woolen blankets. The feverish child is entirely disrobed andis placed on the wet sheet, which is quickly wrapped about the body, over the chest, under the arms, and between the legs--coming incontact with the entire skin surface. The dry blankets are quicklybrought around and tucked snugly about the patient. This is a coolingwet-sheet pack and will often so relieve the nervousness andirritability of a feverish child that he will go to sleep in the pack. In the very young child, under two years, it is important to put someaccessory warmth to the feet such as a warm-water bottle--not hot. Theeffect of this pack is very quieting, and is indicated when thetemperature of the child reaches 103 F. Or more. 3. _The Graduated Bath. _ This is usually administered in a largebathtub and is beneficial in the fevers of the older children. Thetemperature of the water should be one or two degrees higher than thebody temperature, for example--if the child's temperature is 103 F. Then the bath starts out with a temperature of 104 or 105 F. Thetemperature is then gradually lowered, about a degree every twominutes, until it reaches 92 or 90 F. A helper should support the headwhile the mother or nurse briskly rubs the entire skin surface of thebody. This friction greatly facilitates the fever-reducing work of thebath because it brings the blood to the surface where it is morereadily cooled by the bath. This bath should last ten or fifteenminutes. 4. _The Hot Sponge Bath. _ Often, in combating the high fever oftyphoid, the hot sponge bath is valuable. The hands are dipped inwater just as hot as can be borne and are applied to the chilly, mottled skin which is so often seen in high fever. This bath isadministered just as is the tepid sponge bath. Evaporation is allowedto take place to some extent by delaying the drying. In this instancethe child should be wrapped in a warm wool blanket with only a portionof the body exposed at one time. 5. _The Hot-Blanket Pack. _ The hot-blanket pack is indicated at theonset of many fevers such as in typhoid, grippe, pneumonia, etc. Likethe wet-sheet pack, the blankets are spread upon the bed, abundantaccessory heat is applied--such as a half-dozen hot-water bottles. Inthe absence of these, glass jars or hot ears of corn may be utilized. Hot bricks or hot stove lids wrapped in paper are also serviceable. Ablanket, in size to suit the individual (an adult would use a fullsingle blanket, a child one-half of a single blanket), is wrung verydry from boiling water. This may be done by the means of a washwringer, or two persons grasping the blanket by its gathered ends mayso twist it that it looks very much like an old-fashioned twisteddoughnut. The twist is now lowered into boiling water, and as eachpulls the twist wrings itself. This is at once quickly spread out soas to let the child lay on the center, and then the hot sides arebrought in contact with the skin, just as in the wet-sheet pack. Thedry blankets are now brought quickly and snugly about the child. Justoutside the second dry blanket the accessory heat is placed to thesides of the trunk, the sides of the thighs, and one at the feet. Awrapped stove lid or a hot-water bottle is placed over the pelvis andone under the back. Cold cloths are put on the face and around theneck, and these should be changed every three minutes. This packcontinues for fifteen or twenty minutes, at the end of which time theaccessory heat and the wet blanket are removed and the patient iscooled off by a cold mitten friction, a saline rub, a witch-hazel rub, or an alcohol rub; or the patient may be placed in a tub of water, temperature 98 F. , after which he should be carefully dried off. 6. _Sweating Baths. _ Another bath which is effectual at the onset ofgrippe or pneumonia is the sweating bath. The bowels should have movedsome time before the treatment. Have ready a large bowl of ice water, two turkish towels, one sheet, and four wool blankets. The bathtub isnow filled with water at the temperature of 100 F. ; which is quicklyraised up to 103 or 104 F. Ice-water towels are applied to the head, neck and heart. The patient remains in this bath for about tenminutes, after which he steps out and at once gets into the four hot, dry blankets previously spread out on the bed. No time is lost, thepatient is quickly wrapped in the hot blankets and sweating continuesfor twenty minutes. The covering is now loosened and gradual coolingtakes place. It is well to go to bed at once. TONIC BATHS 1. _The Cold Mitten Friction. _ The cold mitten friction is a bath thatis applicable to any condition where the child or adult needs "toningup. " It should always be preceded by heat to the feet. The followingarticles are necessary. Four or five turkish towels, a warm woolblanket, a hot-water bottle for the feet, a bowl containing water, agenerous piece of ice, and a rough mitten without a thumb. Thepatient's clothes are removed and he is wrapped in the warm blanketwith heat to the feet. One part of the body is taken at a time, firstthe arm, then the other arm, then the chest, the abdomen, one leg, thesecond leg, and last the back and the buttocks. A dry turkish towelis placed under the part to be treated, and after the mittened hand isdipped in ice-water, brisk short friction strokes are given to the armuntil it is pink. Several dippings of the mitten in ice-water arenecessary. One cannot be too active in administering this bath. Slow, Delsarte movements are entirely out of place at this time. Action--andquick action--is a necessity. No part of the child's body is leftuntil it is pink. It is an invigorating tonic bath and is indicated inall conditions of low vitality, functional inactivity, puniness, rickets, etc. 2. _The Salt Glow. _ Fill the bathtub half full of warm water, temperature 100 F. Slightly moisten one quart of coarse salt. Standthe patient in the water, placing one foot on the side of the tubwhile you rub the entire leg with the salt until it is very pink. Theother leg is treated in the same manner, as also are the arms, abdomen, chest, and last, the back. By this time he will be all aglowfrom head to foot. Rinse off the salt, and give him a cold dash withthe hands or a spray. THE NEUTRAL BATH Fill the tub with water at just 97 F. , and remain in the bath fortwenty minutes or more, with the eyes covered, all the whilemaintaining the temperature at 97 F. Dry gently with a sheet to avoidexertion and exposure. Go at once to bed. FOMENTATIONS Hot fomentations often relieve suffering and are indicated in suchconditions as menstrual pain, abdominal cramps, colic, backaches, etc. A good substitute for fomentations may be given as follows: Fill a hotbag half-full of boiling water. Over this place a wet flannel and twolayers of dry flannel. Apply for fifteen or twenty minutes over theskin area to be treated, finishing up with a cold water or alcoholrub. A very effectual way of applying moist heat to any portion of the bodyis by the means of hot fomentations which are given as follows: One-fourth of a single woolen blanket (part cotton) is folded andgrasped at the ends and twisted like an old-fashioned doughnut. Thetwist is then immersed in boiling water, the hands still grasping thedry ends, and then by simply pulling out the twist (widely separatingthe hands) the fomentation wrings itself. This is placed steaming hotover the affected area which has been first covered by a dry flannel. It is allowed to remain on for three or four minutes, and then anotherhot one wrung from the boiling water replaces the cool one. About fouror five such applications are made. The skin should be very red at theclose of this treatment. It is finished up with a quick, coldapplication to the reddened skin area. THE SOAP SHAMPOO The undressed child is placed upon a low stool in the half-filledbathtub at 100 F. With the feet in the warm water. A good lather isapplied all over the body with good friction by the means of a shampoobrush and soap. He is then allowed to sit down in the tub and splashabout all he pleases, rinse the soap off and allow him to have a goodtime generally. At the close of the treatment the water is cooled downand the treatment is finished with a brisk rub with the hands dippedin cold water. The skin of the child should be pink at the close ofthe treatment. MOIST ABDOMINAL BANDAGE The moist abdominal bandage is indicated in such conditions as kidneyinflammation which is so often seen in the second week of scarletfever; or in congestion of any of the internal organs such as theliver, the stomach, intestines, etc. , and is applied as follows:Spread out the flannel bandage and over it place the mackintosh. Wringdry the cotton strip from cold water, and spread it over themackintosh. Wrap all three layers, the wet cloth next the skin, closely about the body, so as to prevent the air from getting underit. Be sure that the feet are warm while adjusting the bandage. In themorning remove the bandage, and rub the skin briskly with a turkishtowel dipped in cold water, until the skin is pink and dry. The cottonstrip should be boiled every other day to avoid skin eruptions. HEATING COMPRESS The heating compress is indicated in the following cases: Sprainedankles, rheumatic joints, arthritis, sore throat, etc. Directions:Wring two thicknesses of cheesecloth from cold water, place over thepainful part, and quickly cover with a mackintosh and two thicknessesof woolen blanket bandage. On removing in the morning, sponge withcold water or alcohol. MUSTARD PASTE In the bronchitis of small children, particularly babies, mustardpastes are to be preferred to the hot fomentations which are used tosuch great advantage in children above ten. The mustard paste isadministered as follows: One part of mustard and six parts of flour ofthe same measurements are quickly stirred up with warm water to apaste thin enough to spread well upon a piece of thin muslin, which islarge enough to cover twice the part to be treated. One-half of thismuslin is thus covered with the mustard and the dry piece of clothbrought over. The edges are then folded in such a way that the mustardwill not run out. This is applied to the affected part and allowed toremain for seven minutes on an infant, nine minutes on a child, andten or twelve minutes on an adult. It is then removed and the moisturewhich is always seen on the reddened skin surface is _not_ wiped offbut talcum powder is sprinkled on thickly to absorb it. If this isdone, a mustard paste may be repeated every two hours if necessary andno blistering or other harm will come to the skin. THE OIL-SILK JACKET The oil-silk jacket is used in bronchitis of babies and children. Itconsists of three layers, the innermost layer of cheesecloth, themiddle layer of thin sheet wadding, and the outer layer of oil-silk. This jacket should comfortably cover the chest, front, and back; ithas no sleeves, and is opened on the shoulder and under the arm. Itshould always follow the mustard paste in bronchitis. There shouldalways be two such cheesecloth and cotton jackets with the oil-silkcovering so they may be changed every twelve hours, thus allowing forairing. STEAM INHALATIONS 1. Steam inhalations are indicated in hoarseness and bronchitis. Theymay be given in a number of ways. Perhaps that most convenient for theyoung infant is the "bronchitis tent. " A sheet completely covers thecrib, and, with the bed amply protected with rubber sheeting or anextra blanket, steam is allowed to enter under the sheet at the footof the bed from a funnel put into the nose of the teakettle. The steamshould continue for seven or eight minutes. 2. A large, heavy-paper funnel is put in the nose of the teakettlewhich is boiling on the gas range. The mother holds the child in herarms while she is enveloped with a sheet which also includes thefunnel. A helper carefully guards the flame. The mother and baby maythus conveniently get the steam with very little difficulty. 3. For the older child or adult, steam inhalations are to be had fromthe ordinary croup kettle or from a twelve- or fourteen-inch tin canwhich is filled two-thirds full of boiling water. Over the top isloosely spread a cheesecloth upon which a few drops of compoundtincture of benzoin or eucalyptus are sprinkled. The opened mouth isbrought near the top of this can and a towel is thrown over the head, can and all; the patient thus being able satisfactorily to inhale themedicated steam. LOTIONS FOR SORE MOUTH Boric-Acid-and-Myrrh Lotion. Boric acid 20 grains Tincture of myrrh 1/2 fluidrachm Glycerine 1 fluidrachm Water, enough to make 1 fluid ounce Apply frequently to the inside of the mouth for inflammation orthrush. FOR NOSEBLEED Tannic acid 2 drachms Glycerine 1 fluidrachm Water 2 fluid ounces To be injected or snuffed into the nose in obstinate cases ofnosebleed. THROAT GARGLES Dobell's solution is an excellent throat gargle. A solution of halfalcohol and half water is also a splendid gargle. MOUTH WASH Listerine 2 teaspoons Soda bicarbonate 10 grains Water 4 ounces Essence of cinnamon, six drops in one-half glass cold water, may alsobe used in brushing the teeth and in cleansing the tongue and mouth. DISINFECTANTS 1. Carbolic Acid. Carbolic acid (95%) 6 ounces Glycerine 4 ounces Water 1 gallon Clothes should be soaked in this for several hours, then removed in acovered receptacle and boiled thoroughly. Sheets may be wet with thisand hung at the doors in case of infectious diseases. 2. Chloride of Lime. Chloride of Lime 4 ounces Water (rain) 1 gallon In typhoid fever, all the movements from the bowels should bethoroughly mixed with this, covered and allowed to stand several hoursbefore pouring down the water closet. All vomited matter should betreated the same way. POULTICES There are a number of mush poultices recommended for differentconditions--boils, felons, etc. , but we find the aseptic heatingcompress to be as effectual as any of these dirty, mush poultices andwe suggest that our readers try the boracic-acid poultice which is puton as follows: Over any infected area or abrasion of the skin a thickpadding of cotton moistened by a saturated boracic-acid solution isplaced. This is entirely covered with wax paper or oiled-silk, andheld in place by a binder. It is sanitary and much to be preferred toany of the mush poultices of bygone days. COUGH SYRUP A very useful cough syrup may be made as follows: Two tablespoons offlaxseed are steeped on the stove until clear, the jelly strained andflavored quite sour with lemon juice to which is added rock candy forsweetening. This will often effectively relieve the irritating coughsof childhood. LOTIONS FOR CHAPPED HANDS No. 1. Glycerine 3 ounces Tr. Benzoin 1/2 ounce Water 1 ounce No. 2. Glycerine 2 ounces Lemon juice 1/2 ounce Tr. Myrrh 1/2 ounce No. 3. Glycerine 2 ounces Rose Water 2 ounces Acetic Acid 2 ounces ECZEMA We wish to submit two very useful prescriptions for that troublesomeskin disease which is so annoying in childhood as well as in adultlife. Prescription No. 1 is a clear fluid, and after the affected areais thoroughly cleansed with resinol soap and rinsed in soft water, thelotion is applied and allowed to dry. No. 2 is then patted on withsterile cotton and often repeated to keep the eczematous skin areamoist. This has proved curative in many persistent cases. Lotion No. 1. Acid Carbolic 1 drachm Listerine 1 drachm Rose Water 3 ounces Alcohol q. S. 6 ounces Apply No. 1 and allow to dry of itself. Lotion No. 2. Ichthyol 4 drachms Lime Water 1 ounce Oil sweet almonds 1 ounce Glycerine 1½ ounces Rose Water 1½ ounces Apply No. 2 and repeat to keep moist. CONSTIPATION We submit the following home regime, which has proved successful tomany sufferers for the treatment of constipation. 1. On rising in the morning, remove the moist abdominal bandage(mentioned above); drink two-thirds of a glass of cold water; andspend fifteen to twenty minutes in the following exercises, beforedressing: Abdominal lifting with deep breathing, auto-massage, legraising, trunk twisting, trunk bending--forward and to sides; lyingdown for the trunk raising, and sitting for the trunk circumduction. Immediately following these exercises, go to stool. Have feet raisedfrom the floor eight or ten inches, in order to simulate the squattingposition. 2. Breakfast should include bran or bran bread, and two or three ofthe following foods: Apples with skins, grapefruit, cranberries withskins (but little sugar), and figs. Immediately after breakfast walkfifteen minutes in the open air, practicing deep abdominal breathing. If the results at stool before breakfast were not satisfactory, vaseline rectum and go to stool again. 3. Lunch should consist of fruit only, while dinner should includebran bread and two of the following foods: Spinach, celery, carrots, parsnips, squash, or cabbage. 4. Before retiring, walk in the open air for fifteen minutes; afterundressing, exercise same as morning; and on retiring, apply the moistabdominal bandage. TABLE OF POISONS AND ANTIDOTES _Poison. _ _Antidotes. _ Unknown { Emetic, followed by Jeaunel's antidote { and soothing drinks. Acid--acetic, hydrochloric, { An alkali, such as magnesia, chalk, sulphuric, nitric { whiting, soda, soap; followed by { soothing drinks or sweet oil. Acid--carbolic, creosote { Epsom salts in abundance; soap; no { oil. Dilute alcohol. Acid--oxalic, including { Emetic, followed by lime (as chalk, "salts of lemon" { plaster, whiting) or magnesia, but { not by potash or soda; then soothing { drinks. Acid--prussic { Fresh air; ammonia to nostrils; cold { douche; artificial respiration. Aconite { Emetic, followed by digitalis; no pillow { under head; free stimulation. Alcohol (brandy, etc. ) { Emetic; cold douche on head; warmth { and artificial respiration. Alkalies--ammonia, spirits { Vinegar or lemon juice, followed by of hartshorn, lye, caustic { soothing drinks or sweet oil. Potash { Antimony (tartar emetic). { Emetic if vomiting is not already { profuse; then tannic acid freely, or { strong tea; later, milk or other { soothing drinks; finally, castor oil { to empty the bowels. { Emetic, quickly followed by plenty of { a fresh mixture of the tincture of { chloride of iron with calcined magnesia, Arsenic (Fowler's { washing or baking soda, or solution, Paris { water of ammonia, or by Jeaunel's green, "Rough { antidote. Then white of egg, soothing on Rats") { drinks, or sweet oil; castor oil { to empty bowels. Atropine (see Belladonna). { Emetic; tannic acid freely; cold toBelladonna (atropine) { head; coffee. Stimulants and { warmth if needed. Blue stone; blue vitriol (see Copper). { Emetic (but often useless); externalChloral { heat; stimulants; strong coffee; { strychnine; atropine; artificial respiration. Chloroform, inhaled { Cold douche; friction of skin; inverting { child; artificial respiration. Copper (blue stone; blue { Emetic, followed by white of egg or vitriol; verdigris) { milk, yellow prussiate of potash; { then soothing drinks. { Emetic, followed by white of egg orCorrosive sublimate { milk; soothing drinks; tannic acid (bichlorid of mercury) { freely; castor oil to open bowels. Cyanide of potash (see Acid, prussic). Fowler's solution (see Arsenic). { Inhalation of oxygen; artificialGas (illuminating gas, coal { respiration; ammonia to nostrils; gas) { cold douche. Iodine {Starch or flour mixed with water given { freely; emetic; soothing drinks. Laudanum (see Opium). Lead (sugar of lead) {Emetic, followed by Epsom salts; { white of egg or milk; alum. Matches (see Phosphorus). Morphine (see Opium). Nux vomica (see Strychnine). {Emetic (but generally useless);Opium (including laudanum, { permanganate of potash in doses of 4 morphine, paregoric, { or 5 grains if case is seen early; soothing syrups, { strong coffee; atropine; keep child etc. ) { awake and breathing by cold douche to { head and spine, walking, etc. , but { not to extent of exhaustion; { artificial respiration. Paregoric (see Opium). Paris green (see Arsenic). Phosphorus (match-heads, {Emetic; then permanganate of potash some roach and rat poisons) { in doses of 4 or 5 grains well { diluted, and frequently repeated; { then Epsom salts or magnesia to { open bowels, but no milk or oil of { any kind. Poisonous plants (Jimson {Emetic, followed by tannic acid; weed, poisonous mushrooms, { strong coffee or brandy; ammonia deadly nightshade, { to nostrils; external warmth; tobacco, etc. ) { artificial respiration. Prussic acid (see Acid, prussic). Silver nitrate (lunar caustic) {Table-salt, followed by emetic; milk { or white of eggs. Spoiled food {Emetic, followed by castor oil as { purgative. Strychnine (nux vomica, {Emetic, followed by tannic acid, some rat poisons) { bromide of potash freely, or chloral. Tartar emetic (see Antimony) TABLE SHOWING THE AVERAGE WEIGHT, HEIGHT, AND CIRCUMFERENCE OF HEADAND CHEST OF BOYS[D] At birth. Weight 7½ pounds Height 20½ inches Chest 13½ inches Head 14 inches One year. Weight 21 pounds Height 29 inches Chest 18 inches Head 18 inches Two years. Weight 27 pounds Height 32 inches Chest 19 inches Head 19 inches Three years. Weight 32 pounds Height 35 inches Chest 20 inches Head 19¼ inches Four years. Weight 36 pounds Height 38 inches Chest 20¾ inches Head 19¾ inches Five years. Weight 41 pounds Height 41½ inches Chest 21½ inches Head 20½ inches Six years. Weight 45 pounds Height 44 inches Chest 23 inches Seven years. Weight 49½ pounds Height 46 inches Chest 23½ inches Eight years. Weight 54½ pounds Height 48 inches Chest 24½ inches Nine years. Weight 60 pounds Height 50 inches Chest 25 inches Ten years. Weight 66½ pounds Height 52 inches Chest 26 inches [D] Weights for the first four years are without clothes, after thatwith ordinary house clothes. The weight of girls is on the average about one pound less than boys. They are about the same in height. ICHTHYOL SUPPOSITORIES Ichthyol 5 per cent Cocoa Butter q. S. Ad. To make 24 suppositories. Sig. Use one suppository in the rectum each evening for hemorrhoids. OIL ENEMA The best way to administer an oil enema is by means of a special enemacan which holds one pint, to which is attached a rubber tube. It iswise not to use an ordinary fountain syringe as the oil spoils therubber very quickly. This oil is allowed to flow in slowly, under lowpressure, and should be retained over night. Any oil is acceptable, the cheaper sweet oils will serve just as well as olive oil. TABLE OF INFECTIOUS DISEASES Disease. |Incubation lasts-- | |Date of characteristic symptom from beginning of invasion. | | |Characteristic symptom. | | | |Other principal symptoms. | | | | |Whole duration of disease from onset. | | | | | |Quarantine lasts from onset. | | | | | | Typhoid fever. |7 to 10 days. | |7th or 8th day. | | |Rose-red, slightly elevated spots. | | | |Apathy; diarrhoea; nosebleed; headache. | | | | |2 to 4 weeks. | | | | | |While disease lasts. Scarlet fever. |1 to 7 days. | |1st or 2d day. | | |Intense, bright-red blush over body. | | | |Sore throat; often vomiting with onset. | | | | |7 to 9 days or more (not including | | | | | desquamation). | | | | | |6 weeks. Measles. |10 to 11 days. | |4th day. | | |Dusky or purplish-red, slightly elevated spots, | | | scattered and in characteristic groupings. | | | |Cold in head; running eyes; cough; hoarseness. | | | | |7 to 8 days. | | | | | |3 weeks. German measles. |7 to 21 days. | |1st day. | | |Pale, rose-red spots or uniform blush; no | | | characteristic groupings. | | | |Slight sore throat; sometimes slight running | | | | of eyes and nose. | | | | |3 to 4 days. | | | | | |3 weeks. Chicken-pox. |13 to 17 days. | |1st day. | | |Pea-sized, scattered vesicles. | | | |None; or slight fever. | | | | |A week or less. | | | | | |3 to 4 weeks. Varioloid (Variola). |7 to 12 days. | |3d day (may be 1st or 2d). | | |Red, elevated papules; then vesicles; then often | | | pustules. | | | |Headache; backache; vomiting. | | | | |About 14 days. | | | | | |4 to 8 weeks. Vaccinia (Vaccination). |1 to 3 days. | |1st day (3d after vaccination). | | |A red papule, becoming a vesicle and then a pustule; | | | surrounded by a broad red area. | | | |Often feverishness and malaise. | | | | |About 3 weeks. | | | | | |None. Erysipelas. |3 to 7 days. | |1st or 2d day. | | |Bright-red blush; puffy skin; often vesicles. | | | |Fever; pain. | | | | |4 to 6 days, or several weeks if it | | | | | spreads. | | | | | |Averages 2 weeks. Diphtheria. |2 to 12 days. | |1st or 2d day. | | |White membrane on tonsils and other parts of throat. | | | |Debility; fever. | | | | |10 to 14 days. | | | | | |3 to 4 weeks. Whooping-cough. |2 to 7 days. | |7th to 14th day. | | |A prolonged paroxysm of coughing followed by a | | | crowing inspiration (whoop). | | | |Vomiting; spitting of blood. | | | | |6 to 8 weeks. | | | | | |6 to 8 weeks (while whoop lasts). Mumps. |7 to 21 days. | |1st day. | | |Swelling in front, below, and behind the ear and | | | below the jaw. | | | |Pain when chewing. | | | | |A week or less. | | | | | |3 to 4 weeks. Influenza. |Uncertain. Probably 1 to 7 days. | |1st day. | | |Fever, prostration. | | | |Various respiratory, digestive, or nervous | | | | symptoms, commonest being general aching and | | | | cough. | | | | |3 or 4 days to two weeks or more. | | | | | |While disease lasts. HOT COLONIC FLUSHING The hot colonic flushing is particularly serviceable in combating thesick headaches of migraine. They should be taken at night just beforeretiring with the temperature of water as hot as can be borne, from108 to 110 F. Half of the water is allowed to flow into the colon andis retained as long as possible. This brings the heat in close contactwith the sympathetic nervous system whose headquarters is in theabdomen. ENEMAS _Position for an Enema. _ Lie on left side, knees brought up againstabdomen, with the left arm well underneath. This will relax theabdominal muscles and allow the water to pass upward more freely. Thewater should be allowed to flow until it is felt low on the rightside. _The one, two, three enema_ is an injection that is used for therelief of gas in the bowel. It consists of the following: One partepsom salts, two parts glycerine, and three parts soap suds. It isintroduced by the aid of the colon tube and retained as long as ispossible. Glycerine and soapy water, equal parts, may be introduced into thebowel for temporary relief of a persistent constipation. In instances when feeding by the mouth is impossible, _nutrientenemas_ should be given every three or four hours during the day. Theabsorption does not take place in the large bowel as readily as in thesmall intestines, so only a small amount of a more highly concentratedsolution is given at one time. A child one year of age will be givenone teaspoon, from one to four years of age a teaspoon to a tablespoonis allowed, and up to twelve years from one to eight tablespoons aregiven in the nutrient enema. Peptonized meat preparations may beemployed in greater concentration than directed by the use of themouth. Peptonized milk containing an egg is often used. The pepsin isadded to the mixture only when warm, and is injected at once. EMETICS 1. A glass of warm water containing as much common table salt as can be dissolved. 2. A teaspoon of mustard in a large glass of warm water. 3. A teaspoon of syrup of ipecac, repeated in fifteen minutes if necessary. Any one of these emetics is useful in instances where it is desirableto empty the stomach at once. A CALORIE A calorie is the heat unit used in the estimation of the fuel value ofvarious foods. For instance, an ordinary slice of homemade breadcontains 100 calories. An ordinary fig contains almost 100 calories. Alarge orange or an apple or a glass of grape juice contains about 100calories. There are 100 calories in three teaspoons of sugar or honey. A complete food list with the estimation of calorie value of foods isfound in _The Science of Living_, page 370, while on page 99 of thesame book is a very helpful table showing the amounts of various foodsrequired to equal 100 calories. The reader will find this exceedinglypractical in estimating food values for the household. ACIDIFYING AND ALKALINIZING FOODS Since we find that in all acute diseases the acidity of the urine isgreatly increased and in time of health it is less acid, we submit twolists of foods which tend to acidify the urine or to alkalinize theurine. FOODS WHICH TEND TO ACIDIFY. 1. _Animal Foods_: All forms of flesh foods, fish, fowl, etc. , including all kinds of meat broths, soups, beef tea, bouillon, etc. 2. _Eggs. _ 3. _Breadstuffs_: All kinds of breads, whether made ofwheat, rye or corn, crackers, toasts, griddle cakes, etc. 4. _Pastries. _ All sorts of pies and cakes--except fruit pies, and otherdesserts containing milk or sour fruits. 5. _Cereals_: Rice, oatmeal, and breakfast foods of all kinds, including the flaked and toasted breakfast foods. 6. _Peanuts_, plums, prunes, and cranberries. Plums and cranberriesfall in this column because of their benzoic acid, which the bodycannot fully oxidize. FOODS WHICH TEND TO ALKALINIZE. 1. _Dairy Products_: Milk, ice cream, cottage cheese, cheese, buttermilk, etc. 2. _Potatoes_ and _bananas_. 3. _Soups_: All forms of vegetable and fruit soups and broths. 4. _Fruit Juices_: All the fresh fruit juices except plums. 5. _Fresh Fruits_: All fresh fruits, sweet and sour, except plums andcranberries. 6. _Vegetables_: All kinds, especially beets, carrots, celery, lettuce, and muskmelon. 7. _Dried Fruits_: Figs, raisins, dates, currants--all except prunes. 8. _The Legumes_: Beans, peas, and lentils. 9. _The Nuts_: All the nuts belong in this column, including almondsand chestnuts. CEREAL WATERS, ETC. It is often necessary to give the infant or the young child cerealwater to replace food in occasions of summer diarrhoea, etc. 1. _Barley Water. _ One tablespoon of barley flour in one pint of water. Boil for one-halfhour, strain, and add sufficient boiled water to make one pint. 2. _Flaxseed Tea. _ One tablespoon of flaxseed, one pint of boiling water; let stand andkeep warm for one hour; strain. Add juice of lemon. 3. _Oatmeal Jelly. _ Four tablespoons of oatmeal, one pint of water; boil for three hoursin double boiler, adding water from time to time; strain. 4. _Toast Water. _ One, two, or three slices of bread toasted dark brown, but not burned. Put in one quart of boiling water, cover, and strain when cold. 5. _Arrowroot Water. _ Wet two teaspoons of arrowroot with a little cold water, and rub untilsmooth; then stir into one pint of boiling water and boil for fiveminutes, stirring all the while. 6. _Oatmeal Water. _ One tablespoon of oatmeal to one pint of boiling water, cover and letsimmer for one hour. Add water from time to time as it evaporates;strain. 7. _Rice Water. _ One tablespoon of (washed) rice to one pint of water. Boil three hoursadding water from time to time. FRUIT JUICES Fruit juices are exceedingly beneficial all through life; particularlyis this true during early childhood when the little ones are so likelyto be constipated. Any of the fruit juices are good, particularly thejuices from oranges, raisins, prunes, apples, pears, and cranberries. All these juices are better cooked than raw with the exception oforange juice. All children should have some fruit juice every day. Forthe very young baby the juices are strained through a wire strainerand a clean cheesecloth so as to remove every particle of solidmatter, and there should be added an equal amount of cold, boiledwater for the infant under ten months. LEMONADE AND EGGNOGS Lemonade, along with orangeade, grapefruitade and limeade should beused for children above a year. They should be well diluted and nottoo sweet. Eggnogs are splendid for children who need to be helped along withtheir diet. They may be given at the close of the meal, never betweenmeals--unless so prescribed by a physician. The stomach should haveample time to complete the work of digesting one meal before anotherpartial meal is allowed to enter it. Eggnogs consist of a well-beatenegg into which there is placed a small amount of sugar, flavoring witheither nutmeg, vanilla, or cinnamon, and the glass filled up with richmilk. MILKSHAKE Milkshake is a delightful drink. The white of an egg with one or twoteaspoons of sugar, two tablespoons of chopped ice, flavoring, andone ounce of cream are briskly shaken in a milk-shaker for twominutes. Cold milk is added to fill the glass. MEAT AND MEAT JUICES Beef extracts are regarded by the medical profession as purelystimulants. Beef juice is practically without food value. In thepreparation of beef juice the extractives and juices leave the fibre. The food is in the fibre of the meat. The extractives are purely of astimulating order. We do not advocate the giving of beef tea and beefjuices to children; as a rule, we think that cereal, gruels, strainedsoups, and milk are preferable. The only reason for cooking meats is to destroy the parasites such astapeworm, trichina, etc. , which are so often found in the meat. Thecooking of meat decreases its digestibility, as raw meat is moreeasily digested than cooked meat, but we feel it is necessary toadvocate the cooking of meat in order to kill the parasites. CODDLED EGG A fresh egg, shell on, is placed in boiling water which is immediatelyafter removed from the fire. The egg then cooks slowly in the water, which gradually cools, for seven or eight minutes, when the whiteshould be about the consistency of jelly. For a delicate digestion thewhite only should be given, with salt; it can be easily separated fromthe yolk. The above is the best form of egg for the young child. Lateron the eggs may be soft boiled or poached, or even soft scrambled. SOUPS Two varieties of soups are given children. In the early months ofchildhood, from six years to eighteen months, the soups are usuallystrained, but after eighteen months, soups may be thickened with flourand rich milk making a cream soup of it. Most vegetables make goodsoups. The pulp from such vegetables as asparagus, carrots, beans, peas, tomatoes, and potatoes are made into cream soups by the additionof a little flour, rich milk, butter, and a dash of salt. BREADS New breads should never be given to a child. Only bread twenty-fourhours old should ever be given to a child under six years; it shouldbe cut into slices and allowed to dry out; and even then is better ifslightly toasted. We publish a recipe for bran bread and bran biscuitswhich are exceedingly good for children and adults. _Recipe for Bran Bread. _ Two eggs, beaten separately; three-fourths ofa cup of molasses, with one round teaspoon soda; one cup of sourcream; one cup of sultana seedless raisins; one cup of wheat flour, with one heaping teaspoon baking powder; two cups of bran; stir welland bake one hour. _Bran Biscuits. _ Mix one pint of bran, one-half pint of flour, and onelevel teaspoon of baking soda. Mix one-half pint of milk and fourtablespoons of molasses. Add this to the bran mixture and bake in gempans. INDEX INDEX Abortion, advice on occurrence of, 39; care needed at third month of pregnancy, 38; consequences of, 7, 8; defined, 39; remedy for threatened, 38; warning signs of, 38. _See also_ Miscarriage; Pregnancy Adenitis, 345 Adenoids, 303 Air, supply of fresh, for baby, 213-17, 219 Baby, care of the: Abdomen, shape of, at birth, 105; advice in care of baby, 377-78; bathing, 107-8, 111-12, 190-201; bed for, arrangement of, 108, 115; bouncing harmful, 226; bowels and bladder, training of, 242; breast of baby, care of, 229; buttocks, care of, 200; chafing, how prevented, 201, 333; chest, shape of, 105; circumcision, when desirable, 110; clothing of the, 108; constipation, 279; cord, dressing of, 107; diet after first year, 245-47; ears, treatment of, 198-99; exercise of baby, 223; eyes, treatment of, 107, 198-99; falls, to be prevented, 228; feeding the, 109; genitals of the, how cared for, 110, 200; habits to be guarded against, 378; hair, treatment of, 201, 233; handling, 111; head, treatment of, 104, 233, 344; legs of, at birth, 105; lifting the baby, how accomplished, 228; mouth, treatment of, 199; necessities for newborn baby, 60-61, 64; nose, treatment of, 198-99; pulse and respiration, 105; putting to sleep, 127, 217; registration of birth of, 113; respiration, how started at birth, 105-6; second summer, care during, 230; skin of baby, 106; stools, regulation of, 142; temperature of baby, 226; the "spoiled" baby, 128; things bad for babies, list of, 377; treatment of baby during and after birth, 67, 69; umbilicus, how cared for, 112; urine of baby, 109, 223; warmth necessary, 225; water, how and when administered, 140, 222; weight of baby at birth, 106; when to give first feeding, 70. _See also_ Colic; Crying; Nursery; Nursing the baby; Sleep; Urine; _see also_ under several diseases Babyhood, 1 Backache, cause of, 43; method of relief for, 43-44 Bathing the baby, toilet, etc. , 190-201. _See also_ Baby, care of the Bed for baby. _See_ Baby, care of the; Sleep Bed-wetting, 328. _See also_ Urine Birthmarks, discussion of, 16, 17, 18, 40, 338 Bites, of dogs, snakes, cats, etc. , 349 Blindness, precautions to avoid, in new-born infant, 69, 331. _See also_ Baby, care of the Blisters (fever), 338 Blood-pressure, 46; observation of, 3 Boils, 337 Bottle feeding, additional foods, 153; bottle, preparation of, 149; ice-box, home-made, 148; intervals between meals, 153; nipple, how withdrawn, 152; position of baby during feeding, 150-51; quantity of food, 148; refrigeration a necessity, 148; rules for, 154; schedule for, 147; stomach, capacity of, 148; time allowance for, 152; traveling, food for baby while, 153; treatment of baby after, 152; water, when and how administered, 147 Bowel, prolapse of the, 283 Bow legs, how avoided, 228 Bran bread, recipes for, 448 Bravery, how to instil in a child, 382-84 Breasts, caked (mastitis), care of, 100, 136 ff. ; changes in, a sign of pregnancy, 4; care of, during pregnancy, 33. _See also_ Pregnancy Bronchitis, 304 Bruises, 354 Burns, 358 Calisthenics, how applied, 244 Caretaker (for children), 376-77 Carriages and go-carts, 227 Chafing, 333. _See also_ Baby, care of the Chicken-pox, 294-95 Chilblains, 356 Child culture, 1 Cleft palate, 341 Clothing the baby, bands, 204; booties, 206; caps, 210; diapers, 204; errors in clothing, 208; layette, the, 203-208; nightgowns, wrappers, and slips, 207; rules for, 212; shirts, 204; shoes, 210; short clothes, 209; skirts and petticoats, 206; sleeping-bag, 207; stockings, 206; suggestions for, 202; suits for play, 210; winter garments, 211; wraps, 210 Clubfoot, 342 Colds, 300, 301 Colic, causes and treatment of, 129-32, 142, 274 Confinement, bed and accessories, 61-62, 64; calculation of date of, 5, 6; preparations for, 53 ff. , 57; supplies needed for, 58 ff. ; room for, 61. _See also_ Labor Constipation, treatment of, 31, 40; in baby, 184, 185, 279 Contagious diseases, how contracted, 285; incubation period of various, 287; spread of, 286. _See also_ under various diseases Convulsions, 326 Coughing, 255 Cramps, 41 Croup, 306 Crying, abnormal, 124; birth cry, 123; cause of, 132; colicky cry, 129; fretful cry, 125; habit cry, 127; healthy crying, 123; hunger cry, 124; illness cause of, when, 129; pain cry, 126; "spoiled-baby" crying, 128; temper cry, 128; thirst cry, 124 Cuts, wounds, etc. , 353 Deaf-mutism, 331 Deafness, 302 Deformities, causes of, 17 Delivery, calculation of date of, 5, 6 Depressors, function of, 9, 15 Determiners, function of, 9, 15 Development of child, 240-41 Diarrhoea, 185, 280 Diet: Appetite, improvement of the, 401; assimilation, 360; baby, diet of, 245-47; cellulose, 365; eating between meals, 368; elimination, 360-62; fats, 364; food requirement (daily), 369; foods, full value of, 366; for children, 367; fruit sugars, 363; hygiene, 400; mineral salts, 364; nutrition, 362; proteins, 363; starches, 363; treatment of child, daily program for, 402-4; water, 365. _See also_ Feeding the baby; Nursing the baby Digestion: Disorder of, chronic indigestion, 275; stomach, disordered, 278; stomatitis or thrush, 279; vomiting, 274. _See also_ under various diseases Diphtheria, 296 Discipline, methods of, 316-22 Dislocations and fractures, 254 Doctor, choice of, 55 Earache, 351 Ears, running, 299 Eclampsia, 47, 48; prevention of, 50. _See also_ Urine Eczema, 334-35 Embryonic development, 11, 12 Enema, how administered, 280 Exercise, necessity of, during pregnancy, 27 Exercise of baby, 223 Eye infections, 298 Eyes, ears, and nose, care of, 198; foreign bodies in, 351 Fainting, 359 Fear, overcoming of, in children, 380-82 Feeble-mindedness, 331 Feeding the baby: Bottle-fed baby, healthy characteristics of, 178; changes in food to be gradual, 179; constipation, how treated, 185, 279; diarrhoea, cause of, 185, 280; dissatisfaction, signs of, 181; flatulence, 182; formula, choice of, for, 178; infant foods, 187-89; mistakes in formulas, 180; mixed feeding, 186; overfeeding, 183; vomiting, 182; weight of baby, 183. _See also_ Diet; Milk; Nursing the baby Fertilization, process of, 8, 9 Fever, 264. _See also_ Sickness of child Flatulence. _See_ Feeding the baby "Flour ball, " how prepared, 175 Foods, for baby, 153, 165-76; full value of, 366. _See also_ Bottle feeding; Infant foods; Milk Freckles, 336 Frostbites, 356 Games for children, 392 Germ plasm, 8 Glands, enlarged, 345 Goitre, 42 Governesses, 370-75 Grippe, 302 Habits, inculcation of good, 380-89 Harelip, 341 Headache, in children, 326; relief for, during pregnancy, 45; sign of auto-intoxication during pregnancy, 47 Heartburn, care for, 36 Hemorrhoids, treatment of, 41 Heredity, effect of, on individual, 9, 14; extent of influence of, 14, 15, 19, 20 Hip-joint disease, 343 Hives, 336 Homemaking, 370-75 Hookworm, 278 Hospital, recommended for confinement, 55-56; requisites for, 60 Housekeeping, 370-75 Hygiene, of baby, 222-31; of child, 400-4. _See also_ Diet Hysteria, prevention of, 315 Indigestion, 275 Infant foods, 187-89. _See also_ Feeding the baby; Nursing the baby Infant welfare, 178 Insects, bites of, 348 Insomnia, relief for, 45; in children, 323 Itch, the, 339-40 Jaundice, 276 Kissing the baby, precautions against, 224 Labor, analgesia in, 86; anesthesia in, 84-92; bath, preliminary, 64; care of mother during and after, 67-68; chloroform and ether, administration of, 91; duration of, 65; duties of nurse before and during, 67; "false pains" in, 66; fear in, importance of allaying, 84; laughing gas (nitrous oxid), administration of, 85; effect of, 87; pain of, 71, 84-85; preparations for, 64-65, 67, 72-73; progress of, 65; second stage of, 66; "sunrise slumber" in, 84-90; symptoms of approaching, 64; third stage of, 66; "twilight sleep" in, 71-72, 73-83; what to do in, before arrival of doctor, 67 Layette. _See_ Clothing of baby Leucorrhea, relief for, 37-38 Lice, 339 Lime water, use of, in baby's food, 173 Lochia, the, 97 Lying-in period, the, 93; abdominal binder, 97; "after-pains, " 95; bowels, care of, 98; breast binder, 97; "cold-mitten friction" during, 95; cystitis, how avoided, 100; diet, rules for the, 98; getting up from bed, when to be permitted, 99; hemorrhage, treatment of, 100; infection, advice for treatment of, 100; lochia, the, 97; nipples, care of, 98; nurse, duties of, during, 93; pneumonia, how avoided, 100; rest and exercise during, 94; temperature of mother, 96; toilet of the vulva, 96 Malaria, 346 Maternal instinct, the, 1 Maternal impressions, explained and discussed, 16 Measles, 293-94 Medical supervision in early days of pregnancy, 2 Medicine chest, the, 270 Meningitis, 329 Menstruation, cessation of, a sign of pregnancy, 4; cessation of, due to other causes than pregnancy, 4; passage of ovum at time of, 9. _See also_ Pregnancy Milk, acidity, how counteracted, 158; analysis of cow's, 156; analysis of mother's, 156; annatto, test for, 159; boiling, when necessary, 161; bottled milk, care of, 163; bottles, care of, 166; buttermilk, when used, 174; certified milk, 161; condensed milk, how used, 175; cow's milk, modification of, 157; cream gauge, 158; cream, gravity of, 172; dairy, essentials of a good, 159; "flour ball, " the, 175; food, special, 175; formulas for feeding, 171, 173; goat's milk, use of, 157; herd milk desirable, 159; lactometer, 158; lime water, use of, 173; "modification" of cow's milk, 165; nipples, care of, 166; pasteurization of, 162; peptonized, 174; preparation of, 168-70; schedule for feeding, 171; seven per cent milk, 173; spores, how guarded against, 163; sterilization of, 162; sugar, use of, with, 157; "top-milk" formula, 172; whey, how used, 176. _See also_ Feeding the baby Milk crust, 198 Miscarriage, care needed at seventh month of pregnancy, 39; causes of, 39; defined, 390. _See also_ Abortion; Pregnancy Monstrosities, causes of, 17 Moral training of child, 415-24 Morning sickness, a sign of pregnancy, 4; remedies for, 35 ff. ; vomiting (pernicious), 44. _See also_ Pregnancy Mothercraft, 1; science of, 2, 370-75 Motherhood, characterized, 1; preparation for, 2 Mouth of baby, care of, 199 Mouth wash for use during pregnancy, 30 "Mulberry Mass, " the, 11 Mumps, 291 Nails, ingrowing, 342 Nature, lessons from, in teaching children, 405-12 Navel, bleeding from the, 284 Nervousness, hereditary (in child), 308-10; how overcome, 310-14, 323-32 Nervous system, absence of connection between, of mother and child, 18 Nitrous oxid, effects of, 87-90 Nosebleed, 352 Nurse, choice of, 56-57 Nursery, bath equipment, 121; bed, arrangement of, 108, 115, 119; cleanliness, necessity for, 122; equipment of, 114; heating and ventilation, 118; lighting, 120; refrigerator, 268; sleeping blanket, 118; ventilation of, 120 Nursing the baby, caked breasts, 136-37; diet of mother, 135; foods to be avoided by mother, 136; hygiene of nursing mother, 134; importance of, 133; irritability of mother, effect of, 142; mastitis (caked breast), treatment for, 100; milk supply, how increased, 143; mixed feeding, 186; mother's milk, constituents of, 139; overheating of mother to be guarded against, 142; position of mother when, 141; regularity in feeding, 141; sore nipples, how treated, 138; stools, regulation of, 142; successful or unsuccessful, how determined, 142-43; time of first feeding, 139; to be avoided, when, 144; water, administering, 140; wet nurse, the, 145. _See also_ Bottle feeding; Diet Ovary, the, 8 Ovum, development of, into foetus, 11, 12 Paralysis, infantile, 330 Parents, relation of to children, 413-24 Pernicious vomiting. _See_ Morning sickness Physician, selection of, for treatment during pregnancy, 21-22 Pigeon toe, 342 Placenta, role of, 18 Play and recreation, 390-91 Playmates of children, 311 Pneumonia, 307 Poisons and antidotes, 356-58 Pott's disease, 343 Pregnancy: Bathing, necessity of, during, 29; blood-pressure in, 49, 50, 52; breasts, care of the, 33; cheerful anticipation, advantages of, 4; clothing appropriate during, 22; constipation, how avoided during, 31-33, 40; convulsions, treatment for, 48; craving for special food, in, 40; diet during, 24 ff. ; dizziness during, 47; duration of, 5, 12; exercise, necessity of, 27; fresh air, necessity of, 29; goitre in, 42; hemorrhoids, treatment of, 41; hygiene of, 21 ff. ; irritation of the bladder, 37; kidney complications, 3; medical supervision in early days of, 2; mental state during, how regulated, 33; miscarriage, danger of, at seventh month, 39; morning sickness, remedies for, 35; progress of, 11, 12; quickening, 5; resentfulness of mother, consequences of, 3; rest, necessity of, 28; signs of, 4; swellings in, 42, 47; teeth, care of, during, 30; urine, diminution of, 47; urine, testing of, 30; vision, blurring of, the, 47; water, necessity of, in, 26. _See also_ Abortion; Miscarriage Puerperium. _See_ Lying-in period "Quickening, " 5. _See also_ Pregnancy Rheumatism, 344 Rickets, 345 Ringworm, 337 Rupture, 283 Saint Vitus' Dance, 330 Saliva, flow of, not indicative of teeth-cutting, when, 233 Scalds, 358 Scarlet fever, 292-93 Scurvy, 344 Senses of new born baby, 232, 233 Shortening clothes of baby. _See_ Clothing the baby Sickness of the child: Abdomen in sickness, 254; breathing, 256; chest in sickness, 254; convalescence, 272-73; cough, the, 255; cry of infant in sickness, 255; disinfectants for sick room, 269; examination of sick child, 260; facial expression, 254; feeding directions, 259; fever, 264; gestures indicating sickness, 253; head indicates sickness, 254; medicine chest, the, 270; medicines, 263; mouth, the, 257; nurse, the, 251; nursing records, 262; patent medicines, 271; position of, in sickness, 252; pulse, the, 257; sick room, location of, etc. , 266; skin color, 253; stools, the, 258; swallowing, 258; temperature and pulse, 263; temperature, the, 257; treatment of sick child, 261; urine, the, 258. _See also_ under several diseases Skin troubles, 333 Sleep: Air, supply of fresh, 213-17, 219; bed-clothes, 219; bedtime for baby, 218; daily naps, 221; food, effect of, on, 220; position of baby in, 218; putting baby to, 127, 217; requirements of, by baby, 217; soothing syrups, 220; waking up in night, 219 Smallpox, 295 Soothing syrups, 220 Sore throat, 302 Spasms, 326 Speech of baby, 243 Sperm, blending of, with ovum, 11 Spinal curvature, 342-44 Spoiling the child, 310 Sprains, 355 Stools of baby, 184, 185 Stream of life, the, 8 Sucking habits in baby, to be guarded against, 224, 378 Suggestion, effect of, 19, 380-89 Summer complaint, 278. _See also_ Diarrhoea; Dysentery Sunrise slumber. _See_ Labor Suppressors, function of, 9, 15 Swallowing of bones, buttons, etc. , 350 Syphilis, 346, 347 Teeth, care of, during pregnancy, 30 Teething, 234-37; suggestions for treatment during, 237 Thrush, 279 Tonsils, diseased, 303; tonsilitis, 302 Toys, selection of, 230 Tuberculosis, 346 Twilight sleep. _See_ Labor Twitchings, 327. _See also_ Nervousness, hereditary Typhoid fever, 288-91 Umbilical cord, function of, 18 Uremic poisoning. _See_ Urine Urine: Albumin and casts in, 47, 50; bed-wetting, 328; diminution of, during pregnancy, 47; disturbance in, a sign of pregnancy, 4, 5; eclampsia, 3; examination of, 3; irritation of the bladder, 37; retention of, by child, 328; testing of, during pregnancy, 30, 42, 45, 49, 55; toxemia, indications of, 48; uremic poisoning, 3; urinating after labor, 97; urination of baby, 223; urine an index of disease or sickness, 258. _See also_ Pregnancy; Sickness of child Uterus, entrance of fertilized ovum into, 9, 10 Vaccination, 295 Varicose veins, 41 Vice, secret, causes of, 421 Vomiting, 274. _See also_ Digestion, disorders of; Feeding the baby Vulva, toilet of the, 96 Vulvovaginitis, 334 Walking of baby, 244 Warts, 338 Water: Administered to baby, when, 222; necessity of, during pregnancy, 26, 45, 48, 50; part played by in nutrition of body, 365 Water on brain, 331 Weaning: Breast-fed babies, 241; bottle-fed babies, 241 Weight of baby, 183, 238-39 Whooping cough, 297 Worms, 276