Class "R T~6 1 
 
 Rnnlc ,F & 9 
 
 Copyright^ 
 
 COPYRIGHT DEPOSIT. 
 
IN FOUR VOLUMES ^ ^ ^ ILLUSTRATED WITH 
 FRONTISPIECES IN COLOR BY W. T. SMEDLEY 
 
 '^TEW and original treatises on the building, furnishing, 
 and keeping a home ; on home etiquette, and the con- 
 duct of dinner parties, receptions, weddings, etc.; on food 
 economy and the preparation of both plain and fancy dishes ; 
 on the care of the sick, the hygiene of motherhood, the 
 treatment of infants and young children; on the legal rights 
 of women in the various States of the Union, with advice as 
 to business careers, investments, etc. ; and on the manly and 
 ladylike conduct of young people during the formative period 
 of character. With many illustrations in half-tone. 
 
 I. THE HOMEMAKER (including Home Etiquette). 
 By Carlotta Norton Smith, late Editor of The 
 Art Interchange. 
 
 II. THE HOME COOK BOOK. Practical Receipts by 
 Expert Cooks. 
 
 III. HOME NURSING — MOTHERHOOD— THE 
 
 CARE OF CHILDREN. By Harriet Forbes 
 and Harriet Merrill Johnson, Graduate Nurses 
 of General and Maternity Hospitals. 
 
 IV. AMERICAN WOMEN'S LEGAL STATUS. By 
 
 George James Bayles, Ph.D., Lecturer in the School 
 of Political Science, Columbia University. 
 
 LETTERS TO AMERICAN GIRLS. By Sallie 
 Joy White. 
 
 LETTERS TO AMERICAN BOYS. By Professor 
 William Herbert Carruth, of the University of 
 Kansas. 
 
THE NEWCOMER 
 
 — Home Nursing 
 
Home Nursing 
 
 Motherhood— Care of Children 
 
 BY 
 
 HARRIET FORBES 
 
 AND " 
 
 HARRIET MERRILL JOHNSON 
 
 Graduate Nurses of the Massachusetts Homeopathic Hospital, Boston, and the Sloane 
 
 Maternity Hospital, New York ; Graduates of the Hospital Economics 
 
 Course, Teachers' College, Columbia University ; and Visiting 
 
 Nurses of Nurses' Settlement and Hartley House 
 
 WITH FRONTISPIECE IN COLOR 
 BY W. T. S MED LEY . 
 
 "When one comes to look upon health as simply a mark of intelligence, 
 as a private duty and a public duty, as indeed an essential part of the 
 moral life, and when one comes to regard illness as an immoral and quite 
 unpermissible thing, he has taken an important step in the process of 
 education." — Charles Hanford Henderson. 
 
 NEW YORK 
 
 P. F. COLLIER & SON 
 
 1905 
 
LIBRARY of CONGRESS 
 fwo Copies rtWBiveo 
 
 MAY 22 iy05 
 
 Goyyngiu entry 
 QU\SS</CZ XXc. Noi j 
 COPY 6. i 
 
 Copyright, 1905, by 
 P. F. COLLIER & SON 
 
 u\ 
 
 ^ 
 
CONTENTS 
 
 PART I.— HOME NURSING 
 
 I.— MATERIAL AND SPIRITUAL EQUIPMENT OF THE 
 HOME NURSE 
 
 Ethics of Nursing — What Room Should be Chosen — Care in Ventilation — De- 
 vices for Ventilation — Freeing the Invalid from Noise — Simple Furnish- 
 ings in Sick Room?— Bedsteads — Mattresses — To Make a Sick Bed — 
 Daily Care of Sick Room — Care of Utensils — How to Save Steps . . 7 
 
 II.— GENERAL CARE OF BED PATIENTS 
 
 Structure and Function of Skin — The Cold Bath— Frequency of Bathing in 
 Sickness — The Bed-Bath — The Foot-Bath — Care of the Hair — Care of the 
 Mouth — Changing Sheets for Bed Patients — Changing Night-Dress — Pre- 
 vention of Bed-Sores — Lifting and Moving Patients — Mechanical Appli- 
 ances ............. 23 
 
 III.— ENEMATA, SUPPOSITORIES, AND DOUCHES 
 
 Administration — The Laxative Enema — The Purgative Enema — The Nutritive 
 Enema — The Starch Enema — The Turpentine Enema — Rectal Irrigation — 
 Suppositories — Douches — Gargles, Sprays, and Inhalations — Care of Uten- 
 sils ............. 42 
 
 IV.— OBSERVATION OF SYMPTOMS 
 
 Circulation — How to Take Pulse — Temperature — Use of Clinical Thermometer 
 
 — Respiration — Observation of Symptoms . . . . . -55 
 
 V.— INFLAMMATION, EXTERNAL APPLICATION, 
 MEDICINES 
 
 Inflammation — Treatment — Dry Heat — Hot-Water Bags — Moist Heat — How to 
 Make a Poultice — Fomentations — Cold Applications — Ice Coils — Counter- 
 irritants — Massage — The Giving of Medicine — Hypodermic Injections — 
 Care of Medicines ........... 69 
 
 VI.— CARE OF OPERATIVE CASES 
 
 Preparation for Operation — Emergency Preparation — Preparation of Patient — 
 Full Preparation, for Operation — The Anaesthetic — Assisting the Surgeon — 
 After-Care of Patient— The Problem of Food — Cases of Minor Surgery — 
 Convalescence ........... 90 
 
 VII.— ACCIDENTS AND EMERGENCIES 
 
 Shock — Hemorrhage — Bleeding from Nose — Bleeding from Lungs — Fainting — 
 Fractures — Dislocations — Contusions — Sprains — Chilblains — Frostbites — 
 Toothache— Warts— Cuts — Burns and Scalds — Foreign Bodies — Sunstroke 
 and Heat Exhaustion — Artificial Respiration— Insect Bites — Bites of 
 Snakes and Rabid Animals — Poisons . . . . • • .no 
 
 1 Vol. 3(1) 
 
2 CONTENTS 
 
 VIII.— INFECTION AND CONTAGION 
 
 Micro-Organisms and Disease — Transmission of Disease — The Protozoa — Dis- 
 infectants — Methods of Disinfection — Typhoid Fever — Erysipelas — Mala-' 
 rial Fever — Dysentery . . . . . . . . . .131 
 
 IX.— INFECTIOUS DISEASES (CONTINUED) 
 
 Influenza — Pneumonia — Tuberculosis — Forms of the Disease — Heredity — Chan- 
 nels of Infection — General Precautions — Special Precautions for Attend- 
 ants — Exercises Beneficial to Those with Tendency to Tuberculosis — Sug- 
 gestions for Patients — Care of Patients — Cerebro-Spinal Meningitis . 150 
 
 X.— ACUTE AND NERVOUS DISEASES 
 
 Rheumatism — Tonsilitis — Bronchitis — Pleurisy — Appendicitis — Bright's Disease 
 
 — Neurasthenia — Hysteria — Epilepsy — Insanity . . . . . .166 
 
 PART II.— MOTHERHOOD 
 
 I.— THE PHYSIOLOGY AND HYGIENE OF PREGNANCY 
 
 Indications of Pregnancy — Quickening — Dress — Need of Fresh Air — Exercise 
 
 — Food — Bathing — Sleep and Rest — Heredity . . . . . .185 
 
 II.— AILMENTS OF PREGNANCY 
 
 Nausea — Constipation — Increased Salivation — Varicose Veins and Hemorrhoids 
 — Decay of Teeth — Palpitationi — Sciatica — Pruritus — Irritation of Bladder 
 — Abdominal Bandage — The Physician — Midwives — Advice of Friends — 
 
 * Receipts for Special Diet ......... 201 
 
 III.— PREPARATIONS FOR CONFINEMENT 
 
 Preparations for the Mother — Baby's Wardrobe — List of Clothes — The Nurs- 
 ery Furnishings . . . . . . . . . . .218 
 
 IV— LABOR 
 
 Duration of Pregnancy— Preparations for Confinement — Stages of Labor — Con- 
 tractions of the Uterus — Emergencies — After-Treatment of Mother — After- 
 Treatment of Baby .......... 234 
 
 V— AFTER-CARE OF MOTHER AND CHILD 
 
 Rest — Dressings — Breasts — Diet — The Baby's Bath — The Cord-Dressing — Order 
 of Dressing — Care of Eyes, Nose, Mouth, and Breast — Tub Baths — The 
 Band — Feeding . . . . . . . . . . 245 
 
 VI.— ABORTION AND PREMATURE BIRTH 
 
 Abortion — Premature Birth — Care of Premature Baby — Gavage and Lavage — 
 
 Suppressing Milk — Milk-Leg — Inexorable Laws of Nature . . . 262 
 
 VII.— HABITS AND METHODS OF TRAINING 
 
 Law of Habit — Unwise Training — The Day's Routine — The Baby's Laundry — 
 
 Details of Bath — Naps — The Outing 276 
 
LIST OF ILLUSTRATIONS 
 
 PART III.— CARE OF CHILDREN 
 
 L— INFANT FEEDING 
 
 Mother's Milk — Weaning — Cow's Milk — Modification of Milk — Prepared Foods 
 
 — Points to be Noted — Schedule for Feeding — Household Measures . . 293 
 
 II— DIETARIES 
 
 Digestion — Needs of the Child — Diet Lists from Eleven Months to Three 
 Years and a Half — Sweets for Children — Family Breakfast — Family Din- 
 ner—Supper—The Child at Table 310 
 
 III.— SCHOOL CHILDREN— THEIR FOOD AND EXERCISE 
 
 Breakfasts — Luncheons — Physical Activities and Mental Development — Health 
 
 and Education ........... 323 
 
 * IV.— POINTS ON HYGIENE 
 
 "Toughening" — Baths — The Teeth — Footwear — Dress ..... 336 
 
 V.— DISORDERS OF CHILDREN 
 
 Symptoms of Illness — Colic — Jaundice — Inflammation of the Eyes — Thrush — 
 Diarrhoea — Constipation — Convulsions — Teething — Milk Crust — Eruptive 
 Disorders — Hives — Prickly Heat — Ringworm — Croup — Rickets — St. Vitus's 
 Dance ............. 349 
 
 VI.— CONTAGIOUS DISEASES 
 
 Mumps — Whooping-Cough — Measles — Chicken-Pox — Scarlet Fever — Necessary 
 Precautions in Contagious Diseases — Scarlet Fever is Infectious — Diph- 
 theria ............. 368 
 
 VII.— PROBLEMS OF PUBERTY 
 
 Development of the Child — Puberty — Instruction to the Child — Masturbation 
 
 — Menstruation — Bathing During Menstruation . . . . .381 
 
 LIST OF ILLUSTRATIONS 
 
 Glass Sputum Mug with Metal Cover 
 
 Metal Frame . 
 
 Paper Filler . 
 
 Invalid's Drinking Cup 
 
 Woven Wire Mat . 
 
 A Nursery Ice-Chest 
 
 Water Cooler 
 
 A Rubber Ring 
 
 Horseshoe Air-Cushion 
 
 Canvas and Wood Bed-Rest 
 
 19 
 19 
 19 
 ro 
 
 23 
 
 21 
 
 21 
 
 34 
 34 
 38 
 
LIST OF ILLUSTRATIONS 
 
 A Cradle to Lift the Clothes . 
 
 The Iron Standard Bed Table 
 
 The Wooden Leaf Bed Table 
 
 Trabaud Back Protector on Douche Pan 
 
 A Fountain Syringe 
 
 Hard Rubber Syringe 
 
 Rectal Tube with Return Flow 
 
 Douche Pan . 
 
 Glass Nozzle . 
 
 A Clinical Thermometer 
 
 Hot-Water Bag 
 
 A Stupe Wringer . 
 
 Rubber Ice-Bags . 
 
 Hypodermic Syringe of Glass and Asbestos 
 
 Room Hastily Prepared for Operation . 
 
 A Nightingale 
 
 Pocket Sputum Flask 
 
 Abdominal Bandage 
 
 A Meat Press 
 
 "Eureka" Bed-Pan . 
 
 "Perfection" Bed- Pan 
 
 Baby's Band . 
 
 Baby's Shirt . 
 
 Band 
 
 Skirt 
 
 Petticoat 
 
 Dress 
 
 White Enamel Bath-Tub for Baby 
 
 Rubber Tub .... 
 
 The Flannel Petticoat and Dress 
 
 Slipping on the Flannel Petticoat and Dress 
 
 Placing Baby in the Bath 
 
 Feeder for Premature Baby 
 
 The Murphy Bandage . 
 
 Bath Under the Blanket 
 
 "Hygeia" Nursing Bottle 
 
 A Graduated Glass 
 
 Stomach of Infant Five Days Old (Natural S 
 
 Glass Cylinder Showing the Capacity of the 
 
 ize) 
 Stomach 
 
PART I 
 HOME NURSING 
 
MATERIAL AND SPIRITUAL EQUIPMENT OF 
 THE HOME NURSE 
 
 Ethics of Nursing— What Room Should be Chosen— Care in Ventilation- 
 Devices for Ventilation — Freeing the Invalid from Noise — Simple 
 Furnishings in Sick Room — Bedsteads — Mattresses — To Make a Sick 
 Bed — Daily Care of Sick Room — Care of Utensils — How to Save 
 Steps 
 
 THE thought of accepting an invalid as a member 
 of the household is always a trying one, and often 
 brings consternation into otherwise quiet homes. Possi- 
 bly a few suggestions may lighten the burden of such a 
 situation, and encourage the mother, sister, or wife who 
 is to act the part of nurse pro tern, and who needs to 
 know something of the equipment, both material and 
 spiritual, for such an undertaking. 
 
 The clean gingham dress of the hospital nurse, 
 worn both winter and summer, is a familiar sight, and Dress of 
 typifies that absolute cleanliness w 7 hich is both her i n g nurse 
 personal and her professional characteristic. It is 
 quite possible for the acting nurse also to don a cot- 
 ton gown, which should be simple and easily laundered. 
 Having once felt the comfort of such a working-dress 
 she will hardly wish to return to the heavy woolen 
 skirts so unsuitable for the sick-room. 
 
 We all recognize the absurdity of a nurse's going, 
 as one once did, to take charge of a case and appear- 
 ing before her patient arrayed in a pink silk waist, yet 
 the same incongruity would not appear so great if one 
 of the family, or a familiar friend who was serving in 
 the capacity of nurse, were the offender. The prin- 
 ciple, however, is quite the same in either case. 
 
 (7) 
 
8 HOME NURSING 
 
 But far more important even than the matter of 
 The f dress and quite within the possibility of every one, is 
 care of the need of frequent bathing on the part of the nurse 
 perso™ anc * proper attention to neatness in the details of her 
 toilet — the clean, well-trimmed nails and hair care- 
 fully and simply arranged. 
 
 Deft hands, quick insight, a gentle bearing, good 
 Blessed temper and a generous dash of humor are priceless 
 
 cli3.r3.ctci"" 
 
 istics in a blessings in a sick-room, and may be cultivated in a 
 sick-room vef y j ar g e measurej if their value is sufficiently appre- 
 ciated. The nurse who pounds the pillow on the pa- 
 tient's bed or clumsily jars it every time she passes, 
 who is ill-natured and unkempt, or who reveals by her 
 manner that her work is arduous, is distinctly work- 
 ing against the recovery of her patient, though she 
 may little realize the cost of her thoughtlessness. 
 
 ETHICS OF NURSING 
 
 It is no time when a person is sick to regale him 
 The Gold- with grewsome or unpleasant tales; yet how often a 
 en ue garrulous neighbor delights in the opportunity of set- 
 ting forth some harrowing incident while, it may be, 
 the distressed patient is too weak even to protest. The 
 ethics of nursing is a large subject, but perhaps, after 
 all, the practice of the Golden Rule is its simplest ex- 
 pression. 
 
 CHOICE OF A ROOM 
 
 As regards the chief features of importance in the 
 
 selection of a sick-room, namely, the securing of good 
 
 air, quiet, and plenty of sunshine, we must recognize 
 
 The room that there are many households where these conditions 
 
 best 
 
 adapted- can not be ideal. But wherever a choice is possible, the 
 vaiid'T use room best adapted for an invalid's use should be se- 
 lected even at the cost of some inconvenience to other 
 
EQUIPMENT OF THE NURSE 9 
 
 members of the family, since comfortable and hy- 
 gienic surroundings are a large factor in the recovery 
 of a patient, and model conditions will be described, 
 because the ideal must always be the standard toward 
 which we progress. 
 
 An airy, spacious room, having a southern expos- 
 ure and several windows, so that the sunlight can Having 
 flood daily, and far enough removed from the noise conditions 
 of the kitchen or front door to secure absolute quiet, 
 affords the best possible conditions for a very ill pa- 
 tient. 
 
 VENTILATION 
 
 If once we heartily believed the truth that the body 
 starves for lack of oxygen as it plainly does for lack 
 of food, there would be no necessity for the protest 
 against tightly closed and ill-ventilated rooms. The 
 starvation for oxygen, it is true, is much more slow, 
 and it may be years before one sees evidence of the 
 depletion the body is undergoing in cases where the 
 supply is insufficient, whereas the daily demand for 
 food is a crying one that can not be overlooked. 
 
 In spite of our ignorant efforts to keep out the fresh The body's 
 air, enough oxygen sifts in through the cracks of oxygen 
 doors and windows to satisfy, in a small measure, the 
 demands of the body, and thus relieve the feeling of 
 suffocation which is the most urgent call of the or- 
 ganism to supply its need. If this were not so, the suf- 
 fering would be such that one could not tolerate the 
 
 conditions. As proof of the impoverishment that ex- Proof of 
 
 1 1 1 ,. • 11 -11 thls need 
 
 ists under bad conditions, one has only to .cite the phys- 
 ical effects upon the system observed after a night 
 spent in a closed room — the dull head, lack of appetite, 
 lassitude, and general depression — and compare this, if 
 one has ever experienced it, with the feeling of ex- 
 
10 HOME NURSING 
 
 uberance and delight in nature felt after a night spent 
 in the open air. It is when disease comes, hcwever, 
 in sick- that the real difference between the well and the ill- 
 nourished body is most apparent. Not infrequently 
 people who have never known sickness, but who have 
 all their lives disregarded the laws of health in re- 
 spect to ventilation and whose bodies have lived on a 
 meagre supply of oxygen, are not able to resist the 
 approach of disease. 
 
 For the sick-room, low windows admitting an abun- 
 dance of fresh air and sunshine are much needed, while 
 the addition of a balcony opening out provides attrac- 
 tively for the convalescent days, both in summer and 
 winter. 
 Open win- Window-boxes help to make the chamber cheerful, 
 in^iid° r and are in no way objectionable; but plants filling a 
 side boxes wni dow and shutting out the sunshine should be con- 
 for plants demned. 
 
 If the window is arranged to lower from the top — 
 and all windows should properly be so arranged, since 
 the foul air of a room has a tendency to rise — venti- 
 lation in cold weather is made easy. By reversing the 
 position of the sashes, a current of air escapes in the 
 centre between the unevenly fitting framework. But 
 Good better still for use in the winter, is a board four or five 
 of et ve°n- S inches wide and perhaps an inch thick, just long 
 tiiation enough to fit the window if slipped under the lower 
 sash. This method provides a larger current of air in 
 the centre between the sashes, and in either case there 
 is no draught possible. Another device is to fasten a 
 piece of cloth across the lower part of the window 
 from side to side, so that the air can not blow directly 
 into the room when the bottom sash is raised. 
 
 The use of small screens will not be forgotten, and 
 often one may be improvised by means of a clothes- 
 
EQUIPMENT OF THE NURSE 11 
 
 horse and a couple of sheets or light shawls. A high- The use 
 
 , , , , , , - of screens 
 
 back chair may also serve the same purpose, and for 
 a baby's crib an open umbrella does very well if noth- 
 ing better is at hand to protect against the draught. 
 
 A fireplace provides another means of ventilation 
 besides adding greatly to the charm of the room. 
 
 Ventilation is generally a possibility in any sick- 
 room, but absolute quiet is not so easily secured, and 
 on this account certain cases must be sent to the 
 hospital. 
 
 It must be borne in mind that when the doctor ad- 
 vises the hospital it does not necessarily mean the des- what 
 peration of the case, but very possibly that the in- a hospital 
 creased facilities for the proper care of the patient imv ieb 
 which the hospital affords are demanded in order to 
 hasten recovery. 
 
 NOISE 
 
 There are some devices by means of which an in- 
 valid may be spared the irritation of trifling noises 
 and the sharp, sudden sounds always much more an- 
 noying than the dull, continuous rumble of the street 
 or the general stir about the household. A creaking 
 door-hinge can be oiled, even if one has nothing but How to 
 vaseline with which to do it, and on the door of the l^noiiel" 
 sick-room, which must be frequently unlatched, a in horne 
 
 - 1 J nursing 
 
 small towel may be twisted from one handle to the 
 other to prevent its closing tightly, or a rug be pulled 
 across the threshold to serve the same purpose. 
 
 Windows which rattle can be made secure by the 
 aid of a few pegs whittled from burnt matches, and Devices 
 should be attended to before the patient is settled for 
 the night. If a dripping faucet can not be turned off, 
 a cloth may be tied over it, and the loose, creaking 
 boards in the floor may become such familiar spots 
 
12 HOME NURSING 
 
 to the thoughtful nurse that she almost unconsciously 
 avoids them. If a grate fire or stove is in the room, 
 the care of it may be made far less trying to the 
 nerves of the sick one if the coal is placed in a large 
 paper and laid on the fire when replenishing it, in- 
 stead of being shoveled in the usual way. A wooden 
 poker can be substituted for an iron one, and large 
 clinkers removed with the hand instead of turning 
 them down with the ashes when a new fire is to be 
 built. 
 
 Whispering is always exasperating to a sick per- 
 The tone son, and whatever conversation is necessary in the 
 voice room or immediately outside the door should be 
 
 carried on in low, quiet tones, but never in a stage 
 whisper. One's manner of addressing a patient should 
 be considerate, particularly if he is very ill. He 
 should never be startled by loud or abrupt tones from 
 behind, but having first gained his attention speak 
 distinctly but with quiet voice. These suggestions 
 Hints for are scarcely necessary to one who has had experience 
 perienced with sick people, but to the uninitiated, particularly 
 if she be young and vigorous, without "nerves" her- 
 self, they may possibly be of value, as it is a most 
 difficult thing to realize exactly how an ill person 
 craves the relief from noise and confusion or appreci- 
 ates any effort to minimize such for him. 
 
 FURNISHINGS OF THE SICK-ROOM 
 
 As to the furnishings of the sick-room, the 
 No fumi- greatest simplicity is required both from the hygienic 
 essentials and from the aesthetic standpoints. The sleeping- 
 room, even in health, should be a place free from 
 the unnecessary adornment of heavy hangings and 
 Crowded bric-a-brac, gathering millions of microbes 
 
EQUIPMENT OF THE NURSE 13 
 
 which elude the most careful housewife. If possible, 
 let the walls be painted some neutral tint restful to 
 the eye, so that they may be easily cleaned, and have 
 no more furniture in the room than is absolutely 
 necessary for use. A bed, table, easy-chair, lounge, 
 and screen constitute the essential furniture. A hard- 
 wood floor is best, but if it is necessary to carpet, 
 straw matting is better than wool, and can be found 
 in very attractive styles. Lightweight rugs that can 
 be taken out and shaken every day may be used on 
 the hardwood floor. 
 
 A set-bowl in any bedroom is always objection- 
 able, and is not to be tolerated if the modern method Avoid bad 
 of open plumbing has not been adopted. The con- 
 stant escape of poisonous gases by means of leaky 
 traps is something that should be guarded against at 
 all costs. But it is a simple matter, fortunately, to 
 cover or plug up the escape holes, and water may be 
 kept standing in the bowl if the bedroom is so 
 equipped, though the better plan, of course, is to re- 
 move all plumbing to an adjacent room not used for 
 sleeping. 
 
 The most suitable bedstead for a sick-room is 
 readily admitted to be the single or three-quarter The bed 
 size iron frame with double woven wire mattress and position 
 having a height of two or two and a half feet. This 
 frame painted white can be easily and thoroughly 
 cleaned, and its height makes it convenient for lifting 
 and moving a patient. It should stand in the room 
 in such a position that the patient does not directly 
 face the light from any window, and also so as to be 
 easily accessible from both sides. 
 
 In spite of the supposition that the feather bed Never a 
 has been relegated to the garret- or made over into bed 
 pillows, it is still necessary to emphasize the fact 
 
14 HOME NURSING 
 
 that it is wholly unsuitable for an invalid's use. It 
 is quite impossible to take proper care of a patient 
 unless this is discarded. It retains the heat of the 
 body, and if it becomes damp is an offence, if not 
 a positive menace. It is also very difficult to 
 lift a person from side to side as he lies in the 
 hollow. 
 
 The hair mattress is, of course, the most satis- 
 factory bed, yet some patients complain of the tuft- 
 ings, and it must be admitted that if the strings give 
 way the hair may move and cause irregularities in 
 the surface of the bed. The mattress manufactured 
 Mattress by the American Interlaced Curled Hair Company 
 tuftings of Philadelphia, Pa., is especially sanitary, and as the 
 hair is in sheets it requires no tufting and is easily 
 kept in order. The ticking can be slipped off and 
 washed, and as the interior itself is very porous it is 
 cooler and can be more easily cleansed and fumigated 
 than any other mattress more compactly made. In 
 The value cases of long illness a second bed is of great value, 
 beds and by bringing both beds close together the patient 
 
 can be drawn on a blanket or stout sheet from one 
 mattress to the other and the mattress thoroughly 
 aired on a balcony or in another room every day. 
 A mattress turned once a day does not readily get 
 out of shape, but in case it begins to sag, a light 
 shawl or blanket folded not too thick can be placed 
 under the centre to keep it level. 'Mattresses should 
 Care occasionally be wiped over with a cloth wet in some 
 
 mattress antiseptic solution and put out of doors to dry. A 
 whisk-broom may be used instead of the cloth if pre- 
 ferred and the mattress thoroughly sprinkled with 
 the solution. 
 
EQUIPMENT OF THE NURSE 15 
 
 PREPARATION OF A SICK-BED 
 
 To prepare a sick-bed, place first a stout pad to 
 cover the centre of the mattress, and over this, drawn Th f P a f 
 
 ' and under 
 
 tightly and evenly, the bottom sheet, which should be sheet 
 neatly tucked in at the corners. Next should always 
 come a protector of some sort large enough to ex- 
 tend from the edge of the pillow to within two feet 
 of the bottom of the bed. This protector may be of 
 black or white rubber, enamel cloth (which, however, 
 cracks easily), or sheets of tar paper folded' between 
 newspapers, if rubber is not obtainable or if the 
 patient has serious objection to its use on account of 
 its heat. In cases where there is no immediate cause _ 
 
 The pro- 
 
 for the rubber sheet it may be placed next to the tector and 
 mattress, and thus serve to protect it in case of any 
 accident occurring. 
 
 The rubber sheet is to be covered by what is 
 known in hospital phraseology as the "draw-sheet," 
 an ordinary-sized sheet folded with two hems to- 
 gether, though, if desired, a single piece of cotton 
 of the width of the doubled sheet would answer the 
 purpose quite well and be somewhat more easily 
 laundered. This is put on so that the hemmed edges 
 come at the bottom and the other edge high enough 
 under the pillow to prevent the possibility of a rest- 
 less patient getting the elbow under it. It should be 
 tucked in at one edge evenly and then drawn as tight Care 
 as possible from the other side, pulling always at the draw sheet 
 centre first, and, after tucking that in, making smooth 
 the rest of the side. In tucking in the draw-sheet 
 with a patient in bed, this method of procedure is 
 essential if the sheet is to be made tight. The patient, 
 if able, should lift the hips slightly while the sheet 
 is being tightened. 
 
16 HOME NURSING 
 
 A draw-sheet properly put on ought to add much 
 to a patient's comfort, as it ensures a smooth, firm 
 surface underneath the back and it can be changed 
 so easily that the patient need have no sense of 
 fatigue while it is being done. 
 
 The covering for the bed ought always to be light, 
 Blankets but sufficiently warm, and the top sheet should fold 
 than quilts over the edge of the blankets to keep them from 
 becoming soiled. Blankets, or even lightweight 
 shawls, if one is reduced to an extremity, are far 
 better than bedquilts of any sort, and two light 
 blankets are warmer than one very heavy one, be- 
 cause of the layer of air between them which acts 
 as an additional covering. The coverlet, if heavy, 
 may be replaced by a sheet, though dimity is being 
 sold now in place of the Marseilles or other heavier 
 materials. At night it should be removed and folded 
 neatly to keep it fresh for day use. In tucking 
 in the clothes at the bottom of the bed, they ought 
 not to be drawn tightly over a patient's toes, a fact 
 which some nurses, overzealous for appearance, are 
 apt to forget. In some cases where there is extreme 
 Comfort nervousness or where the feet are particularly sensi- 
 first P : at a p nt tive to any irritation, it is better not to have the 
 pearance c i thes tucked in at all at the bottom. The comfort 
 
 second 
 
 of the patient should never be sacrificed in order to 
 gain a better appearance of the bed. 
 
 DAILY CARE OF ROOM 
 
 The daily care of the sick-room is most im- 
 portant. The room should at all times present a tidy 
 and restful appearance. If the weather is cold a 
 light shawl may be thrown over the -patient's head 
 and extra covering provided so that the apartment 
 
EQUIPMENT OF THE NURSE 17 
 
 may be thoroughly aired. This should be done both 
 night and morning for a few minutes, and in cases Frequent 
 where the air becomes offensive it should be done 
 several times during the day. 
 
 If there is a carpet on the floor the surface dust 
 can be removed by going over it lightly with a damp To clean 
 cloth wound round a broom. No thorough sweeping ^ c * t r c 
 should be attempted with the patient in the room. 
 A damp dust-cloth is also to be used for the furni- 
 ture, so that as little dust is stirred up as possible. 
 Soiled dishes and remnants of food should never be 
 allowed to stand in the room, but should be removed 
 at once after the patient has eaten. Frequently he 
 will insist that it does not matter, or will even object ness tX atid 
 to tidiness, but there is an unconscious feeling of rest orderliness 
 that is engendered through orderliness of which he is 
 himself quite unaware, and this should not be denied 
 him. A little tact or playful insistence will usually 
 remedy any objection on his part. The same thing 
 is true in regard to the serving of meals to a con- 
 valescent or to some member of the family who is 
 temporarily kept in bed and who thinks to save work 
 by urging that he does not care how things are 
 served. He may be quite honest in his feeling, and 
 yet find that the dainty service tempts his appetite so 
 that he is able to eat a far better meal than otherwise. 
 
 The necessary medicines, mouth-wash, pitcher of 
 water, and all the paraphernalia of the sick may 
 stand on a small table or shelf, placed if possible out 
 of sight of the patient, as it is pleasanter to have all 
 the reminders of sickness removed. A clean towel 
 on the table looks more suitable than an elaborate 
 table-cover, and a fresh sheet of white wrapping- 
 paper laid over that saves laundry and may be 
 changed every day or two as necessary. 
 
18 HOME NURSING 
 
 If the patient is able to be moved into another 
 
 In case room there should be a weekly cleaning of the sick- 
 
 cieaning y room, with thorough sweeping, cleaning of brasses, 
 
 beating of mattress and airing of blankets, since 
 
 fresh air has germ-destroying powers that may be 
 
 utilized by every one. 
 
 Large and small squares of cloth are needed for 
 Of the various purposes about the sick-room, and can easily 
 squared be. made and kept on hand for use when required, 
 of cloth There should be several bed-pan covers, made of 
 heavy cloth or doubled thicknesses of old sheeting, 
 furnished with loops to hang by, and separate smaller 
 cloths for wiping the bed-pan and the wash-bowl. It 
 is convenient to have these latter of different size or 
 of figured cotton, so that they can be readily dis- 
 tinguished from each other. Pieces of old sheets or 
 toweling can be cut into convenient sizes and hemmed 
 to slip under the bed-pan when it is used, and a 
 quantity of small pieces of old cotton torn into squares 
 of about six inches will be found useful for the 
 necessary bathing after the bed-pan has been used. 
 Absorbent cotton can of course be used for the same 
 purpose, but is more expensive. 
 
 GARE OF UTENSILS 
 
 The care of the utensils in use about the sick- 
 room must not be overlooked. The utmost cleanli- 
 ness is necessary in regard to them. Bed-pans and 
 urinals should be rinsed each time after their use with 
 cold water, and then washed with scalding water 
 and soap and dried with a cloth kept for the purpose. 
 A weekly scouring with sapolio is necessary if the 
 use of the pan continues many weeks. Sputum mugs 
 should be boiled every day for twenty minutes, and a 
 small pan kept expressly for this use. 
 
EQUIPMENT OF THE NURSE 
 
 19 
 
 In preparing a mug for a tuberculosis or pneu- 
 monia case one should be selected which is smoothlv Special 
 
 11* T£. Care * °* 
 
 glazed so that no germs may lodge in any crack. If sputum 
 this is neatly lined with toilet-paper, letting the paper mug 
 entirely cover the edge and fold down over the out- 
 
 Glass Sputum Mug with Metal Cover 
 
 side of the cup, the lining can be very easily lifted 
 out and burned and a fresh lining made. It is best 
 to have two mugs, so that one may be in use while 
 the other is being sterilized. A very useful cover can 
 be made by cutting out a piece of cardboard the size 
 
 Metal Frame 
 
 Paper Filler 
 
 of the cup and putting a large safety-pin through the 
 centre for a handle. 
 
 Excellent appliances for the use of tuberculosis 
 patients are made, consisting of a papier-mache form 
 which is inserted in a covered metal holder. 
 
20 HOME NURSING 
 
 In nursing cases of cancer, tuberculosis, typhoid 
 Keep the fever or contagious diseases, care must be taken to 
 dishes keep all dishes, knives, forks, and spoons used in the 
 
 SCD3.r3.tG 
 
 sick-room separate from those in general use. It is 
 better to keep the sick-room dishes upstairs, and to 
 have a small dishpan in some convenient place for 
 
 Invalid's Drinking Cup 
 
 washing them, so that they need not be sent to the 
 kitchen, as errors are apt to occur and the dishes get 
 mixed. They are best disinfected after they are no 
 longer needed by boiling them for half an hour. 
 There are a few things which, if conveniently ar- 
 
 Littie con- ranged, can save many steps on the part of the nurse. 
 
 foi m sav- es If a patient is on fluid diet, or it is necessary to heat 
 water continually, it is always possible to have a 
 
 vemences 
 for sav- 
 ing steps 
 
 Woven Wire Mat 
 
 saucepan and some device for heating liquids which 
 may be kept in an adjacent room or in the halL Also 
 a dishcloth and towel can be kept at hand so that the 
 glass and saucepan may be washed as soon as used. 
 A very simple arrangement for heating, if gas can be 
 used, is by means of a woven wire mat which can 
 
EQUIPMENT OF THE NURSE 
 
 21 
 
 be bought for a few cents, and is intended to rest on 
 the gas globe. This will hold quite a good-sized pan 
 and heat its contents very quickly. 
 
 
 A Nursery Ice-Chest 
 
 A nursery ice-chest, which is a tin box with two 
 or more compartments, is an ideal thing to hold the^st 6 
 milk and foods that are being used constantly. A 
 
 Water Cooler 
 
 very good substitute can be planned for use in cool 
 weather by having fastened outside the window a 
 large uncovered soap-box, with the open side facing 
 
22 HOME NURSING 
 
 the room. This can be protected by a piece of white 
 enamel cloth tacked on to form a curtain over the 
 front, and the whole thing can be kept sweet with 
 soap and water. 
 
 Food must never be allowed to stand in the ice- 
 Milk and box till it becomes old, and milk and butter should 
 
 butter . 
 
 should nave a separate compartment if possible, as their 
 ciai care flavor is very easily affected by strong-smelling foods. 
 The ice-box should be looked over every day, and 
 the shelves wiped with a damp cloth. Once a week 
 there should be a thorough cleaning with washing 
 soda and warm suds followed by careful drying in 
 the sun if possible. 
 
II 
 
 GENERAL CARE OF BED PATIENTS 
 
 Structure and Function of Skin— The Cold Bath— Frequency of Bathing in 
 Sickness— The Bed-Bath— The Foot-Bath— Care of the Hair— Care of 
 the Mouth— Changing Sheets for Bed Patients— Changing Night-Dress— 
 Prevention of Bed-Sores— Lifting and Moving Patients— Mechanical 
 Appliances 
 
 THE comfort of a sick person, whether he realizes 
 it or not, depends upon clean surroundings, a 
 clean body and the ease with which his wants are 
 attended to. This ease is one of the gifts which ex- 
 perience, particularly trained experience, gives. It 
 means that the added burden sickness has brought is The gain 
 
 •111-1 from absc- 
 
 not made apparent to the patient, that the little wants lute rest 
 
 of mind 
 
 are met before they are realized, and that the re- and body 
 sponsibility of medicines and nourishment is given 
 over by him with a sense of relief; in short, that 
 freedom from care and anxiety is made possible, and 
 with it that absolute rest of body and mind which 
 adds greatly to the chances of a speedy recovery. 
 
 The subject of bathing and its importance, both 
 in health and in sickness, is so familiar to the students 
 of hygiene and lovers of good health, that we are apt 
 to forget the great number of people who have little 
 sympathy with what they consider the fads of 
 would-be reformers. The ignorance of this great 
 number about the necessary function of the skin and 
 its delicate structure makes their proper care of the 
 body very dull and perfunctory work, if indeed they 
 do not actually neglect it. 
 
 (23) 
 
24 
 
 HOME NURSING 
 
 a micro 
 scope 
 
 STRUCTURE AND FUNCTION OF THE SKIN 
 
 The skin is in two layers. The upper or scarf 
 skin is what is raised as a blister when one is burned, 
 
 Scarf skin and this is constantly rubbing off in minute scales. 
 We are generally unconscious of this, though we can 
 easily recognize it in the dandruff and in the dried 
 skin that we find on an arm or leg that is left for 
 weeks in a bandage or splint. Although this scarf- 
 skin is constantly being shed, it is as constantly being 
 renewed from the second layer, called the true skin. 
 This upper skin is not sensitive at all, while the under 
 layer is supplied with blood-vessels and nerves. 
 
 The two Under the microscope we see that these two layers 
 
 layers or * J 
 
 skin under f s ki n are composed of a multiplication of tiny bodies 
 which are called cells, the upper ones being very flat 
 and horny, while the lower ones are larger and ir- 
 regular in outline. As the lower cells grow, they push 
 up toward the top and become flattened, so that as 
 scarf-skin they are the tiny scales we can see. This 
 is going on constantly all over the body, whether or 
 not we can detect it, and the principle is just the 
 same as that which makes the swelling buds push ofT 
 the old year's leaves. 
 
 Another substance that is present on the skin at 
 all times is perspiration, which is constantly being 
 poured out from small glands found in the true skin. 
 At an ordinary temperature, when we are in health, 
 the amount of perspiration is insensible, but as we all 
 know in certain diseases, or when the temperature is 
 raised from any other cause, it is poured out in large 
 quantities. 
 
 The sweat is not wholly water. In health it con- 
 tains some salt, and in diseases of the kidneys, when 
 they do not perform their proper amount of work, it 
 
 The per- 
 spiration 
 
CARE OF BED PATIENTS 25 
 
 also holds some of the waste matter of the bodv, What it 
 
 contains 
 
 which would otherwise be carried off in the urine. and accom 
 
 phshes 
 
 Sometimes in sickness a person can not be made 
 to perspire sufficiently, and when by means of medi- 
 cine and treatment we find the skin growing moist 
 we regard it as a sign of returning health. By this 
 we see that the elimination of water from the body 
 through the pores of the skin is a very necessary 
 process as a means of regulating the heat of the body, 
 and that anything that interferes with the free action 
 of these glands must be guarded against. 
 
 The third substance that we find excreted on the 
 skin is a sort of oil which is also contained in little Th ? lub r,i- 
 
 cating oil 
 
 glands. This serves to keep the skin soft and flexible, 
 particularly to lubricate the hair and to keep it smooth 
 and glossy and also to protect the body from mois- 
 'ture, exactly as the oil enables the birds' feathers to 
 shed water. The openings from these glands are 
 larger in some parts of the body than in others. For 
 instance, we find them very large and apparent about 
 the nose, and when they become clogged with the 
 secretions they are still more enlarged and form what 
 we know as pimples. 
 
 There also escapes from the skin some gases like 
 what we exhale from the lungs, and it is capable, too, The skin's 
 of absorbing small quantities of substances that may and ab- 
 be rubbed upon it. It is for this reason that patients, powers 
 particularly babies that are losing flesh, are rubbed with 
 oil or milk, though this is not considered as important 
 a function as it once was. 
 
 To sum up then, we should say that the skin is 
 protective — that it is a helper to the kidneys in getting what the 
 rid of the waste of the bodv in the perspiration and in P r °- 
 
 1 l tection 
 
 to the lungs in getting rid of some of the carbonic 
 
 acid gas ; that it absorbs to a limited extent substances 
 2 Vol. 3 
 
26 HOME NURSING 
 
 rubbed over the outside layer and very rapidly absorbs 
 those injected beneath the upper, or scarf, skin; and 
 that, finally, through the sweat glands, it is a power- 
 ful regulator of the heat of the body. 
 
 It is easy to feel the significance. of the bath as 
 Conse- regards health and comfort in the face of these facts 
 
 quent 
 
 values of relating to the structure and function of the skin. All 
 
 the bath & 
 
 these glands are essential to our well-being. If they 
 are clogged in any way we feel the results. On ac- 
 count of the oil that is present the warm bath at least 
 once a week is advisable. Plenty of soap, warm water, 
 and a thorough drying afterward, taken at night, clears 
 up the skin, relaxes the muscles, and makes the chances 
 for restful sleep more sure. 
 
 But it is the value of the daily cold sponge that 
 we need to emphasize. 
 
 THE COLD BATH OR SPONGE 
 
 In our changing climate we are very liable to colds. 
 
 ?on y e Cold ^ we on *y realized what a safeguard the splashing 
 cold sponge is there would be more willingness to over- 
 come the first unpleasantness of the use of cold water 
 in the winter. 
 
 The first effect of the cold bath is to drive the 
 blood from the surface, to reduce the temperature of 
 the body and to retard the action of the heart. A 
 
 its effects natura l reaction should take place under normal con- 
 ditions, and the blood be sent to the surface of the 
 body with a general quickening and stimulation of the 
 circulatory and respiratory centres. If this reaction 
 does not occur and if a feeling of pleasant, tingling 
 warmth does not follow, the cold bath is not bene- 
 ficial. 
 
 If one accustoms the chest to the splash of cold 
 
CARE OF BED PATIENTS 27 
 
 water followed by a vigorous rub which leaves the 
 surface red and glowing, the resistance to cold is 
 greatly increased. 
 
 Another advantage in the daily bath is the fact 
 that the body is exposed to the air at least once a dav. Value of 
 
 J k ■* air on 
 
 We keep our bodies so securely wrapped from the the skin 
 air that draughts are dangerous and the ordinary 
 change of passing from warm rooms to cool out-of- 
 doors brings on colds. 
 
 If for any reason the daily bath is impossible, a D bath 
 brisk rub with a coarse towel or brush fulfils to a 
 certain extent the same purpose. 
 
 These facts which we emphasize as so important 
 in health one can easily see are vastly more potent in 
 sickness, for at such times the excretions of the skin 
 arise from a diseased body. 
 
 In most cases a daily warm sponge bath is of posi- 
 tive benefit to a patient, though if there is extreme Daily 
 
 - 1 ^ warm 
 
 weakness the entire surface of the bodv should not be sponge 
 
 benefits 
 
 bathed at one time, and it may sometimes be better the patient 
 to substitute for the soap and water bath an alcohol 
 sponge, wiping off the surface of the body and re- 
 freshing the patient without fatiguing him. 
 
 FREQUENCY OF BATHING IN SICKNESS 
 
 In ordinary cases of sickness, then, we may say 
 that a daily bath is called for and very rarelv is there Guard 
 
 1 r • • i • • • r r against 
 
 any danger of injury to the patient arising from it if cfiiii and 
 proper care is taken not to chill or to fatigue him. 
 The windows should always be closed, and the room 
 made sufficiently warm before beginning. 
 
 Baths given in sickness are varied in kind and pur- 
 pose, but it is seldom that anything other than the 
 cleansing bath or alcohol sponge would be called for 
 
28 HOME NURSING 
 
 in the home without the aid of a nurse especially 
 trained to administer it. 
 
 THE BED-BATH 
 
 Before beginning a bed-bath everything required 
 Have for use must be at hand — a basin, soap, hot and cold 
 
 everything * x 
 
 at hand water, slop- jar, face-cloths, towels, and clean linen — 
 as it is annoying to a patient to be left in the midst 
 of his bath while the nurse goes after some forgotten 
 article, and it is evidence of poor management if this 
 occurs. 
 
 The patient is now to be placed between blankets, 
 Snt be- an< ^ ^ e bedding removed. A very convenient plan 
 blanket ^ two blankets are not available, and it is often 
 and towei s j m pi er j n anv case, is to substitute for the under 
 blanket a large Turkish towel which can be slipped 
 under the different parts of the body as they are being 
 bathed and thus protect the bed 'as a blanket would 
 do. After a towel has become thoroughly damp it 
 should be replaced by a fresh one. A sponge or 
 flannel wash-cloth will retain the heat better than 
 cotton. Only a small part of the body should be ex- 
 posed at a time and that thoroughly washed and dried 
 before going on. The water should be kept comfort- 
 ably warm, and changed once during the bath. All 
 fresh linen must be well aired and warmed before 
 putting on the patient and careful attention given to 
 the hair, mouth, and nails. 
 
 THE FOOT-BATH 
 
 A foot-bath in bed can be easily managed, and is 
 
 The proc- sure to be refreshing to the patient, who lies on his 
 
 foot-baVJf back with knees flexed and the top covers turned 
 
 back over his body. The lower part of the mattress is 
 
 then covered by a folded blanket, over which is laid a 
 
CARE OF BED PATIENTS 29 
 
 towel. The foot-tub is placed on this, the feet gently 
 lowered into the water, and the top blanket drawn 
 back over the tub. After removing the bath the feet 
 rest on the towel and must be left thoroughly dry and 
 warm. 
 
 THE CARE OF THE HAIR 
 
 The combing of the hair is a detail of the toilet 
 which most patients dread, yet this is quite unneces- 
 sary if it is properly done. If arranged in two braids 
 it is both comfortable and easily cared for, even if a Hair best 
 person is very ill or can not lie easily on her side, and two braids 
 it should never be allowed to become snarled or mat- 
 ted. If it is braided closely once, or in case of unusual 
 restlessness twice, a day, there will be no difficulty 
 in keeping it free from snarls. It is surprising to find 
 how many people do not realize the need of this daily 
 care of a patient's hair, and having once neglected it 
 during the critical part of an illness find it so matted 
 that they are helpless, and perhaps have it cut when 
 there is really no need. 
 
 If the hair becomes matted it needs only to be 
 wet with alcohol and left a few moments to dry, when Treatment 
 the tangles can then be picked out lightly with the hair is 
 
 r -r i «- • r • ^t m atted 
 
 fingers if one has a sufficient amount of patience. No 
 hair need ever be sacrificed if this method is remem- 
 bered, though it may take many hours of labor at 
 different intervals to remove all the snarls. In comb- 
 ing, begin always at the ends of the hair, holding it 
 firmly, but without exerting any tension on the scalp. 
 If the hair has been wet with blood, as in the case of 
 a scalp wound, the clots can be removed by the use 
 of a solution of soda. 
 
 A shampoo may be managed easily in the convales- 
 cent days by placing the patient across the bed so that 
 
30 HOME NURSING 
 
 the head pillow lies along the side. The pillow should 
 Shampoo be protected by a rubber sheet and the hair washed 
 
 for the . r , J 
 
 convaies- m a basin placed on a low table or chair by the bed. 
 A little alcohol rubbed afterward in the scalp will 
 help to dry it quickly and prevent the patient from 
 taking cold. If a cot bed is used it will not be neces- 
 sary to change the patient's position, as the same thing 
 can be done at the head of the cot. 
 
 Sometimes one is confronted with the unfortunate 
 in case problem of the best way of removing lice from the 
 accident, hair. The routine practice recommended in the large 
 
 of vermin * . ° 
 
 schools of New York, where there is constant inspec- 
 tion of the heads, is to wash the hair and scalp thor- 
 oughly with kerosene and leave the head bound up 
 in a towel overnight. The kerosene, though un- 
 pleasant to use, has a good effect upon the hair and 
 scalp. In the morning hot vinegar is applied to de- 
 stroy the nits. This can be poured upon the hair, but 
 since its effects are not specially beneficial it is better 
 to dip a fine-tooth comb into the vinegar and to thor- 
 oughly moisten the hair while it is being combed. The 
 vinegar softens the gelatinous substance which at- 
 taches the nits to the hair, so that tihey come off easily. 
 
 Another treatment that is invariably effective is a 
 thorough wetting of the scalp and hair with tincture 
 of larkspur, which is left overnight in the same way. 
 Iti is not necessary to follow this treatment with the 
 vinegar. A second application may be demanded if it 
 is found that the first has not been successful in de- 
 stroying the nits. 
 
 If children are in a public school where this 
 And con- trouble is common it is much wiser not to keep the 
 
 tammation 
 
 at school hair very long, and absolute vigilance is necessary m 
 order to make sure that the heads are perfectly free 
 from vermin, as, once started, the nits appear very 
 
CARE OF BED PATIENTS 31 
 
 rapidly. A neglected head means that eventually an 
 eczematous eruption appears, which is due directly to 
 the presence of the vermin. 
 
 THE CARE OF THE MOUTH 
 
 The care of the mouth during sickness must not 
 be overlooked. If the patient is not too ill, the teeth Cleaning 
 
 r m m , with brush 
 
 should be brushed night and morning, but if that is or cotton 
 impossible small squares of muslin or bits of absorbent 
 cotton wet in a boracic acid or listerine solution may 
 be used to wipe the tongue and gums. A mild solu- 
 tion of boracic acid (half a teaspoon to a glass), or a 
 few drops of tincture of myrrh in a glass of water, 
 makes a good mouth-wash, and if a patient is on milk 
 diet, it is necessary to wipe out the mouth frequently 
 in order to keep it sweet and clean. 
 
 In cases of pneumonia or typhoid fever, where the 
 mouth and teeth accumulate an offensive and tenacious The sordes 
 
 ... °f pneu- 
 
 substance known as sordes, it is necessary to use a monda and 
 mouth-wash which will help to cut this substance and 
 make it more easy of removal. Equal parts of lemon- 
 juice, glycerine, peroxide of hydrogen, and water used 
 freely both night and day will keep the mouth in as 
 good condition as is possible. 
 
 In such cases, as will be seen later on, the fingers 
 should not be introduced into the mouth unless a rub- 
 ber cot has first been put on, because of the danger of 
 infection, and if a cot is used it should be kept in a 
 solution of boracic acid or other harmless antiseptic. 
 Swabs made of cotton wound round a toothpick can 
 be used instead, and burned at once. 
 
 CHANGING SHEETS FOR BED PATIENTS 
 
 To change the sheets with a patient in bed, it is 
 necessary first to fold the fresh draw-sheet and lay it 
 
32 HOME NURSING 
 
 in large plaits ready to slip under the patient. He is 
 turned on the side most easy for him, the bedding 
 loosened, and all covering but the top sheet and a 
 light blanket removed. 
 
 The under sheets in succession, including the rub- 
 The under- ber, are then rolled as near as possible to the patient's 
 ber sheet, back, while the clean under sheet which has been 
 
 and draw- 7 
 
 sheet tucked in firmly at top and bottom follows closely the 
 
 soiled one. The rubber sheet is now unfolded and put 
 back over the fresh under sheet, and the draw-sheet 
 laid over it and tucked securely in at one end, the 
 other folded portion being drawn closely to the 
 patient. If this has been done carefully the roll of 
 soiled and fresh sheets can be easily flattened, the 
 patient gently rolled over it, and the other side of 
 the bed made. 
 
 To change the top sheet, first lay the fresh one over 
 To change the soiled, and while the top one is being held by the 
 sheet patient, if he is able, draw the other from under it so 
 that there may be no exposure of the body. 
 
 CHANGING THE NIGHT-DRESS 
 
 The changing of a night-dress on a helpless patient 
 To change, seems a very wonderful thing to those who for the 
 gown is first time are watching it done by skilled hands, yet 
 
 simple .. „ ' . ° i • , , . * 
 
 it is a very simple matter, and requires only a little 
 practice to accomplish without fatigue to the patient. 
 The fresh night-dress, arranged to slip easily over the 
 head, is first placed on the patient's chest. The soiled 
 one is then gradually drawn up from under the back 
 until it is well past the shoulders, when the sleeves 
 can be easily slipped off, the head gently lifted, and 
 the soiled night-dress exchanged for the fresh one. 
 The nurse should slip her own hand through the fresh 
 
CARE OF BED PATIENTS 33 
 
 sleeves at the wrist and, gently grasping the patient's 
 arm, draw it through so that no effort on his part is 
 necessary, and finally the rest of the night-dress must 
 be pulled smoothly into place. The use of a short 
 night-dress open in the back is sometimes of great Value of 
 value with very ill patients, especially if frequent night- 
 sponging is required, since it can so readily be slipped 
 off. Any plain nightgown can be utilized for this 
 purpose with very little trouble. 
 
 In removing a nightgown or other garment from 
 a person having a disabled arm, it is necessary to take 
 off the sleeve from the well arm first, in order to give 
 plenty of room for the other, and in putting on a gar- 
 ment the process is reversed for the same reason. 
 
 THE PREVENTION OF BED-SORES 
 
 In cases of wasting disease or with aged or para- 
 lyzed patients, there is a tendency to the formation of ^^event 
 bed-sores, and unless one has had some experience bed - sores 
 it is hard to realize in how short a time such a sore 
 can make its appearance nor what extreme vigilance 
 is necessary in order to prevent it. 
 
 A bed-sore is really a part of the tissue of the 
 body which is cut off through pressure from the circu- 
 lation of the blood and which therefore becomes dead 
 tissue. It is caused, as stated, by unrelieved pressure 
 accompanied usually by heat and moisture, and those 
 parts of the body where the bones are nearest the sur- 
 face are naturally the places to be specially guarded. 
 The hip-bones and base of the spine, the elbows, shoul- Where 
 der-blades, heels, and even the tips of the ears should appear 
 be closely watched for the slightest indication of red- 
 ness or pricking sensation, which gives the first warn- 
 ing of danger. If possible the position should be 
 
34 HOME NURSING 
 
 changed from time to time, or if there is any reason 
 
 why that can not be done some measures must be taken 
 
 The Hng to relieve pressure. A rubber ring- is useful for the 
 
 and horse- A ° 
 
 shoe spine or hips if it is not blown up enough to make it 
 
 hard. A very slight amount of air in the ring will be 
 
 A Rubber Ring 
 
 sufficient to lift the pressure and will prevent its being 
 uncomfortable. The "horseshoe" air cushion, though 
 more expensive than the ordinary round rubber ring, 
 is very much more comfortable and more sanitary on 
 
 Horseshoe Air-cushion 
 
 account of its construction. Small soft rings made of 
 cotton and wound with a bandage are very useful for 
 lifting an elbow or heel, and can be renewed as they 
 become soiled or out of shape. 
 
 Besides the relief from pressure there must be an 
 effort to increase the blood supply in the part in order 
 
CARE OF BED PATIENTS 35 
 
 to build up new tissue. As in the case of the sick 
 bodv as a whole we aim first at cleanliness, so here Alcohol 
 
 1 1 1 • 1 1 c ana - ? entle 
 
 we do the same and bathe with soap and water, follow- friction, 
 ing this by the application of pure alcohol and gentle 
 friction with the ball of the thumb, working always • 
 
 toward the centre. The alcohol helps to harden the 
 tender skin and the massage forces the blood through 
 the surrounding tissue. Another measure for estab- 
 lishing better circulation is the use of hot douching pouch- 
 of the part, followed by cold. Care must be observed powder 
 that the water is not hot enough to scald the tissues. 
 This should be kept up for at least ten minutes night 
 and morning. A little zinc oxide powder may be used 
 to dust the surface and assist in absorbing moisture. 
 Powders as a rule are better omitted, as they are apt 
 to cake and form hard particles which do more harm 
 than good to the tender flesh. 
 
 It is necessary that the bed should be kept abso- 
 lutely dry and smooth. Crumbs must be brushed out How the 
 and the wrinkles smoothed frequently. It is some- of the 
 
 bed helps 
 
 times difficult to accomplish this, especially in the case 
 of a paralytic or aged person when there is inconti- 
 nence of urine to fight against. However, by the use 
 of a sufficient number of thick pads about fifteen 
 inches square, made of absorbent cotton covered with 
 gauze or cheesecloth, it is possible to keep the bed 
 dry, and the patient need never be left to lie on wet 
 sheets. It is quite possible that the patient will object 
 to such frequent disturbance as the changing of the 
 pads requires, for at night also there will need to be 
 several changes, but no objection on the part of the 
 patient can outweigh the importance of this task, and 
 a little tact and sweet temper, which we remember is 
 always at the nurse's command, will usually pacify 
 the unhappy one. 
 
36 HOME NURSING 
 
 There should always be special bathing with warm 
 Of need water after urination. This is essential not only in 
 quent order that the patient may be kept quite clean and free 
 from unpleasant odors, but because when a bed-pan 
 • is being used the urine runs back between the but- 
 
 tocks and is sufficiently irritating if left to dry to cause 
 chafing and sometimes even a slight fissure. 
 
 If once the skin becomes abrased the alcohol can 
 £? sk?n of course be used only round the edges of the bed- 
 abrasion SO re, which we must then regard as an open wound 
 and treat accordingly. The advice of a doctor should 
 be sought in such cases. It is always necessary to 
 apply a dressing at once and small thin pads of ab- 
 sorbent cotton covered with gauze or clean linen and 
 fastened in place with strips of adhesive plaster will 
 protect the sore from infection. 
 
 LIFTING AND MOVING PATIENTS 
 
 The expert lifting and moving of patients requires 
 much practice, but a few hints may be useful in pre- 
 venting the awkwardness one feels who has never 
 taken care of sick people. 
 
 In moving a patient from one side of the bed to 
 Do not the other it is not necessary either to drag or pull him 
 puii the over. One arm should be placed obliquely under the 
 shoulders with the hand supporting the back, while 
 the other is carried over and under the other shoulder. 
 In this way half of the body can be lifted on to the 
 fresh side. Then with one hand and arm under the 
 lower part of the back and the other below the hips, 
 the rest of the body can be drawn into place very 
 gently. If the patient is able, he can assist by clasp- 
 ing the hands around the nurse's neck. 
 
 In raising a patient in order to readjust pillows, 
 
CARE OF BED PATIENTS 37 
 
 support is given in the same way with the head resting in chang- 
 
 110 J ^ mg pillows 
 
 on the nurse's shoulder, while her free hand changes 
 the pillows. 
 
 To lift toward the head of the bed, the hand and 
 arm are placed under the back as indicated above, and > v . hen two 
 
 r join in 
 
 the other hand under the hips, and the patient lifted lifting 
 gently and steadily. If two people join in lifting, one 
 on each side, in this way even a very heavy person can 
 be easily moved. 
 
 To change a mattress with the patient in bed 
 assistance is necessary. One person draws the mat- Method 
 
 .of chang- 
 
 tress with the patient on it half way off the bed while ing the 
 
 mattress 
 
 the other mattress is slipped into place. The patient 
 is drawn across by means of the sheet on to the fresh 
 mattress, which can then be slipped the rest of the 
 way on to the bed. 
 
 If a patient is to be lifted on to a couch or easy- 
 chair, it must be placed with the head toward the foot 
 of the bed and near enough so that the persons lifting 
 need take only a few steps. They should stand both 
 on the same side of the bed and carrv hands and J.° change 
 
 the patient 
 
 arms well under the shoulders and buttocks of the* 0300 " 011 , 
 patient, and then by simply wheeling about the couch 
 can be reached. 
 
 MECHANICAL APPLIANCES 
 
 For a patient who is to sit up in bed the bed-rest 
 is a very useful article, and the best kind is that hav- 
 ing a simple wooden frame with canvas support. This Th e bed- 
 can be put at various angles as desired, and with a 
 hair pillow at the bottom to give firm support to the 
 lower part of the back, and a small pillow for the head, 
 the patient can be made comfo'rtable. It is best for 
 him to have either a pillow under the knees or one to 
 brace the feet against, so there need be no feeling 
 
38 
 
 HOME NURSING 
 
 of effort to keep from slipping toward the foot of the 
 bed. 
 
 The knee-pillow also gives great relief to a patient 
 
 The knee- suffering from any abdominal pain, as it supports the 
 
 legs in a flexed position and so relaxes the muscles of 
 
 Canvas and Wood Bed-Rest 
 
 the abdominal wall. The pillow should be a feather 
 one, medium-sized, and not too thick, and it is best 
 to have it covered with a rubber case under the linen 
 one. A pillow tucked close to the back when the pa- 
 tient is lying on one side or against the abdomen if 
 
 A Cradle to Lift the Clothes 
 
 there is pain there, when in the same position, relieves 
 the strain somewhat and is found grateful to him. 
 Small, soft pillows made of absorbent cotton, if noth- 
 ing better is at hand, are much appreciated by patients, 
 and can be tucked in various places to relieve pressure, 
 
CARE OF BED PATIENTS 89 
 
 as between the knees when lying on the side or to lift 
 an elbow or shoulder from the mattress. 
 
 In arranging pillows to take the place of a bed- 
 rest it is necessary to have four or five of good size, Substitute 
 
 ° - for the 
 
 and they should be piled with each additional one bed rest 
 placed behind the others in order to give the firmest 
 support. A very useful though not elegant substitute 
 
 The Iron Standard Bed Table 
 
 for a bed-rest is a straight-backed chair inverted so 
 that the back makes an inclined plane against which 
 pillows can be laid. A bandage or other stout piece 
 of cloth which is long enough if fastened securelv to An aid t0 
 
 » t> 'a patient 
 
 the foot of the bed serves as assistance to a patient 
 not able to raise himself easily, alone. 
 
 In some cases a frame known as a "cradle," 
 which can lift the bedclothes from a sensitive bodv 
 
40 
 
 HOME NURSING 
 
 A cradle 
 to lift the 
 clothes 
 
 or limb, is very much needed. These can be bought 
 cheaply, but a very satisfactory one can be made in a 
 short time by means of three or four split barrel- 
 hoops wound tightly with bandage and fastened at the 
 ends to two straight pieces of board about one and a 
 
 % 
 
 The Wooden Leaf Bed Table 
 
 half feet long. This placed in the bed over the affected 
 part affords relief and comfort. 
 
 There are two kinds of bed-tables. One has an 
 
 Bed tables iron standard which can be drawn close to the bed, 
 
 and a wooden leaf reaching over it which can be 
 
 fastened at any desirable height by means of a screw. 
 
 Trabaud Back Protector on Douche Pan 
 
 The other is a simple, light, and low table which can 
 be placed on the bed with the legs resting on either 
 side of the patient's body. A very good table can be 
 fashioned with a cutting-board and a few books placed 
 on either side of the patient to give it support. 
 
CARE OF BED PATIENTS 41 
 
 A great need has been met in the appliance known 
 as the "Trabaud Back Protector," which is a cushion Device to 
 
 remove 
 
 that can be attached to the douche or bed-pan, and pressure 
 
 1 from the 
 
 removes entirely the pressure upon the spine. It can s P ine 
 also be used as a pillow after it has been detached from 
 the pan if desired. 
 
Ill 
 
 ENEMATA, SUPPOSITORIES, AND DOUCHES 
 
 Administration— The Laxative Enema— The Purgative Enema— The Nutritive 
 Enema— The Starch Enema— The Turpentine Enema— Rectal Irrigation- 
 Suppositories— Douches— Gargles, Sprays, and Inhalations— Care of Utensils 
 
 Defini- 
 tion of 
 enemata 
 
 Laxative 
 Nutritive 
 Sedative 
 
 Astringent 
 Emollient 
 
 Anti- 
 spasmodic 
 
 Anthel- 
 mintic 
 
 Antiseptic 
 
 THE general term injection indicates the introduc- 
 tion of fluids into the body. When they are 
 carried into the intestines through the rectum we 
 speak of giving enemata, though the general term 
 injection is commonly made a specific one, and used 
 instead of enema. 
 
 There are many different kinds of enemata, as 
 there are various purposes in their use. The classi- 
 fication as given in Isabel Hampton's "Text-Book on 
 Nursing" is as follows : 
 
 Simple laxative and purgative enemata. 
 
 Nutritive enemata for the introduction of nourish- 
 ment. 
 
 Sedative enemata for local or systematic effects. 
 
 Astringent enemata, which check hemorrhages and 
 diarrhoea, e. g., hot water or ice water, solution of 
 alum or nitrate of silver. 
 
 Emollient enemata for soothing irritated and pain- 
 ful mucous membranes. Starch and certain drugs are 
 used in solution for this purpose. 
 
 Antispasmodic enemata, to relieve flatulence, in 
 which, for example, turpentine is used in solution. 
 
 Anthelmintic enemata for destroying worms: salt, 
 turpentine, and quassia are used in solution in this way. 
 
 Antiseptic or germicidal enemata, used in the vari- 
 ous forms of dysentery. 
 (42) 
 
ENEMATA 45 
 
 THE LAXATIVE ENEMA 
 
 The laxative enema may be better if the bowels are 
 particularly sluggish, and the use of olive or cotton- The meth- 
 seed oil or a little glycerine will usually be sufficient oil enema 
 to correct the difficulty. Six ounces of oil should be 
 warmed to blood heat by placing it in a vessel of hot 
 water and then very slowly injected by means of a 
 hard rubber syringe with a soft rubber tube attached 
 to the nozzle. It is important that the oil be given 
 with great deliberation, in order that it should be re- 
 tained easily. The warming of the oil is necessary for 
 the same reason, because oil injected cold will cause 
 pain and there will be an intense desire to reject it 
 at once. The use of the hard rubber syringe is better, 
 
 □ 
 
 Hard Rubber Syringe 
 
 because oil is injurious to the soft rubber and a bag 
 once used for oil enemata is soon destroyed. 
 
 The oil enema is best given at night and followed 
 by a soap-suds enema in the morning, though if for 
 any reason it seems more convenient, the oil may be 
 given in the morning and retained for an hour or two 
 previous to the soapy enema. 
 
 One should be somewhat cautious in the use of 
 glycerine, since its effect is to increase the peristaltic Care in 
 action of the bowels, and in some cases its irritating fnem" ne 
 properties are so great as to cause an inflammation of 
 the mucous membrane lining the intestines, producing 
 pain and diarrhcea. In such a case much relief can 
 be afforded by an irrigation of the bowel with normal 
 
46 HOME NURSING 
 
 salt solution, the use of which will be spoken of 
 later. 
 
 The glycerine enema is usually given in amounts 
 varying from half a teaspoon to half an ounce and 
 diluted with an equal quantity of warm water. It is 
 seldom necessary to follow a glycerine enema with a 
 soap-suds one, as with the use of oil. 
 
 THE PURGATIVE ENEMA 
 A purgative . enema is made with drugs,, such as 
 turpentine, castor oil, or Rochelle salts. In obstinate 
 cases of constipation, the enema may be given high up 
 in the bowel by the use of a soft rubber catheter or 
 • rectal tube attached to the end of the syringe and in- 
 serted six or eight inches. 
 
 The bowels should not be allowed to become ac- 
 
 Caution customed to the habitual use of the enema, as by so 
 
 tifeTnema doing the natural action is weakened. Various means 
 
 of overcoming the tendency to constipation will be 
 
 cited in a later chapter. 
 
 THE NUTRITIVE ENEMA 
 The nutritive enemata are resorted to when feeding 
 by the stomach needs to be suspended or supplement- 
 ed by additional nourishment to be administered per 
 rectum. Concentrated foods are employed and the 
 Concen- physician in charge of the case will usually wish to 
 suggest the formula for use. Two simple formulae are 
 as follows : 
 
 i. One whole egg, 
 Pinch of table salt, 
 Three ounces of peptonized milk, 
 Half an ounce of brandy. 
 Or, 2. The whites of two eggs, 
 
 Two ounces of peptonized milk. 
 
ENEMATA 47 
 
 Each one of these makes about four ounces, the 
 amount that should be given at one time. It should 
 not be given oftener than once in four hours or six 
 times in the twenty-four hours. The frequency, how- 
 ever, will be regulated by the physician, according to 
 the special requirements of the patient. 
 
 The absorptive power of the rectum is less than 
 that of anv other part of the intestines. This kind of Nutritive 
 
 J r enema 
 
 enema therefore should be given as high as possible, g^en^as 
 using the rectal tube or soft rubber catheter for the possible 
 purpose. 
 
 A simple enema should precede the first nutritive 
 one, in order to clear out the bowel, so that ready ab- 
 sorption of the nutritive substance can take place. If 
 there is a continued use of the nutritive enema, we 
 shall find that some part remains unabsorbed in the 
 bowel, causing irritation of the mucous membrane as 
 it decomposes. It is therefore necessary that the in- 
 testines should be flushed with warm water as often After care 
 as once in twelve hours in order to free the bowels of 
 the unabsorbed material. 
 
 Medication may be given rectally when it is likely 
 not to be retained if given by mouth. It should always 
 be given with the tube inserted at least six inches. 
 In case of hemorrhage from the bowels, hot water or 
 ice water injections may be ordered and should be 
 given with a fountain syringe hung rather low so 
 that the force of the stream of water will not be too 
 great. 
 
 THE STARCH ENEMA 
 
 In cases of dysentery or diarrhoea, a starch or gruel 
 enema is frequently useful. The starch should be How made 
 cooked as for laundry use and thinned till it can pass 
 easily through the syringe. It should be given slowly 
 and gently through a rectal tube. 
 
48 
 
 HOME NURSING 
 
 Guard 
 
 against 
 
 burning 
 
 THE TURPENTINE ENEMA 
 
 The turpentine enema may be given in cases of 
 distressing flatulence and frequently affords great re- 
 lief. Ten drops to a pint of water is the amount gen- 
 erally used, and it should be very thoroughly mixed 
 with the water, in order to guard against the possibil- 
 ity of burning. 
 
 RECTAL IRRIGATION 
 
 Rectal irrigation differs only from enemata in that 
 the water is not meant to be retained in the bowel, the 
 object being merely to wash out the irritating sub- 
 stances there which may be the occasion of a diar- 
 rhoea. The water is allowed to run slowly into the 
 
 Rectal Tube with Return Flow 
 
 The tube 
 for rectal 
 irrigation 
 
 bowel and may be expelled at once. It should be con- 
 tinued until the flow of water is clear, showing that 
 the bowels are freed from irritating matter. 
 
 A rectal tube with return flow is convenient for 
 giving an irrigation, since it obviates the necessity of 
 inserting the tube several times, though if done care- 
 fully this need cause little irritation. 
 
 A salt solution (one teaspoon of common salt to a 
 
SUPPOSITORIES 49 
 
 pint of warm water) is generally used for irrigation, 
 
 as it is at the same time somewhat stimulating. In The salt 
 
 r 1 i n -i 1 solution 
 
 cases of shock or collapse or with very weak patients, enema 
 the saline or salt solution enema is often ordered. In- 
 troduced in this way it is taken up quickly by the tis- 
 sues and increases the volume of the blood supply, 
 which has become depleted and thus renders the heart's 
 action more normal. 
 
 For the green stools so common in the case of 
 babies, rectal irrigation twice a day at first, and as the 
 stools improve once a day, together with careful feed- 
 ing, is often a means of entirely correcting the trouble. 
 
 SUPPOSITORIES 
 
 Suppositories are small solid cones of various sizes, 
 usually made of cacao butter and medicated. These are 
 largely used for introducing into the rectum to take the 
 place in a measure of enemata, and, though retaining 
 their shape under ordinary conditions, melt readily at 
 the heat of the body. 
 
 The suppository should be oiled with vaseline and 
 
 carried with the index ringer gently into the rectum, introduc- 
 
 The finger should be inserted its entire length, and if the sup- 
 • , -1 1 . r - p° sit » r y 
 
 the patient at the same time bears down as if to expel 
 
 it, a certain amount of suction is produced which car- 
 ries it further up into the bowel. By holding the finger, 
 after it has been removed, a moment over the opening 
 to the rectum till the bowel has become accustomed 
 to the foreign body, there will be less likelihood of its 
 being expelled. A suppository should act in fifteen 
 or twenty minutes, and meantime the patient should 
 remain quiet in the recumbent position. 
 
 Vol. 3 
 
50 HOME NURSING 
 
 DOUCHES 
 
 By the term douche is meant "a jet of fluid direct- 
 of e douches e< ^ with a certain amount of force upon a limited sur- 
 face external or internal." Those given internally are 
 the nasal, aural, and vaginal douches. 
 
 Douches may be either of plain water or medicated, 
 and are given for cleanliness, to reduce inflammation 
 and for the purpose of stimulation. 
 
 The vaginal douche of plain water given for clean- 
 doSe 1 Hness should be tepid, and a quart or a quart and a half 
 is a sufficient quantity. The hot douche, ordered to 
 check hemorrhage or to allay inflammation of the pel- 
 vic organs, is given in larger quantity — from two to 
 four quarts being the amount usually used — and at a 
 
 Douche Pan 
 
 temperature ranging from 112 F. to n8° F., according 
 as the patient can bear the heat. The prolonged appli- 
 cation of the hot water causes after the first expan- 
 sion of the blood-vessels a contraction which is more 
 or less lasting and by that means hemorrhage is 
 checked. 
 
 Any medication which is to be given in the douche 
 Position should be included in the last quart. It is necessary 
 patient that the patient should be in a recumbent position as a 
 douche is of very little effect if taken sitting. Further- 
 more it is always advisable that she remain lying down 
 for a half-hour after the douche, as it has a somewhat 
 weakening effect upon the tissues. 
 
DOUCHES 51 
 
 Douche pans may be bought at little cost, or in case 
 of emergency a new tin pan large enough for the pa- 
 tient's buttocks to rest in can be utilized successfully. 
 The fountain syringe is generally preferred for giving 
 douches, as the flow of water is steady and under low 
 pressure. If used after operative cases, it is wiser to 
 hang the bag rather low so that the force of the stream 
 may not be too strong upon the bruised tissues. 
 
 The best nozzle is the glass one, which can be kept 
 absolutely clean bv boiling for twenty minutes. Care The glass 
 
 " . ° , , , , nozzle best 
 
 must be taken in the use of glass or metal nozzles, that 
 they are not inserted too hot, as they retain the heat, 
 and there is danger of burning the delicate membrane 
 lining the vagina. 
 
 The water 'must be allowed to pass through the 
 tube before the nozzle is inserted, to expel the air and 
 
 Glass Nozzle 
 
 cold water as in the case of any injection. The per- 
 forations of the nozzle should always be at the side, Use ex- 
 never in the end as in that used rectally, since in that 
 case there would be danger of injecting the fluid into 
 the uterus and thus causing serious trouble, particular- 
 ly in confinement cases, where the mouth of the uterus 
 remains partly open. 
 
 For douching the ear, a medicine dropper makes a 
 very good nozzle. It can be attached to the tube of a in douch- 
 
 £ . . ri in & the eal * 
 
 fountain syringe and the flow can be governed by 
 pressure of the fingers. It is important here, as in 
 vaginal douching, that the force of the stream of water 
 is not too great. By drawing up the tip of the ear 
 very gently, the auditory canal is straightened, giving 
 
52 HOME NURSING 
 
 more ready access to the inflamed area. Cold water 
 
 should never be injected into the ear. 
 
 The same precaution against the use of too great 
 Nasal force in douching is applicable to the nasal douche, as 
 and neces- there is danger of perforation of the extremely delicate 
 
 sary care or j 
 
 tissues, if care is not exerted in its use. The use of the 
 nasal douche should never be made habitual. Physi- 
 cians who make a specialty of ear diseases object par- 
 ticularly to this method of treatment, since it often 
 sets up an inflammation of the ear. If an attempt is 
 made to blow the water forcibly out of the nose, one 
 can feel it distinctly in the passage leading to the ear. 
 It is in this way that the harm arises, consequently if 
 the nasal douche is used the head should be held down 
 and the water allowed to drain out of the nose before 
 the handkerchief is used at all. 
 
 GARGLES, SPRAYS, AND INHALATIONS 
 
 Gargles are employed for cleansing and medication 
 Orgies °^ ^ e throat and tonsils. A generous swallow should 
 be taken and used vigorously for four or five succes- 
 sive times, and as frequently during the day as di- 
 rected or as indicated by conditions. 
 
 A severely inflamed throat in which the mucus col- 
 lects rapidly should be gargled as often as once an 
 hour. In mild conditions three times a day may be 
 frequent enough. After the use of an acid gargle the 
 mouth should be thoroughly rinsed with a solution 
 of some alkaline substance, such as bicarbonate of 
 soda, to counteract the effect upon the teeth of the 
 strong acid. 
 
 For simple sore throat a glass of water with a 
 
 throat 6 teaspoon of salt or alcohol diluted two-thirds with 
 
 water, makes a good gargle. For tonsilitis, peroxide 
 
DOUCHES 53 
 
 of hydrogen one part in five of water is very cleansing 
 and gives great relief. 
 
 Insufflation, or the blowing of a powder into a 
 cavity, may be accomplished by means of a glass insiif- 
 tube or a hollow roll of stiff paper containing the 
 prescribed powder. This must be placed far back in 
 the throat and can usually be forcibly inspired by the 
 patient, though if necessary the nurse can blow the 
 contents through the tube. The atomizer is in general 
 use now for spraving the nose or throat, and its use A sim- 
 
 . ° . pie ato- 
 
 needs no explanation. Inhalation of steam can be mizer for 
 
 r > > bronchial 
 
 given by means of a pitcher of boiling water, having colds 
 closely fitted over it a thick paper cone with a hole 
 large enough for the patient to breathe through. In 
 this way none of the vapor is lost, and the patient 
 receives it by the mouth and exhales through the nose. 
 This treatment often affords great relief in cases of 
 severe bronchial cold when there is considerable diffi- 
 culty of breathing. 
 
 CARE OF UTENSILS 
 
 After a syringe has been used it must be washed 
 in soap-suds, rinsed in hot water, and hung up to dry. Care of 
 It should never be put away in the box wet. Hard 
 rubber syringes, if not frequently used, are apt to leak. 
 The leakage can usually be avoided by soaking before 
 use in hot water, which swells the washers sufficiently 
 to make them tight. 
 
 The nozzle, after being washed, should be left 
 standing in a solution of carbolic acid. The long- rub- Care , of . 
 
 ° nozzle and 
 
 ber rectal tube or soft catheter, after being thoroughly rectal tube 
 washed, can be boiled two or three moments before 
 it is put away. This softens the rubber somewhat, and 
 eventually spoils the tube, so that if left standing for 
 
54 HOME NURSING 
 
 some hours in a strong solution of carbolic acid the 
 same end is attained. 
 
 A bed-pan should be warmed by allowing the hot 
 Getting water to run over it before giving it to a patient. If 
 
 the bed- . ,..,.„, . . 
 
 pan ready the patient is very stout and it is difficult to get it into 
 place, the edges may be oiled a little. Sometimes, with 
 very thin or emaciated patients, it is necessary to pad 
 the edges of the bed-pan, as a bed-sore may be started 
 from frequent or careless placing of the pan. 
 
IV 
 
 OBSERVATION OF SYMPTOMS 
 
 Circulation— How to take Pulse— Temperature— Use of Clinical Thermometer 
 —Respiration— Observation of Symptoms 
 
 ANY ONE who has the care of the sick should 
 know how to observe accurately the changes What use 
 J ° tempera- 
 
 in temperature, pulse, and respiration, since these, ture, pulse, 
 are essential guides to knowledge of the progress ration 
 of disease. 
 
 CIRCULATION 
 
 Some idea of the structure of the organs of circu- 
 lation and the office of the blood may possibly be 
 helpful to an understanding of normal and diseased 
 conditions. 
 
 The blood is the most important fluid of the body, 
 
 and its office is to convey nutritive material to all parts Offices of 
 
 , • ttVi the blood 
 
 of the system and to bring away waste matter. When 
 
 examined under the microscope the blood is seen to 
 consist of a thin, colorless fluid in which float millions 
 of small solid bodies known as corpuscles. The liquid 
 is called plasma and the corpuscles are of two kinds, 
 the work of each differing somewhat. The red cor- 
 puscles are known as the oxygen carriers, while the 
 white ones, on account of the work they do, have 
 sometimes been spoken of as the "scavengers" of the 
 body. The blood when removed from the body and 
 exposed to the atmosphere has a tendency to clot, and 
 it is this property which prevents severe hemorrhage 
 following even slight wounds. 
 
 (55) 
 
56 HOME NURSING 
 
 The organs of circulation are the heart and blood- 
 The great vessels. We can form some idea of what the strength 
 circulation of an organ must be which can pump out huge streams 
 of blood night and day without cessation throughout 
 a lifetime. And so it is that the heart is fashioned 
 of strong, thick walls of muscular tissue, the contrac- 
 tions of which force its contents through the tubes 
 which are meant to convey the blood to all the tissues 
 of the body. It is enveloped in a membrane which 
 secretes a lubricating fluid that prevents its move- 
 ments from meeting with any friction. It also has a 
 very delicate lining and the congestion of either of 
 these membranes gives rise to disease. 
 
 The heart is partitioned into four cavities with a 
 Details complicated and very beautiful arrangement of valves, 
 work The blood brought to it by one set of blood-vessels, 
 
 known as arteries, is carried away by others called 
 the veins. The larger arteries, which receive and pass 
 along the blood that the heart contains, are necessarily 
 of firmer tissue and more elastic than are the veins 
 which merely convey the stream of blood back to the 
 heart again. These blood-vessels are constantly 
 branching and diminishing in size as they divide. 
 Their walls also become much thinner as they ap- 
 proach the capillaries or network of extremely delicate 
 blood-vessels which unite them and in which the ex- 
 change of waste and nutritive material takes place. 
 This pumping of the heart can be felt over its apex, 
 its pump- which lies a little to the left of the centre of the chest, 
 ou g r pSise- and also along the course of the large arteries as they 
 approach the surface of the body. Pulse is the peri- 
 odic distention of the blood-vessels due to this con- 
 traction of the heart. The blood is forced from the 
 heart into the arteries, and because of the elastic char- 
 acter of the arterial walls is carried on throughout the 
 
 beat 
 
OBSERVATION OF SYMPTOMS 57 
 
 entire arterial system. The condition of the heart 
 is indicated by the character of the pulse-beat, which 
 may be felt whenever a large artery comes near the 
 surface of the body. The usual place for counting 
 the pulse, because it is most convenient, is at the wrist, 
 though it may be felt also at the temporal artery and 
 at the neck and ankle. 
 
 HOW TO TAKE PULSE 
 
 It is sometimes difficult for one not accustomed to 
 taking the pulse to do so readily, but if counted at the To find 
 wrist the artery is easily found by carrying the first 
 two or three fingers lightly down the outer edge of 
 the thumb until they rest on the artery just at its base, 
 where, with very slight pressure, the pulsation may 
 be felt and the rate counted for a half-minute. The 
 fingers should be used instead of the thumb in feeling 
 the pulse, because of a pulsation in the thumb itself, 
 which interferes with the correct count. 
 
 The normal pulse-beat for an adult varies between 
 sixty and seventy in a man and sixty-five to eighty in The nor- 
 
 a 1 m i> 1 1 • i ma l pulse- 
 
 a woman. A child s pulse varies between ninety and beat 
 one hundred. The pulse-beat even in health changes 
 somewhat with age, sex, climate, position, exercise, 
 and other conditions. It is apt to be more rapid in 
 women than in men, slower in sleep than when awake, 
 quicker just after taking food and more rapid stand- 
 ing than sitting or lying down. There may be con- 
 siderable variation within the limits of health." 
 
 The character as well as the rate of the pulse 
 change under abnormal conditions. It may be full or Character 
 
 ., . of the 
 
 small according to the volume of blood coursing P ulse 
 through the vessel. When it can be stopped easily on 
 pressure it is said to be compressible. It may be 
 
58 HOME NURSING 
 
 irregular if the length or force of the beats differ 
 from one another, or intermittent if a beat is omitted 
 from time to time. An intermittent pulse may exist 
 even in health, but an irregular pulse is usually re- 
 garded as more serious. When the perfect action of 
 the valves of the heart is interfered with, the pulse 
 at once shows irregularity. 
 
 In sickness the pulse indicates how the system is 
 
 in sickness enduring the attack of disease. In most cases the 
 pulse is quickened by disease and the more frequent 
 the number of beats the weaker generally is the con- 
 dition of the heart. 
 
 The effect upon the pulse of any medication should 
 
 Effect of be carefully watched. Stimulants of course increase 
 
 medication ■ 
 
 the strength and frequency of the hearts action, 
 while drugs which are given to reduce fever have a 
 depressing effect upon the contractions of the heart, 
 and render the pulse slower and weaker. 
 
 We should not, however, consider the pulse by 
 itself in disease. 
 
 TEMPERATURE 
 
 The regulation of the body's heat is interfered 
 Normal with in disease, and the ratio maintained between 
 th e at bod y pulse, temperature, and respiration is always signifi- 
 cant. The evenly balanced production and escape of 
 the heat of the body keeps its temperature normally 
 at about 98.4 F., in spite of variations in the ex- 
 ternal conditions of heat and cold. The normal 
 standard we may say lies between 97^4° and 99^°, 
 according to the time of day when the temperature 
 is taken, and the variation of even a degree from this 
 should be regarded as abnormal. The temperature 
 of an adult is said to reach its highest point between 
 5 and 8 p. m v and is lowest from 2 to 6 a. m. The 
 
OBSERVATION OF SYMPTOMS 59 
 
 range of temperature within which life can be sus- Range of 
 
 . , . , , , the tem- 
 
 tained is about twenty degrees — we may say between perature 
 95° and io8° F. The danger of either a very high or 
 very low temperature is chiefly in the length of time 
 the condition lasts. Very high temperature is some- 
 times found in cases of hysteria without danger to 
 life, but that is because the temperature soon drops 
 to normal. 
 
 Most disorders are accompanied with rise of tem- 
 perature, though this is by no means essential to a 
 condition of disease. 
 
 THE USE OF THE CLINICAL THERMOMETER 
 
 Every household should possess a clinical ther- 
 mometer. This is a frail little instrument, the glass 
 
 A Clinical Thermometer 
 
 of which usually magnifies so that the rise of the 
 mercury can be easily traced. The mercury should 
 be shaken down below QS° before it is used. The Use of 
 
 - , . . , the clin- 
 
 time required for it to register will usually be indi- ical ther- 
 cated on the thermometer or explained where it is 
 bought. These instruments are self-registering, i.e., 
 the mercury remains stationary after the thermome- 
 ter is withdrawn until it is forcibly shaken down. 
 
 The temperature can be taken either in the mouth, 
 axilla, rectum, or groin. If taken by mouth the Ways of 
 thermometer should be placed under the patient's the body's 
 
 . , tempera- 
 
 tongue, being careful that the teeth do not close sud- tu re 
 
 denly upon it and that the lips are kept firmly held 
 
 together. When the temperature is taken by axilla 
 
 the armpit should first be wiped dry, the therome- 
 
60 HOME NURSING 
 
 ter laid in place, and the arm held closely to the side, 
 with the elbow flexed. It is better that the attendant 
 should hold the arm in place if the patient is weak, 
 so that there need be no effort on his part. The 
 thermometer should be left in place eight or ten 
 minutes. 
 
 The rectal temperature is the most accurate, and 
 The most should invariably be taken in the case of children and 
 
 3.CCtir3.t6 
 
 tempera- in serious illness where great exactness is demanded 
 
 ture - fe 
 
 or if for any reason the temperature by mouth is 
 questioned. A little vaseline on the bulb of the 
 thermometer makes it easy to insert, and it should 
 be carried in an inch and a half. Often the patient 
 is able to do this for himself. Rectal temperature is 
 always a half-degree higher than that taken by 
 mouth or axilla. 
 
 The temperature of a delirious person should 
 When the never be taken by mouth, for fear of accident, and 
 delirious care should be observed in any case not to give a 
 hot or cold drink just previous to taking the tempera- 
 ture. 
 
 Upon the first sign of illness the temperature 
 should always be taken. It may be found only slight- 
 ly elevated, but if each day shows an increase of 
 temperature, how*ever slight, a physician should be 
 consulted. A rise of temperature beginning each day 
 a little earlier is not a good indication. 
 
 The temperature of a sick person should be taken 
 How often at least twice a day, and in some cases it is necessary 
 
 the tem- J 
 
 peratm-e to take it every hour or two. A morning temperature 
 taken ' ma y be normal when the evening temperature will 
 show a considerable elevation. 
 
 The thermometer, after it has been used, should 
 be washed off with soap and water and carefully 
 dried. It must not, however, be held under the hot- 
 
OBSERVATION OF SYMPTOMS 61 
 
 water faucet, as is sometimes done by careless hands. 
 
 If the thermometer has not been thoroughly dried Care of 
 
 ° J the chn- 
 
 before being put back into the case, the latter grows icai ther- 
 musty, so that the thermometer when taken out has 
 an unpleasant odor, which is detected at once if a 
 mouth temperature is taken. It is always well to 
 wipe the thermometer with a damp cloth before giving 
 it to a patient. If it is in constant use it may be kept 
 in a glass of some antiseptic solution. A bit of cot- 
 ton may be placed in the bottom of the glass for the 
 bulb to rest upon. 
 
 RESPIRATION 
 
 The processes of circulation and of respiration 
 are closely allied and what affects the pulse is apt 
 also to influence the breathing. The blood which is 
 collected from all parts of the body and sent to the 
 lungs is then purified by being brought in contact 
 with the air. The lungs are sponge-like bodies com- The lungs 
 
 i r ■ ■ 11 i • 11- and their 
 
 posed ot minute sacs or air-cells having very delicate action 
 walls surrounded by a network of capillaries. The 
 capillary membrane is extremely thin and of a re- 
 markable structure which permits the passage of 
 gases, and of nutrient material held in solution, 
 through it to the tissues. Hence the interchange of 
 gases that is possible in the lungs. The oxygen 
 which has been drawn into the lungs is taken up by 
 the red corpuscles, which have a great affinity for it, 
 and the carbonic acid and water in the blood, having 
 an equal affinity for the air, pass into it. 
 
 The rate of respiration varies as does the pulse, . 
 and is also influenced by position, emotion, exertion, Rate . s of 
 
 • . J l respiration 
 
 and other conditions. The respirations can be 
 counted either by watching the rise and fall of the 
 chest or by placing the hand upon it. They are best 
 
62 HOME NURSING 
 
 counted when the patient is asleep or unaware of 
 being observed, as otherwise there is likely to be an 
 unconscious control. If the hand is left a moment 
 on the wrist as if still taking the pulse the respiration 
 can easily be counted. 
 
 The average number of respirations for a healthy 
 Average of adult is eighteen to the minute, and in a child from 
 
 respiration " . 
 
 twenty to twenty-four. The ear should be trained 
 to detect readily a change of breathing if it should 
 take place, as is frequently the case in the night. 
 
 OBSERVATION OF SYMPTOMS 
 
 One who is constantly with a sick person has an 
 
 How the excellent opportunity of noting his true condition, and 
 
 hei rse th nay can ^ e °f ver y rea l assistance to the doctor if she has 
 
 physician the keenness to observe closely and can report in a 
 
 simple and direct way all the changes that may have 
 
 taken place between his visits. 
 
 Some patients are inclined to exaggerate their ills, 
 while others make light of them, and it may some- 
 times be difficult to distinguish between real and im- 
 aginary disturbances. The attitude a patient takes 
 The atti- or his expression often suggests the nature of his 
 
 the patient trouble. For instance, a person with pain, tender- 
 suggestive 
 
 ness, and distention of the abdomen lies on the back 
 
 with the knees flexed in order to reduce the tension 
 of the abdominal muscles, while in the case of colic 
 a person frequently prefers to lie flat on the abdomen, 
 as the pressure upon it seems to give some relief. 
 When one lung is congested the patient turns natu- 
 rally toward the affected side in order to give the 
 well lung freedom of motion. When there is great 
 difficulty in breathing, as in asthma or in heart dis- 
 ease, the patient can not lie down, but must be 
 
OBSERVATION OF SYMPTOMS 63 
 
 bolstered up in bed day and night. As relief is 
 gained the recumbent position is resumed. Patients 
 who are extremely weak often slip toward the foot 
 of the bed. This is considered a sign of failing 
 strength. 
 
 Great restlessness is also often an unfavorable 
 svmptom. Sometimes in the course of disease the other 
 
 1 symptoms 
 
 arm or hand is kept constantly in one position. This 
 
 is significant of some brain affection, as is also 
 
 grinding of the teeth or rolling the head from side to 
 
 side. Any swelling of the face or other parts of the 
 
 body should be reported at once, whether or not it is 
 
 attended by pain. Any unusual facial expression 
 
 should be regarded as noteworthy. If breathing is 
 
 difficult the distended nostrils may be the first sign 
 
 of it. Any contortion of the muscles, however slight, 
 
 should be regarded as significant. 
 
 A chill is always considered a serious symptom, 
 
 whether in the course of disease or otherwise. If Serious- 
 i • iiii- i ness °f a 
 
 the person is apparently well this may mean the onset chin 
 
 of some acute trouble. The patient should be given 
 a hot drink, abundant covering, and hot-water bags. 
 The temperature must be taken and the doctor noti- 
 fied. High fever is sure to follow a genuine chill. If 
 a chill occurs in the course of an inflammatory con- 
 dition, it is probably due to the formation of pus, 
 which must be given an outlet. In malaria the chills 
 are prolonged and often severe, but are seldom re- 
 garded as alarming. 
 
 One should be able to describe the character of 
 a cough, whether it is dry, i. c, without expectora- Charac- 
 tion, or loose ; whether short, frequent, choking, in- cou s h and 
 cessant, or if it is more troublesome at night or after 
 eating. The sputum or expectorated matter should 
 be examined and often must be saved for the doc- 
 
64 HOME NURSING 
 
 tor's inspection, as it has a characteristic appearance 
 in various diseases. 
 
 If there is perspiration the amount and character 
 Perspira- of the moisture should be noted when it first appears, 
 
 tion 1 , 1 • • ,1 
 
 and whether it is warm or cold. 
 
 When there is persistent vomiting the vomited 
 matter must also be carefully described or saved in 
 a covered vessel for the doctor to see. It should be 
 observed also whether vomiting follows immediately 
 the taking of nourishment or seems to have no con- 
 nection with it. The same care is necessary regard- 
 Abnormaii- ing the observation of stools and the necessity of 
 
 ties in ° J 
 
 aSd^tolis sav ^ n §" anything which appears abnormal. Curds may 
 be seen and are easily recognized if milk is not being 
 digested. Some drugs affect the color of the stools 
 so that they might appear alarming if one were 
 ignorant of this. Iron and bismuth blacken the stools. 
 The presence of blood gives them a dark color and 
 tarry consistency. In cases where the function of 
 the gall-bladder is interfered with the stools are clay- 
 colored. 
 
 The condition of the tongue and mouth is signifi- 
 
 The sig- cant. Note the color of the tongue and if it is coated, 
 
 nificant ■ ° , 
 
 tongue and dry, swollen, or bitten. In fever cases it is almost 
 
 mouth •" ' ■ 
 
 always furred, though this condition is. not absolutely 
 a sign of ill-health. When the tongue begins to clear 
 from the edges it is a sign that the intestinal tract is 
 resuming its normal condition and improvement may 
 be looked for daily. The odor of the breath and the 
 condition of the gums and throat also indicate the 
 state of the stomach. 
 
 The color and texture of the skin is another thing 
 what that is significant in disease. The skin may be yellow, 
 
 stones ^ « 
 
 Sa s te8 as * n J auncn ce, showing that the liver is disordered; 
 waxy, as in Bright's disease of the kidneys; anaemic 
 
OBSERVATION OF SYMPTOMS 65 
 
 or pallid, showing a lack of red corpuscles in the 
 blood; or mottled, or covered with an eruption. Any 
 eruption in the course of disease or any unusual rash 
 appearing in apparent health should be reported to 
 the physician. The place of its first appearance should 
 be noted, as also the character of the eruption and 
 the patient's general condition. A rash may be due 
 to the development of some contagious or infectious 
 disease, to the effect of some poison in the system, 
 or may result simply from a disordered state of the 
 digestion, but the doctor should always be the one to 
 decide upon the matter. 
 
 The condition of the kidneys is detected by the 
 examination of the urine, which in health will appear Considera- 
 
 . . tion as to 
 
 of a pale amber color, with characteristic odor, the urine 
 and should be voided to the amount of about 
 fifty or sixty ounces in the twenty-four hours. 
 Some variation is expected in health, due to 
 the season and the amount of liquids taken 
 into the system. In winter the urine shows a larger 
 amount and is paler than in summer, when there is 
 more loss of water through perspiration, and there- 
 fore a more concentrated and highly colored fluid. 
 Under diseased conditions the urine should be care- 
 fully measured each time it is voided, in a measuring 
 glass kept for the purpose and used for nothing else. 
 Any sediment, opacity, unnatural color, or odor 
 should be noted. The doctor may wish at any time 
 a specimen of the urine for examination, and unless when the 
 otherwise stated the first urine voided in the morning wishes a 
 should be saved in a perfectly clean and dry bottle. 
 Under some nervous conditions, as when one has a 
 severe headache, the urine is voided very frequently 
 and is paler than normal urine. The increased amount 
 is also a characteristic of hvsteria. Retention of 
 
66 HOME NURSING 
 
 urine means the complete inability to void it, and we 
 have already spoken of that as a condition which 
 must receive attention from the doctor or skilled 
 nurse. 
 
 The suppression of urine, however, is a much more 
 Suppres- serious complication, and implies, not as in retention, 
 
 sion of r 
 
 urine that the muscles around the neck of the bladder re- 
 fuse to act, but the inability of the kidneys themselves 
 to perform their function, the bladder being found 
 empty upon catheterization. Unless these organs can 
 be forced to act, and will respond to treatment, the 
 issue must be fatal, as the system soon becomes thor- 
 oughly poisoned through absorption of the waste 
 matter which should be thrown off by means of the 
 kidneys. 
 
 Incontinence of urine or lack of power in the blad- 
 inconti- der to retain its contents is common as old age advances 
 urine and the muscles are inclined to relax. The same con- 
 dition exists sometimes in disease and implies extreme 
 weakness. Incontinence may sometimes accompany 
 retention of urine, the bladder being so full that some 
 of the contents dribble away. None of these conditions 
 should be kept from the knowledge of the physician. 
 Painful and frequent urination may indicate an irri- 
 tated and inflamed state of the bladder, and treatment 
 is always necessary in order to hasten relief. 
 
 The eye is sometimes the first thing to indicate a 
 indka- general disorder of the system. It may be unduly 
 the eye prominent, as in a disease of the thyroid gland known 
 as goitre, or the pupils may be abnormally or unevenly 
 contracted or dilated. Sometimes the eyelids droop, 
 as in certain nervous disorders, or there may be squint- 
 ing, which accompanies brain trouble. Pufrmess about 
 the eyes and face suggest heart or kidney difficulty. 
 The color of the eyeball may be abnormal or the eye 
 
OBSERVATION OF SYMPTOMS 67 
 
 take on an unnatural brightness or peculiar lack of ex- 
 pression, all of which is significant in disease. 
 
 Hearing, too, is sometimes temporarily impaired by 
 disease, as in the deafness accompanying typhoid fever, state of 
 but often this sense becomes more acute than in health. 
 An increased keenness of hearing may precede deli- 
 rium. Any discharge from the ear should always be 
 noted as to its character and amount. 
 
 The mental state is subject to frequent changes in 
 disease. If there is delirium, notice its character, The ner - 
 
 ' vous men- 
 
 whether it be. mild, muttering, or inclined to be violent. tal state 
 A delirious patient should never be left alone for an 
 instant, no matter how mild the nature of the delirium, 
 for at any moment an idea may seize his brain and be 
 instantly acted upon, which might bring fatal con- 
 sequences. Many such accidents have resulted from 
 a delirium thought to be mild and therefore not need- 
 ing special watchfulness. Any manifestation of a ner- 
 vous character, such as incoherency of speech, dulness 
 of intellect, difficulty of swallowing, involuntary twitch- 
 ing or actual convulsions, are grave symptoms. Ob- 
 serve the mental state before, during, and after a con- ^ t l° r T l and 
 vulsion, whether the attack is sudden, how long it lasts, convulsion 
 and whether the spasms are general or confined to one 
 part of the body. 
 
 Sleeplessness may be regarded as a serious condi- 
 tion, according to the length of time it lasts. Watch- sieepiess- 
 fulness is necessary in order to make an accurate re- 
 port as to the amount of sleep a patient actually ob- 
 tains in the twenty-four hours, since it is never safe 
 to trust to a sick person's account of himself and the 
 short naps which he has been able to get if summed 
 up may amount to several hours of sleep. It is never 
 wise to oppose any statement in regard to the lack of 
 sleep, as it can do no good and only irritates a nervous 
 
68 HOME NURSING 
 
 person. He may be soothed and his mind diverted from 
 the troublesome subject in the various ways that sug- 
 gest themselves to a thoughtful person. 
 
 The careful observation of symptoms added to 
 
 ftlfobser" g"°°d reasoning as to their meaning will often throw 
 
 Symptoms muc h % nt on the disease in question and make the 
 
 nursing of a case more than mere drudgery if one has 
 
 any taste along scientific lines. 
 
 A little judicious questioning of the doctor, if he 
 is inclined to give explanation, will interest him and 
 add much to the intelligent understanding of the work 
 to be done. Close observation of symptoms, however, 
 is of small account if there is no attempt to report con- 
 ditions to the doctor in an accurate and orderly fashion. 
 The memory ought never to be relied upon, but 
 The value notes of some kind should be kept in the sick-room and 
 written important points recorded from time to time. A neatly 
 
 statement \ r J 
 
 written statement simplifies the account for the doc- 
 tor and will be much appreciated by him, whether he 
 takes the trouble to show it or not. A sheet of ruled 
 paper with columns marked off in which to tabulate 
 the time, pulse, temperature, respiration, nourishment, 
 sleep, urine, and stools, with a margin where remarks 
 can be added, will be found a convenient form of keep- 
 ing the record. A small blank book in which the doc- 
 tor's orders can be written is also a valuable acquisition. 
 
INFLAMMATION, EXTERNAL APPLICATION, 
 MEDICINES 
 
 Inflammation— Treatment— Dry Heat— Hot- Water Bags— Moist Heat— How 
 to Make a Poultice— Fomentations— Cold Applications— Ice Coils— Counter- 
 irritants— Massage— The Giving of Medicine— Hypodermic Injections- 
 Care of Medicines 
 
 A 
 
 INFLAMMATION 
 
 LARGE number of diseases, both medical and sur- 
 gical, are of an inflammatory nature at some time 
 
 during their course ; all diseases the names of which 
 terminate in "itis" are understood to be inflammatory. 
 Inflammation implies changes in the tissues, which are 
 brought about by certain irritants. These irritants, How con- 
 whatever they may be, cause a larger amount of caused " 
 blood than is usual to be sent to some part of the 
 body. This condition is known as congestion. It 
 means that the tissues can not take up the excess of 
 nutritive material fast enough, that the capillaries be- 
 come clogged, and that there is an oozing of some of the 
 constituents of the blood into the surrounding tissues. 
 The congestion may slowlv disappear in a few days, The resuit- 
 
 i • r i- 1 • r. • i- 11 in S inflam- 
 
 but if not soon relieved, inflammation must follow, mation 
 This state is characterized by pain, swelling, tenderness, 
 heat and redness. It may subside by gradual return to 
 a healthy condition, or it may go on to suppuration, 
 which is the formation of pus or matter. 
 
 If for any reason inflammation takes place, the 
 white corpuscles of the blood, which we have called the 
 scavengers, hasten to the spot, make their way through 
 
 (69) 
 
70 HOME NURSING 
 
 the walls of the blood-vessels and begin their work of 
 absorbing the irritant. If they are successful, we say- 
 that resolution has taken place and the inflammatory 
 condition disappears ; but if not, the symptoms of red- 
 ness, swelling, pain, etc., increase in severity and pus 
 is formed. If the inflammation attacks mucous sur- 
 yvhen pus faces, there will be a natural outlet for the pus, as these 
 
 is iormed L 
 
 surSces US a ^ wa y s * ea d to tne external membrane of which they 
 are merely a turning in, and with drainage thus estab- 
 lished the inflammation will probably subside. If, 
 
 Uvous however, a serous membrane, as those are called 
 
 membrane w hich line the cavities of the body or any solid part, 
 is affected, the pus has no means of escape. Such an 
 accumulation of pus is known as an abscess, and 
 unless an opening is made to afford free drainage 
 for the imprisoned matter it remains as a menace 
 to life. 
 
 Sometimes an abscess is left to burst spontaneously, 
 
 Abscess and if the body is in good general condition, it will 
 
 and blood- J ° ° 
 
 poisoning absorb the poison and throw it out of the system. But 
 there is always great danger of blood poisoning, and 
 even if the person escapes such consequences, and there 
 seems to be a speedy recovery, the possibility remains 
 that the poisonous matter has not been entirely evacu- 
 ated and that what is left will be sufficient to set up 
 further irritation and cause a repetition of the same 
 conditions. 
 
 For this reason it is plain that an abscess which has 
 Serious- not had free drainage, even when its immediate con- 
 an S ab°scess tents have disposed of themselves, needs to be cleared 
 out and thoroughly purified before health can be as- 
 sured. If an abscess in either the pelvic or abdominal 
 cavity is neglected, the consequences are very liable to 
 be fatal. When there is severe pain with a throbbing, 
 full sensation and increase of temperature attending an 
 
INFLAMMATION 71 
 
 inflammatory condition, we may be quite sure that pus 
 is forming. In severe cases, chills also occur and are 
 always to be regarded as a serious symptom. 
 
 TREATMENT FOR INFLAMMATION 
 
 The treatment for inflammation is always to seek 
 if possible to remove the cause and to allay the irrita- Removing 
 
 r the cause 
 
 tion that has resulted. Various measures may be 
 adopted in order to accomplish this. Both cold appli- 
 cations and hot are used in the early stages, some 
 doctors preferring the former and some the latter 
 method. 
 
 DRY HEAT 
 
 Dry heat is used to increase the temperature of the 
 body, whether general or local, to allay inflammation What dry 
 
 , . " , . heat is 
 
 or to encourage suppuration, and to induce free per- used for 
 spiration when it is desired to relieve the work of the 
 kidneys. Dry heat is less enervating to the tissues than 
 moist and there is less danger of taking cold after its 
 use. 
 
 "When dry heat is to be employed to induce perspi- 
 ration, the patient may be placed on a chair with his Method of 
 feet in hot water, the clothing removed and blankets perspira- 
 fastened from his neck down around the chair reach- 
 ing to the floor. A lighted alcohol lamp is placed in 
 a basin underneath the chair, and the patient is kept 
 well wrapped up. After sitting thus for a half-hour or 
 an hour, free perspiration may be expected to follow, 
 and the patient should then be put to bed between 
 warm blankets and sponged off with alcohol. Any ar- 
 rangement for a hot air bath to be given in bed will 
 scarcely be practicable outside the hospital. 
 
72 
 
 HOME NURSING 
 
 How to 
 
 make a 
 hot-water 
 bottle 
 ready 
 
 HOT-WATER BAGS AND BOTTLES 
 
 Hot-water bags for ordinary use should never be 
 filled more than half full, as they are unwieldy if en- 
 tirely full. If the bag is held by the handle when rilling, 
 rather than by the top, there will not be danger of 
 scalding the hand as the water bubbles up from the 
 bag. As much air as possible should be expelled from 
 the bag before screwing on the top. It is well to form 
 
 Hot- Water Bag 
 
 Bottles 
 
 and bricks man ^ 
 
 the habit of turning a bag upside down after filling, in 
 order to be sure that the top is screwed on firmly and 
 that there are no leaks. Hot-water bottles are useful 
 times where bags are not available. They 
 should always be well protected with flannel and 
 should not be filled more than two-thirds full, for fear 
 of their cracking; for this reason also the corked end 
 should always be turned away from the patient. Bricks 
 
INFLAMMATION 73 
 
 may be used and retain their heat a long time, but they 
 are clumsy. 
 
 Flannels for application to any part of the body 
 may be kept hot while carrying to the patient, by plac- in appii- 
 iiiQ- them in a heated paper or towel. After bein^ hot flan- 
 
 & r l to nels 
 
 put in place they should be coyered with other warm 
 flannel or cotton of several thicknesses. 
 
 Bags made of flannel and filled lightly with salt 
 or sand can be heated very hot and will remain so for Hot sand 
 
 and salt 
 
 a considerable time. These are useful for earache or in ba s s 
 neuralgia of the face. Better for such use is a Japa- 
 nese hot box or stove, which can be found in almost any 
 place where Japanese goods are sold. It is a little A J a P a - 
 metal box slightly curved on one side and having a hot-box 
 sliding cover to admit a fuse which when lighted will 
 retain its heat for hours. These can be bought in va- 
 rious sizes, ranging in price from ten cents upward. 
 
 MOIST HEAT 
 
 Moist heat relaxes the tissues more than the dry. 
 By causing the superficial blood-vessels to dilate, it Effect h of^ 
 draws the blood to the surface, relieves the conges- 
 tion of the more deep-seated vessels, and so eases the 
 pain. It is very effectual in hastening suppuration. 
 
 For localized pain, hot compresses (fomentations) 
 or poultices are useful. The latter are better if the 
 pain is deep-seated. They can be made of any non- 
 irritating substance which retains heat well. When 
 applied for relief of the deep-seated parts or to hasten 
 suppuration, the poultice ought to be large enough to 
 cover a considerable surface, but if placed directly 
 over a wound it should be only slightly larger than the 
 opening. After makingf the poultice it should be taken Applying 
 
 . . , , a poultice 
 
 to the sick-room between two hot plates. It may then 
 4 Vol. 3 
 
74 
 
 HOME NURSING 
 
 When a 
 poultice 
 
 should be oftener. 
 
 removed 
 
 be placed in the palm of the hand and carefully slipped 
 off on to the inflamed area. By so doing there will 
 be no danger of the poultice being applied too hot. 
 The skin of a child, an unconscious person or a para- 
 lytic is abnormally tender and may be blistered by an 
 application that would produce no such effect upon a 
 healthy adult. After the poultice has been applied, it 
 should be covered with flannel and oiled silk, rubber 
 tissue or enamel cloth to help retain the heat longer. 
 
 A poultice of ordinary size will keep warm several 
 hours, but a small thin one will need to be changed 
 It must never be allowed to become hard and 
 dry, nor should poulticing be long continued, as it may 
 defeat the purpose for which it was applied, by water- 
 soaking the tissues. If no directions are given as to 
 the length of time a poultice is to be continued when 
 one has been ordered by the doctor, he should be 
 asked in regard to it. 
 
 HOW TO MAKE A POULTICE 
 
 To make 
 a linseed 
 poultice 
 
 Linseed meal is perhaps the most common sub- 
 stance used for the making of poultices. To make a 
 linseed poultice stir the meal slowly into a saucepan 
 of boiling water ^nd let it boil two or three minutes, 
 stirring all the time. It should be thick enough when 
 taken off the fire to be beaten well with a spoon, in 
 order to remove all lumps, and introduce enough air 
 to make it light. This is a very important part of the 
 process, as otherwise the poultice will not have the 
 proper consistency. When finished, it should be light 
 and smooth and just thick enough to be cut with a 
 knife. Sometimes a linseed poultice is made with an 
 antiseptic solution instead of water, and is applied over 
 a discharging wound. 
 
INFLAMMATION 75 
 
 A bread poultice is made by pouring boiling water 
 over slices of bread, from which the crusts have been To make 
 cut. When thoroughly soaked, the water is drained poultice 
 off, the softened bread is beaten well and spread. 
 These retain their heat only a short time. 
 
 Dough which has just been mixed is sometimes 
 used as a poultice. It is not necessary that it should JJjJJitice 
 be raised at all, as the heat of the body will do that. 
 
 Starch makes a soothing poultice and is sometimes 
 prescribed in diseases of the skin. It is made by mixing s ^ a J5- h 
 the starch with a little cold water and adding boiling 
 water to make a thick paste. 
 
 A hop poultice is made by filling a thin bag loosely Hop 
 
 . , , , , ._, poultice 
 
 with hops and wringing it out in hot water. Bran 
 may also be treated in the same way. 
 
 A mustard poultice is made by adding to a linseed 
 or flaxseed poultice one part of mustard to six of the Mustard 
 meal. A good substitute for a mustard poultice is 
 said to be a clean flat sponge which has been dipped 
 into mustard paste. If this is covered with a thin piece 
 of cloth and applied, it can be removed by moistening 
 the sponge with warm water. 
 
 A spice poultice is made by mixing a teaspoon 
 each of mustard, ginger, black pepper, cinnamon, Spice 
 cloves, and allspice together, " and adding hot water 
 little by little until the mass is of the consistency of 
 putty. This may be left in place all night without 
 danger of blistering and is a very soothing poultice, 
 because of the essential oils contained in the various 
 spices. 
 
 FOMENTATIONS 
 
 Fomentations or hot stupes are applications of moist 
 heat by means of flannel or flat sponges wrung out in 
 pure or medicated hot water. This means of applying 
 
76 
 
 HOME NURSING 
 
 Fermenta- heat is pleasanter and simpler than the use of poultices, 
 stupes but it is necessary that the cloths be changed as often 
 as every ten or fifteen minutes if the treatment is to 
 be effectual. Unless constant attention is'-given to their 
 application, they have no value. They must never be 
 left to get cold. 
 
 Two pieces of coarse flannel are better than one. 
 Wringing These are dipped in scalding water, wrung out as dry 
 as possible and quickly applied. A cloth which is cool 
 enough to be wrung out with the hands can do very 
 little good. A stupe-wringer, such as is used in every 
 hospital, is a very convenient article to have in the 
 
 A Stupe Wringer 
 
 Conven- 
 ience in 
 manipu- 
 lation 
 
 household and is perfectly simple to make. It consists 
 of a stout piece of crash or ticking eighteen by fifteen 
 inches, with a stick or small rod run through a hem 
 at either end. In place of this a strong towel may be 
 used, though it is less convenient, and the hands are 
 apt to get burned if there are no sticks to use in twist- 
 ing. 
 
 It is a good plan, when stupes are being used, to 
 have two basins, one containing the hot water and an- 
 other in which to lay the wet stupe-wringer. Two 
 stupe cloths are necessary, so that one need not be re- 
 moved until the other is ready to put on. The stupe 
 is picked out of the hot water and laid in the centre 
 of the stupe-wringer or towel and the ends twisted 
 tightly. 
 
INFLAMMATION 77 
 
 After the stupe is in place it should be covered with 
 a drv flannel or thick laver of cotton batting and oiled Necessary 
 
 ° precautions 
 
 muslin be placed on top of that. The first few stupes 
 that are used can not be borne as hot as they can be 
 later. Care must be taken not to allow the patient's 
 nightdress to become damp, and it is well to place a 
 piece of rubber cloth or folded newspaper over the 
 mattress to prevent any dampness, though if the cloths 
 are wrung dry, as they should be, there will be no pos- 
 sibility of their dripping. 
 
 After stupes are discontinued, a dry flannel should 
 be kept over the part as protection for a while. 
 
 If turpentine stupes are ordered and no special di- 
 rections are .given for their application, one part of Ju P cs ntine 
 turpentine may be mixed with one of oil or vaseline, 
 warmed and rubbed over the surface to be treated, and 
 plain hot-water stupes applied. This method prevents 
 irritation to the skin from the use of the turpentine. 
 
 When small compresses are used for the eye or any 
 part of the face, they can be wrung out in a lemon 
 squeezer. 
 
 A breast compress should be made with a small 
 hole in the centre to admit the nipple, which should J mpress St 
 never be covered. 
 
 COLD APPLICATIONS 
 
 In the earlier stages of inflammation, either cold 
 or hot compresses may be prescribed, according to the 
 preference of the physician, as both are useful in re- 
 ducing inflammation, though heat must be used with 
 caution, on account of its tendency to induce suppura- 
 tion. Heat and cold have an opposite effect upon the Effect of 
 
 i 1 j T-i i-i « c °ld on 
 
 blood-vessels. I he one dilates the superficial vessels, as lhe b lood 
 
 . vessels 
 
 we have already said, and thus relieves the congestion 
 of the deeper parts, while the other contracts them and 
 
78 
 
 HOME NURSING 
 
 Ice bags 
 to fit 
 different 
 parts of 
 the body 
 
 sends an excess of blood to the deeper vessels, which 
 in their turn react and force the blood again to the 
 surface, thus establishing a better circulation through- 
 out the tissues. 
 
 Cold compresses are usually changed hourly or once 
 in two or three hours, according to the amount of in- 
 flammation. 
 
 The ice-bag now in general use furnishes a very 
 effectual way of applying cold. Besides the ordinary 
 round bags with metal screw top, they can be bought 
 of various shapes to fit the different parts of the body. 
 
 Rubber Ice-Pags 
 
 There are the helmet-shaped ones for the head, which 
 can be tied in place, and the long, narrow ones, which 
 are useful for the neck and spine. One of the most sat- 
 isfactory bags, because of its slight cost and conven- 
 ience in handling, is made of rubber tissue and has no 
 cover. The top is firmly tied with a piece of tape, so 
 that the water from the melted ice does not escape. 
 These come in various sizes and are lighter and less 
 clumsy than other bags. 
 
 If there are no better facilities for cracking ice it 
 can be placed in a stout cloth and pounded. In filling 
 
INFLAMMATION 79 
 
 the bag, one should be careful not to drop in sharp 
 pieces heavily, which might pierce a hole in it. The 
 bas: should not be more than half filled with ice and the Preparing 
 
 & the ice 
 
 air must be excluded, as in filling a hot-water bag, be- 
 fore the cover is put on. A small piece of gauze or a 
 handkerchief should always be placed between the ice 
 bag and the skin, as otherwise there might be danger 
 of "frost-bite." If the surface of the skin shows any 
 spot that is deep red or purplish at any time during Guard_ 
 the continued use of an ice bag, it is an indication that frost bite 
 the ice is irritating the skin, and it should be taken 
 off. A bag for the head can be wrapped in a thin 
 cloth and pinned to the pillow, so that the weight may 
 be somewhat lifted from the patient's head. 
 
 ICE-COILS 
 
 Ice-coils are also used extensively for inflammatory 
 conditions. They consist of rubber or lead tubing, 
 made into a coil with a yard or two of the tubing 
 left at each end, so that a siphon can be made. A 
 large pan of ice water must be arranged to stand above Arrange- 
 the patient's head, with one end of the tubing placed ice - coil 
 in it and fastened to the side of the pan with adhesive 
 plaster, so that it can not slip, but loosely so that there 
 will be no obstruction to the flow of the water. The 
 coil is then put in place, and the other end of the 
 tube allowed to rest in a pail or foot-tub, which is 
 placed near the bed to receive the water. A piece of 
 tape tied round the upper tube serves . to retard the 
 stream of water, which should be regulated until it 
 drops very slowly from the end of the tube. There 
 may be some difficulty in starting the flow of the 
 water, but by pinching the tube to give suction it can 
 be done. It is better not to tie the regulating tape 
 
80 
 
 HOME NURSING 
 
 Effect of 
 counter- 
 irritants 
 
 Fomenta- 
 tions and 
 poultices 
 
 Mustard 
 paste 
 
 The after 
 oiling and 
 covering 
 the skin 
 
 until the stream has been induced to flow freely. If 
 there is no ice-coil available, one can be made by sew- 
 ing rubber tubing in the form of a coil upon a piece of 
 cloth. 
 
 COUNTER-IRRITANTS 
 
 Counter-irritants are remedial agents applied to 
 produce dilatation of the superficial blood-vessels and 
 contraction of those in some adjacent or deep-seated 
 part of the body, probably through reflex action of the 
 nerve endings. 
 
 Fomentations and poultices are regarded as mild 
 counter-irritants. Counter-irritants are often applied 
 to places remote from the seat of the pain as when a 
 mustard foot-tub is used to relieve a congested state 
 of the head or abdomen. Mustard is one of the most 
 common substances used to produce counter-irritation. 
 Mustard paste, which is more rapid in its action and 
 more irritating than a mustard poultice, is made by 
 mixing flour with the mustard in different proportions. 
 The ordinary formula is one part of mustard to six of 
 flour. This is rubbed into a paste with a little cold 
 water and spread between two pieces of cloth. It 
 should not be kept on longer than twenty minutes, and 
 as some skins are more sensitive than others, it should 
 be watched closely and removed before that if nec- 
 essary. With unconscious patients the application must 
 be closely watched. 
 
 After the plaster has been taken off, the surface of 
 the skin should be oiled and covered with a soft piece 
 of muslin. Tepid water should always be used to mix 
 the mustard, as hot water or vinegar robs it of its 
 full strength. If the plaster is to be used on a child, 
 one-third glycerine should be added to the water used 
 for mixing or the proportion of mustard should be 
 reduced by one-half. 
 
INFLAMMATION . 81 
 
 Mustard leaves are small sheets of paper covered 
 with a mustard preparation put up in a tin box and 
 obtainable at any large drug store. If these are used 
 they have only to be dipped in tepid water and applied. 
 A thin piece of gauze or muslin placed between the 
 mustard leaves and the skin renders its effect more 
 gradual. 
 
 A cayenne pepper plaster can be made by mixing Cayenne 
 a tablespoon of cayenne with flour and water to form piaster 
 a thin paste. 
 
 Iodine is a counter-irritant in very general use. 
 The external skin or mucous membrane is painted with iodine 
 it, using a camel's-hair brush or cotton swab for its 
 application. More than two coatings will be apt to 
 blister the surface. If the skin becomes too much ir- 
 ritated, sponging with alcohol will relieve the smart- 
 ing. 
 
 For lumbago or sciatica the use of a hot flatiron, 
 which is passed over the surface protected with twoAg n 
 or three thicknesses of flannel, often gives great relief, 
 particularly if warm turpentine and oil in equal parts 
 has first been rubbed over the affected part. 
 
 Sometimes it is thought necessary to stimulate 
 rapidly, as in condition of shock, and aqua ammonia is Aqua 
 ordered as a counter-irritant. A piece of gauze or cot- 
 ton wet in the solution is applied and covered close with 
 oiled silk. This is left on five or ten minutes. Chloro- 
 form is also used in the same way. 
 
 Croton oil is such a strong irritant as to produce an 
 eruption. It is often diluted with an equal amount of Croton oil 
 olive oil and a very little of it is rubbed into the sur- 
 face with a piece of flannel at intervals of four or five 
 hours till the eruption appears. 
 
 The practice of cupping, though somewhat out of 
 date, is still used for the relief of pain or labored 
 
 ammonia 
 
82 
 
 HOME NURSING 
 
 The prac- 
 tice of 
 cupping 
 
 The 
 method 
 
 breathing, but it should not be attempted by unskilled 
 hands. To prepare for dry cupping it will be necessary 
 to have a spirit lamp, alcohol, a glass or metal rod or 
 stiff wire, absorbent cotton, and five or six wine or 
 medicine glasses, unless the regular cupping set is avail- 
 able. 
 
 The inside of the cups are heated by the aid of these 
 appliances in such a way that when the cups are rapid- 
 ly applied to the surface to be treated and held down 
 firmly for an instant, a partial vacuum is formed in 
 cooling, the skin is sucked up to fill it, and the blood 
 is consequently drawn to the surface. In removing the 
 cups, which adhere closely, the flesh near the rim of 
 each cup is pressed down to admit the air, and the cup 
 can then be lifted easily. 
 
 The process of wet cupping, which is always done 
 by the physician, is much the same, except that the skin 
 is first scarified before the cups are applied. 
 
 Leeches are very seldom used in this country, as 
 wet cupping answers the same purpose. 
 
 bing and 
 variations 
 
 MASSAGE 
 
 It is quite impossible to attempt any exposition of 
 Simple rub- scientific massage without practical demonstration. 
 There are, however, several variations of simple rub- 
 bing suggested by the massage movements which are 
 perfectly possible to untrained hands and prove their 
 usefulness by the relief they give. 
 
 Tired backs are soothed by a gentle pounding mo- 
 tion with the lightly clinched hands, alternating one 
 with the other over the soft parts, always avoiding the 
 bones of the spine. This may be followed by a soft pat- 
 ting with the palms of the hands and light rapid strokes 
 extending from the neck to the base of the spine and 
 repeated for several times. The circular motion with 
 
 Soothing 
 tired backs 
 
INFLAMMATION 83 
 
 the palm, keeping the fingers together and the hand 
 steady so that it stirs the deeper tissues under it in- 
 stead of moving lightly over the surface, is often very 
 restful. The inclination of one entirely unfamiliar 
 with massage, is to rub up and down the back without 
 taking the hand off, as if using a flatiron, whereas 
 passing the hand over the surface in this same circu- 
 lar motion will generally be more effective. 
 
 Regular massage given by a skilled operator is 
 very useful in many nervous disorders and in joint af- After- 
 
 ' . a r i i -■ . effects 
 
 fections. After a general massage the temperature is of the 
 usually found to have increased about a degree, and 
 there should be entire rest for an hour afterward in 
 order to get the full benefit of the treatment. 
 
 Sometimes the massage, instead of having a seda- 
 tive effect upon the nerves, seems to have quite the op- 
 posite, but in general the effect is a soothing one and 
 for this reason it is often very helpful in cases of 
 insomnia. 
 
 The head massage is simple and sometimes gives 
 considerable relief in cases of severe headache. It also Head 
 
 massage 
 
 serves as a most useful remedy for dandruff and fall- and ,i ts 
 
 J t results 
 
 ing out of the hair, because it stimulates the scalp and 
 causes new growth to appear. In the latter case it 
 must be used faithfully once, or better still twice, a 
 day for weeks before there is any evidence of improve- 
 ment. A little vaseline rubbed into the roots of the 
 hair at the same time tends to increase its growth. 
 
 When massage is to be given it is necessary to take 
 a position behind one's patient, and placing the hands Method 
 
 . of head 
 
 on opposite sides of the head, compress it gently and massage 
 give semi-rotary motion to the scalp, which will move 
 freely under the hand. The hands may be moved 
 from time to time so as to include each portion of the 
 head till the whole has been treated. One hand may 
 
&t HOME NURSING 
 
 be placed on the forehead and the other at the base of 
 the head and pressure with the same circular motion 
 applied. Beginning with the back of the head and 
 keeping one hand firmly on the forehead stroke down- 
 ward with the other in a V shape, gently pinching the 
 flesh in the nape of the neck. In stroking the fore- 
 head, place the thumbs between the eyebrows and 
 stroke firmly over the temples to the ears, both thumbs 
 working. together so as to act upon the nerves around 
 the orbits of the eyes. Friction and kneading of the 
 neck are of the greatest benefit. 
 
 For facial massage, make upward and outward 
 Facial circular movements with the tips of the fingers and 
 
 massage r & 
 
 do not reverse. 
 
 THE GIVING OF MEDICINES 
 
 Medicines may be introduced into the system in 
 How medi- various ways, the most common, of course, being 
 
 cines are i , , t i . ,_, 
 
 given through absorption in the alimentary canal. Ihe most 
 rapid absorption is gained when medicines are in- 
 jected into the tissues under the skin. Medicine may 
 also gain entrance through the rectum, through the 
 skin, and through the lungs by means of inhalation. 
 Medicines taken by mouth are absorbed in the stomach 
 and, to some extent, in the intestines. They are given 
 in the form of solutions, powders, pills, capsules, or 
 tablets. Solutions should always be well shaken and the 
 dose poured into a small glass and diluted according 
 to direction. 
 
 If no directions are given, dilute as little as possi- 
 ble. A large amount of water added to a disagreeable 
 dose often makes it harder to take and more nauseat- 
 ing. Its action also is naturally retarded by too great 
 
 To take dilution. A bit of ice held in the mouth before taking 
 
 unpleasant 
 
 doses a bad dose dulls the nerve of taste, rendering the taste 
 
INFLAMMATION 85 
 
 less unpleasant. If the nose is held while the dose is 
 being taken and it is placed far back in the throat and 
 the mouth is held open a moment afterward, the dose 
 will not be found very disagreeable. Many offensive 
 doses are now given in capsules and taken like pills. 
 They may often be thrown into the throat and carried 
 down with a quick swallow of water. 
 
 Sometimes, especially in the case of children, the 
 pill may be concealed in a spoonful of jelly or custard Concealing 
 or it may be crushed and given as a powder. Bitter or P a P er 
 powders may be inclosed in rice paper wafers which 
 come in boxes prepared for such use. A moistened 
 wafer is first laid on a teaspoon, the powder placed in 
 its centre and another wafer folded over it. The 
 spoon is now filled with water and the whole placed 
 on the tongue and taken with a drink of water. If 
 pills have become hardened with age, they may pass 
 through the body undissolved and so are worthless. 
 
 Castor oil if not given in capsule form may be 
 sandwiched between two lavers of sherry, strong cof- To take. 
 
 . . ' castor oil 
 
 fee or orange-juice. The sherry is first placed in the 
 medicine glass, the rim and sides of which have been 
 moistened with it, the oil is then carefully dropped into 
 the centre without allowing it to touch the sides of the 
 glass, more sherry is added and the dose is prepared. 
 This can be taken in one swallow, and if carefully made 
 ready, there will be no flavor of the oil left in the 
 mouth after taking it. 
 
 HYPODERMIC INJECTIONS 
 
 A drug which requires fifteen or twenty minutes 
 to act if given by mouth will usually be absorbed in ^ . , 
 
 r • • r • Quickness 
 
 five minutes if given by hypodermic injection. 'Mor- °. f absorp- 
 . . . tlon °f the 
 
 prune is commonly given in this way on account of dose 
 
 its bad effect upon the stomach. Brandy, whiskey, 
 
86 HOME NURSING 
 
 or ether are also given by hypodermic injection when 
 rapid stimulation is necessary. 
 
 It sometimes happens that in the course of a pro- 
 Surgicai tracted disease a member of the family must be de- 
 
 cleanlmess . .... 
 
 necessary pended upon to give hypodermic injections, and it 
 
 should never be done carelessly. The principles of 
 
 surgical cleanliness must be observed each time if 
 
 abscess formation is to be avoided. Both solution 
 
 and syringe must be as nearly sterile as it is possible 
 
 to make them, and the skin thoroughly cleansed with 
 
 pure alcohol before the needle is inserted. The 
 
 sterilizing needle is sometimes sterilized by being passed through 
 
 of hypo- an alcoholic flame just before inserting, but this 
 
 syringe method dulls the needle and makes its insertion more 
 
 Hypodermic Syringe of Glass and Asbestos 
 
 painful. The best method is to boil the needle for a 
 minute. This can be done in a tablespoon of water 
 over an alcohol or gas flame. It is not necessary to 
 touch the needle itself in screwing it into the barrel 
 of the syringe if one is careful in doing it. 
 
 The barrel of the syringe can be sterilized by draw- 
 Steriiizing ingf through it several times pure alcohol followed 
 
 the barrel , , ., , 
 
 by boiled water. 
 
 A comparatively new hypodermic syringe which 
 can be boiled entire is now on the market. It is made 
 wholly of glass with asbestos packing. 
 
 If the needle is in frequent use it may be kept in 
 a strong solution of carbolic acid and carefully 
 washed off with boiled water before using. 
 
 ' When the skin has been cleansed, either on the 
 outer fleshy part of the arm or leg, and the syringe 
 
CARE OF MEDICINES 87 
 
 is ready for use, the air should be expelled from it 
 
 bv pointing: the needle upward and gently pressing: How to 
 
 P . . gi v e the 
 
 the piston till a drop of the solution appears at the hypo-, 
 point. A small fold of skin is then pinched up be- injection 
 tween the thumb and finger of the left hand, and the 
 needle quickly inserted for at least half an inch, in a 
 slanting direction, and then withdrawn very slightly 
 in order that the fluid may flow more easily. The 
 fluid should be injected slowly, the needle then quickly 
 drawn out and the thumb placed over the spot for a 
 moment to prevent the escape of any of the medicine. 
 A hypodermic injection must never be given over 
 a bon\' prominence or in the region of the large 
 blood-vessels, as serious results have been known to 
 follow the introduction of a solution into a vein. 
 
 CARE OF MEDICINES 
 
 [Medicine bottles need to be distinctly labeled and 
 those containing poison especially marked to indicate Label 
 the fact. A bow of ribbon may be tied round the medicine 
 neck of a bottle to distinguish it if no means of 
 labeling is at hand. All medicines intended only for 
 external use should be kept by themselves on a shelf 
 separate from the others and never within the reach 
 of children. The medicine closet should always be 
 kept locked and should be in a dry, cool place. 
 
 When medicine is being poured from the bottle, 
 the label should be kept on the upper side, so that Precaution 
 
 1 L * in pour- 
 
 it may not become defaced. A medicine should never ing out 
 
 ■* medicines 
 
 be poured from the bottle till the label has first been 
 looked at. Such a precaution prevents the possibility 
 of a mistake being made, and the habit of glancing 
 always at the label is very easily formed. One is 
 never sure that the bottles may not have been dis- 
 
88 v HOME NURSING 
 
 arranged. No medicine should be poured out in the 
 dark : always have full, bright light. 
 
 It is a great mistake to keep medicines on hand, 
 Never as many of them spoil easily, and either become 
 
 use old , 1 J F , r , 
 
 medicines worthless or are so concentrated from long standing 
 that they are no longer safe to use. There ought to 
 be a frequent overhauling of the medicine closet, and 
 all prescriptions the use of which has been discon- 
 tinued should be thrown away. All bottles should 
 have corks and be kept closely covered. 
 
 It is a temptation for one who has observed a 
 Never pre- good many cases to suggest remedies which she 
 another, knows to have been useful to others. This habit, 
 however, is never a safe one to indulge in, and the 
 more actual knowledge one gains upon the subject 
 of the action of drugs and their varied effects on 
 different constitutions, the less willing is one to yield 
 to the temptation of prescribing. 
 
 It is important that medicines be given regularly 
 Prompt- and promptly. If there are no special orders given, 
 regularity a half-hour may be allowed between medicine and 
 
 in giving 
 
 medicines food. Most drugs act more powerfully on an empty 
 stomach than on a full one, though medicines which 
 are apt to produce nausea, as cod-liver oil, are given 
 after eating. Both spoon and glass should be washed 
 each time after using and a separate glass kept for 
 strong-smelling medicines. 
 
 In giving medicine to an unconscious patient, if 
 
 Medicines the lips are moistened first and rubbed lightly with 
 
 to an un- r ° J 
 
 conscious the spoon, he can often be made to swallow. In the 
 
 patient r ' 
 
 case of a baby the spoon should be held a moment 
 between the teeth and the child will be obliged to 
 swallow. 
 
 The use of patent medicines is deplorable. Their 
 apparent power is generally due either to the action 
 
CARE OF MEDICINES 89 
 
 of some powerful narcotic or to a very large per- 
 centage of alcohol, and in either case the temporary Don 't use 
 
 ,.,',. . patent 
 
 relief which they give only conceals the real condi- medicines 
 tion or progress of disease and the person is left far 
 worse off than before taking them. 
 
VI 
 
 CARE OF OPERATIVE CASES 
 
 Preparation for Operation— Emergency Preparation— Preparation of Patient 
 —Full Preparation for Operation— The Anaesthetic— Assisting the Surgeon 
 —After-care of Patient— The Problem of Food— Cases of Minor Sur- 
 gery—Convalescence 
 
 PREPARATION FOR OPERATION 
 
 THE need of a surgical operation to be performed 
 in the home is a possibility in any family, and 
 it is quite natural that the responsibility of prepara- 
 tion 'in 6 ™' ti° n should bewilder one not accustomed to such an 
 the home undertaking. 
 
 The mention of the word operation at once sug- 
 gests the amazing knowledge the surgical world has 
 gained in regard to the treatment of wounds and the 
 precautions necessary even in dealing with minor 
 surgery. 
 
 Two words in common use among doctors and 
 Asepsis nurses may need explanation. They are asepsis and 
 sepsi antl " antisepsis. The former indicates a condition of sur- 
 gical cleanliness or, in other words, a thing which is 
 said to be aseptic has been rendered not only free 
 from ordinary dirt, but free, so far as it is possible 
 to make it, through various means, from any trace 
 of poison-bearing germs. The latter term — antisep- 
 sis — refers to the means used to destroy microbes 
 found either in a wound or upon the hands of the 
 operator or on articles which might come in contact 
 with the wound. 
 
 There is a notable distinction between ordinary 
 cleanliness and surgical cleanliness, which must be 
 (90) 
 
CARE OF OPERATIVE CASES 91 
 
 borne in mind by all who assist in preparing for an 
 operation, and one's effort must be always toward 
 aseptic conditions so far as it is possible throughout 
 the preparation and after-care of surgical cases. 
 
 EMERGENCY PREPARATION 
 It often happens that the need of operation is so 
 imperative as to demand the immediate work of the what 
 
 . to do 
 
 surgeon, and in such a case it mav be valuable to before the 
 
 . ' . surgeon 
 
 know what is absolutely essential in the way of the arrives 
 preparation which has to be hastily made. There is 
 usually the lapse of a couple of hours, if not more, 
 before the surgeon arrives with instruments and dress- 
 ings, and in that time much can be accomplished. 
 There will be need of plenty of boiled water, both 
 hot and cold, and large kettles should be placed on 
 the stove at once and the water allowed to boil 
 twenty minutes. The water should cool in the vessel 
 in which it has been boiled, and it must be closelv Bo j led 
 
 * J water 
 
 covered and remain so until it is needed, when it can 
 either be poured into the proper receptacles or taken 
 out with a utensil which has also been boiled and 
 rendered sterile. 
 
 The room chosen for the operation should yield 
 the best possible light, and it is far better not to 
 remove hangings from the windows, for fear of fill- 
 ing the air with dust particles. They can be covered 
 if there is time with sheets, and the carpet, particu- ^| e S u ^? wn 
 larly where the table is to stand, may be covered with Wlth sheets 
 heavy manila paper or old sheets tacked down firmly. 
 
 The kitchen table usually furnishes the best sub- 
 stitute for an operating table, and it should be covered Prepara- 
 
 . . tl0n of 
 
 first with several thicknesses of blankets, then with the kitchen 
 
 ' table 
 
 a rubber sheet and a cotton one, all securely pinned 
 underneath, so that they will not be in the way. A 
 
92 
 
 HOME NURSING 
 
 Small 
 tables, 
 stool, 
 foot-tub, 
 and bowl 
 
 Position 
 of the 
 operating 
 table 
 
 Sterilizing 
 basins 
 for the 
 solutions 
 
 Treatment 
 of china 
 pitchers 
 
 flat pillow should be placed where the head is to rest, 
 and if nothing better offers this can be fashioned out 
 of a small blanket slipped into a pillow-case. 
 
 The only other furniture in the room will be two 
 small tables for the solutions, instruments, and dress- 
 ings, a commode or table for the surgeon's use in 
 scrubbing up unless there is a bathroom adjoining, 
 and a stool for him if he wishes it. A piano-stool 
 may be made use of, and if it is upholstered should 
 be covered with a towel neatly pinned into place. A 
 large pail or foot-tub is necessary to receive the soiled 
 pieces of gauze or cotton used during the operation, 
 and a bowl or pail large enough to hold a solution for 
 rinsing the hands from time to time should be placed 
 on a chair or stool within reach of the surgeon. 
 
 The operating table should be placed near the 
 window, and all the light possible must be admitted. 
 Bon ami or sapolio smeared over the panes makes 
 them opaque and yet does not exclude the light as a 
 curtain would do. 
 
 For the arrangement of the various articles in the 
 room the accompanying sketch may be suggestive. 
 
 If it is possible to get two new enamel basins to 
 hold the solutions it is the better plan, as they can so 
 easily be sterilized. After a thorough scrubbing with 
 sapolio and plenty of hot water, they should be rinsed 
 and dried, a spoonful of alcohol placed in each, being 
 particular to wet the sides of the basins with it, and a 
 lighted match applied. This must be done carefully 
 and in a suitable place, so that there will be no danger 
 from the flames. When the dishes are cool they can 
 be lifted into place, always remembering that the 
 fingers must not touch the inside, which has been 
 made sterile. China pitchers and bowls will probably 
 have to serve as receptacles for the supply of water 
 
CARE OF OPERATIVE CASES 
 
 93 
 
94 HOME NURSING 
 
 sterilizing and since they can not be treated in this way they 
 must be carefully scrubbed and rinsed with some anti- 
 septic solution followed by boiled water. 
 
 The surgeon will doubtless bring his own supply 
 
 of sterilized towels and dressings, which he will take 
 
 charge of himself, but it is always safer to provide 
 
 unsterilized towels, which can be wrung out in an 
 
 antiseptic solution and used if necessary. Two dozen 
 
 of these should be furnished, but it is not essential 
 
 that they be fine-face towels. Clean sanitary napkins 
 
 or dish-towels answer the purpose quite as well. 
 
 Plenty of alcohol, bichloride tablets, carbolic acid, 
 
 other and brandy should be on hand, and a clean brush for 
 
 in the the surgeon's nails. Safety-pins and bandages will 
 
 operation ^ e neQ ded. An abdominal bandage can be made of 
 
 three yards of white cheesecloth doubled and folded 
 
 the required width. 
 
 The room should be kept at a temperature of 70° 
 Tempera- F. unless an abdominal operation is to be performed, 
 
 ture of ...... . .. 
 
 the room in which case it will be necessary to have the tem- 
 perature remain at 8o° F. 
 
 THE PREPARATION OF THE PATIENT 
 
 The preparation of the patient will be very little 
 
 Bodily beyond putting on a fresh nightdress and stockings, 
 
 ituai treat- which are better white than black. The hair, if not 
 
 "/"lie already so arranged, should be plaited in two braids. 
 
 patient All food -and water must be withheld. Everything 
 
 possible should be done to inspire the patient with a 
 
 quiet and hopeful attitude of mind, and no trace of 
 
 excitement or nervous tremor should be observed in 
 
 the sick-room. On no account should the patient be 
 
 a witness of any of the preparations. 
 
 The anaesthetic will be given before the patient is 
 moved into the operating-room, and it is not neces- 
 
CARE OF OPERATIVE CASES 95 
 
 sary that there should ever be any knowledge of the 
 appearance of that room. The patient should void Before 
 urine the last thing before the anaesthetic is admin- anaesthetic 
 istered. If there are false teeth they must be removed, 
 as accidents have been known to occur from their 
 being left in while a patient was unconscious. Be- 
 fore being moved into the operating-room the patient 
 should be covered with a light blanket carefully ar- 
 ranged to avoid exposure. 
 
 FULL PREPARATION FOR OPERATION 
 All of this preparation can be done in the short 
 time allotted if it is undertaken quietly and system- More 
 atically. If, however, an operation is to take place pre para- 
 at some future date, a more careful preparation of tl0ns 
 the room and patient can be given. In such a case 
 the room should be thoroughly cleaned and aired, the 
 hangings and carpet removed, the walls brushed 
 down, and the floor scrubbed and washed with a 
 bichloride solution. The further preparation would 
 remain about the same as above except that it would ?.? . ster " 
 
 r llizing 
 
 be possible to sterilize towels. Packages of these towels 
 should be done up in two covers of muslin and steril- 
 ized according to the directions for sterilization given 
 in Chapter III of Part II. They should not be 
 sterilized earlier than the day before the operation. 
 
 The preparation of the patient, unless special con- 
 ditions exist, consist of a thorough evacuation of P/epara- 
 the bowels by means of a cathartic if the doctor ap- the patient 
 proves, followed by enemata till the water comes clear, 
 and a cleansing bath the night before the operation. 
 After the enemata nothing should be given in the 
 way of food except beef tea or malted milk, and all 
 nourishment must be withheld for at least three hours 
 before the operation. 
 
96 
 
 HOME NURSING' 
 
 To make 
 an ether 
 cone 
 
 Guard 
 against 
 inflam- 
 mable 
 character 
 of ether 
 
 When one 
 of the 
 family- 
 assists 
 
 THE ANESTHETIC 
 
 It is customary for the surgeon to provide the 
 anaesthetic. If ether is to be administered and there 
 is no inhaler used, an ether cone can readily be made 
 by folding two or three thicknesses of newspaper to- 
 gether to make a pad about sixteen inches long by 
 nine inches wide and covering this entirely with a 
 piece of loosely woven toweling. This pad can then 
 be twisted into the shape of a cone and pinned with 
 a small opening left at the top. A bit of absorbent 
 cotton can be put inside to receive the ether. 
 
 If the operation is at night and ether is used, it 
 is well to bear in mind the inflammable character of 
 the fumes. Ether fumes are heavier than air, and the 
 lights should be kept above the region of the can or 
 inhaler. 
 
 When chloroform is used as an anaesthetic it is 
 usual to apply vaseline over the lips and nose to pre- 
 vent irritation from the vapor. During the time that 
 the patient is getting under the influence of the anaes- 
 thetic it may be necessary that some one of the family 
 be in the room to give some assistance if the patient 
 is inclined to struggle, and considerable anxiety may 
 be removed if one realizes something of the natural 
 effect to be expected from an anaesthetic. The quick- 
 ened breathing and deeply flushed face need not cause 
 any alarm, as it does not indicate distress. 
 
 ASSISTING THE SURGEON 
 
 During the operation it will seldom be necessary 
 for one of the family to be present, as in almost all 
 cases the surgeon brings his own assistants. If, how- 
 ever, conditions require it, the duties will doubtless 
 be very simple and will consist of nothing more than 
 
CARE OF OPERATIVE CASES 97 
 
 the explicit following of the doctor's orders. A cool Explicit 
 
 , , . t . , . follow- 
 
 head, close attention to directions, and strict care not j ng f 
 to touch dressings or instruments are all the re- ^^l s 
 quirements that are necessary for such a trying 
 experience. 
 
 If, as is altogether probable, there will have to be 
 moments or even hours of intense anxiety outside a 
 closed door, the alternative is a difficult one. It is 
 well to provide one's self with some work which de- Contro1 
 
 r . . anxieties 
 
 mands concentration, because it is always possible to by work 
 keep the mind better controlled if the hands are occu- 
 pied. 
 
 The first thing, however, to be attended to will 
 be the preparation of the patient's bed. The only Special 
 
 r i- 'iiii -11 1 needs of 
 
 variation from an ordinary sick-bed that will be patient's 
 necessary is the placing of a blanket in the bed and precau"* 1 
 several hot-water bag's. There should be at least four tion . s 
 
 against 
 
 bags provided if the case is an abdominal one, and heat 
 extreme care must be taken not to have them too hot. 
 Frightful burning accidents from contact with hot- 
 water bags have occurred in the case of unconscious 
 patients, and it must never be forgotten that the 
 lowered vitality of an ether patient produces an ab- 
 normally sensitive condition. The method of holding 
 the bag to the cheek a moment in order to test its 
 heat before putting it into the bed is always a safe 
 one. One bag should be filled only half full and may 
 be laid over the heart to stimulate its action. Heat 
 should never be applied directly over or in the region 
 of the operation, as there is danger of its producing 
 hemorrhage from the sudden expansion of the blood- 
 vessels. 
 
 The pillow should be a low one, preferably of 
 hair, and a towel should be laid over the pillow-case. £J2JJ and 
 
 Two basins and gauze or towels for wiping the 
 5 Vol. 3 
 
98 HOME NURSING 
 
 mouth are to be placed on a table near the bed, for 
 vomiting is almost sure to follow the anaesthetic. 
 
 AFTER-CARE OF THE PATIENT 
 
 After the patient is returned to the sick-room he 
 must not be left a moment until consciousness is en- 
 tirely regained. Ether affects persons very differ- 
 The com- ently. With some the unconsciousness and relaxation 
 oTthe are profound and the awakening from it is like that 
 patient from a deep sleep. With others the mind seems more 
 disturbed and there is constant groaning and often 
 excited talking as the effect of the anaesthetic wears 
 off. It will be found, however, that there is no re- 
 membrance later of distress of mind or body, and if 
 this can be borne in mind the strain on the one at- 
 tending will be much less great. 
 
 If there is continued nausea or vomiting it may 
 Nausea De relieved by giving bits of cracked ice to hold in 
 
 and food °. , ~ 
 
 the mouth or a little black coffee may serve to settle 
 the stomach. Sometimes the fumes of acetic acid 
 (vinegar) relieve the feeling of nausea or a cold com- 
 press over the throat may do the same. After an 
 abdominal operation nothing should be given without 
 the doctor's knowledge, and he will wish to leave ex- 
 plicit orders as to the times and quantity of the feed- 
 ings, which must be very cautiously regulated. The 
 patient will probably express alarm lest the effort of 
 vomiting break open the wound, but there is almost 
 no chance of such a possibility, as the surgeon always 
 bears in mind this additional strain and strengthens 
 the wound accordingly. 
 
 Surgeons differ in regard to the time when ab- 
 
 Tuming dominal cases may be turned, some regarding it 
 
 essential that the patient should remain on the back 
 
 for twenty-four or even thirty-six hours, while others 
 
CARE OF OPERATIVE CASES 99 
 
 allow their patients after six hours to be turned a 
 little on the side with a pillow at the back. 
 
 It is impossible to give full instructions in regard 
 to the care of abdominal cases, since so much de- Need of 
 
 ..' . r 1 i • a special- 
 
 pends upon the condition of the patient, and it is very i s t the 
 necessary that one who thoroughly understands the first week 
 nursing of such cases should have the responsibility 
 for the first week at least. 
 
 The knee pillow is useful to relieve the strain upon 
 the abdominal wall, and a small pillow that can be ^[j^, 
 easily turned is much more comfortable for the head 
 than a large and thick feather one. 
 
 The gas pains, which are often very severe, may 
 begin to be felt during- the first twelve hours. The Relieving 
 
 ° . gas pains 
 
 soft rubber rectal tube inserted and moved about in 
 the rectum may bring away some of the gas and give 
 immediate relief, though it is hardly to be expected 
 so soon after the operation that the gas will be suffi- 
 ciently low in the bowel to be reached by the tube. 
 Gas pains indicate the activity of the bowels, and are 
 looked for as a sign that all is going well. At the 
 end of twenty-four hours, if the gas is not passing off 
 freely, the doctor will doubtless order a hot saline 
 enema to be administered high, using the soft rubber 
 tube. He may remain himself to give the first 
 enema, but if not some assistance will be needed in 
 giving it, as it is never wise to attempt it alone while 
 the patient is so weak and needs to be lifted on to the 
 bed-pan. As the bowels become warm with the water 
 the gas should begin to pass off. 
 
 It must be remembered that the bowels have been 
 thoroughlv emptied before the operation, so that it In difficult 
 
 •11 i r • .i cases 
 
 will not be necessary for the patient to retain the 
 water as for an ordinary enema. Sometimes the 
 patient is unable on account of weakness to expel 
 
100 HOME NURSING 
 
 the water, and then it should be returned by inserting 
 the long rectal tube. If after several bags of the 
 saline enema there has been no gas expelled, the 
 patient should rest a while and then the treatment 
 should be resumed until successful, as it is very im- 
 portant that the gas should not be allowed to collect 
 in the bowels. If relief does not come with the use 
 of the saline enema, the doctor will probably advise 
 some medication to be added. 
 
 With the free escape of gases the patient will 
 find great relief, and the abdomen, if it has been at 
 all distended, will appear normal again. 
 
 THE PROBLEM OF FOOD 
 
 If there are no complications attending an ab- , 
 dominal case, and the wound heals without suppura-, 
 tion, the patient will be feeling very comfortable at 
 the end of a week and will begin probably to take 
 solid food. 
 
 A few days after the operation, if the doctor 
 
 First food allows it, orangeade can be given occasionally and 
 
 few days will be most refreshing if served ice-cold with a dash 
 
 o£ lemon- juice added. If tgg albumen is mixed with 
 
 it, it can be given as nourishment, but the egg should 
 
 not be beaten, simply stirred enough not to be stringy. 
 
 The problem of variety in liquid diet is apt to be 
 
 troublesome, but there is really quite a list to choose 
 
 from if one's attention is directed to it. Milk, of 
 
 Milk course, remains the chief resource if the patient can 
 
 take it. It may be given cold or warm, as preferred, 
 
 and if very rich it can be mixed with seltzer water. 
 
 The old-fashioned gruels made of oatmeal, Indian- 
 
 Grueis meal, flour, rice, and cracker have different degrees 
 
 choked °* usefulness if properly prepared. The first two are 
 
 considered rather too heating for fever cases, and the 
 
CARE OF OPERATIVE CASES 101 
 
 last are good in cases of diarrhoea. Indian-meal gruel 
 is frequently under-cooked, and served in this way is 
 not easily digested. It should be cooked four hours, 
 and is then delicate and of sweet flavor, quite different 
 from the raw unpalatable stuff that is sometimes 
 carried to the sick-room. 
 
 The various foods on the market, such as Im- 
 perial Granum, Malted Milk, Cereal Milk, and Eskay's Other 
 Food, are useful. The latter is one of the newer foods 
 and is especially delicate and pleasant. With all of 
 these foods the directions are given on the box, 
 though in almost all cases the time given for cooking 
 is too short and individual taste may suggest some 
 variation, such as pouring the hot malted milk upon 
 a tablespoon of thick cream, which makes it a most 
 delicious drink. 
 
 Koumiss, is enjoyed by some patients, and is di- 
 gested by very delicate stomachs when other foods 
 are rejected. Fruit egg-nogs, expressed beef -juice, and 
 broths help to make variety, and albumen water, while 
 not especially palatable, can be taken without distaste 
 by most persons. 
 
 The following receipts for invalid cookery may be 
 helpful : 
 
 FRUIT EGG-XOG 
 
 One egg, one orange, half a lemon, two to four 
 teaspoons of sugar. Beat the yolk of the egg and 
 add the orange and lemon juices. Add sugar to the 
 white of the egg, and beat until stiff. Combine and 
 mix well. Pour upon cracked ice and serve at once. 
 Thin slices of banana or a few strawberries may be 
 added if desired. 
 
 EXPRESSED BEEF-JUICE 
 
 Take one pound of thick round steak, broil slightly 
 
102 HOME NURSING 
 
 and place on a hot platter. Cut in small pieces and 
 press out the juice by means of a meat-press, lemon- 
 squeezer, or potato-ricer. Add a very little salt, and 
 serve either ice-cold or warmed by placing the cup 
 in hot water a few moments before serving. If heated 
 over the fire it will curdle. 
 
 CORN-MEAL GRUEL 
 
 One pint of boiling water, one scant tablespoon of 
 Indian-corn meal. Mix the meal with a little cold 
 water and stir into the boiling water. Boil for four 
 hours. Strain and season with salt. Sugar and cream 
 may be added if wished. 
 
 MEAT-BALLS 
 
 Scrape raw beef and mold into tiny balls three- 
 quarters of an inch in diameter, with a bit of chopped 
 parsley added. Place in a hot pan over the fire, with 
 a little butter and seasoning, and keep the pan moving 
 until the balls are evenly seared. Serve on bits of 
 delicately browned toast. 
 
 PRUNES WITH WINE 
 
 Wash quickly in hot water half a pound of dried 
 prunes. Soak overnight. Cover with claret and 
 simmer until soft. Add sugar to taste and cook ten 
 minutes more. Serve cold. 
 
 CASES OF MINOR SURGERY 
 
 The cases of minor surgery, by which we mean 
 those that are not naturally attended with serious re- 
 sults, frequently do not require the services of a 
 trained nurse, though the nursing demands intelli- 
 gent watchfulness and attention to detail in the gen- 
 eral care. 
 
 Rectal cases are often treated at home with en- 
 
CARE OF OPERATIVE CASES 103 
 
 tirely satisfactory results. It must be expected that 
 there will be great suffering unless the doctor ap- Precaution 
 proves of the use of morphine, which is usually given JJJ 0V ^ of 
 at first to such cases if treated in the hospital, because |^J£" 
 a very large number of nerve-endings have to be ex- 
 posed by the operation. The removal of hemorrhoids, 
 while not regarded as a difficult operation, is yet one 
 that demands the utmost skill. Very alarming nerv- 
 ous disorders sometimes follow if too large an area 
 of the mucous membrane is interfered with, and too 
 great a number of nerves are exposed. This all goes 
 to show that even minor cases require the work of a 
 skilled operator, and a choice should not be made 
 without careful consideration and advice. If this 
 precaution is observed there need be little fear of the 
 ultimate result not being successful. 
 
 The diet in such cases will have to be limited to 
 foods which do not tend to increase the accumula- Special 
 tidn in the intestines. Only malted milk, broths, and Jjjiet 
 albumen water should be given, unless the doctor 
 allows more variety. Whenever the doctor thinks 
 best he will order purgatives or an enema, to secure 
 a free passage of the bowels. If an enema is ordered, 
 oil should be given the night before. 
 
 In cases where the operation has been for repair 
 of laceration of the perineum, which is sometimes In lacera- 
 ruptured during child-birth, the stitches should be of the 
 douched with warm water after each time of voiding penneum 
 urine, as absolute cleanliness is essential if a good 
 result is expected. 
 
 Liquid diet is required till the bowels have moved, 
 which will probably be the third day. Light diet 
 should follow for another day, and then if the bowels 
 have been thoroughly cleared and the temperature is 
 normal, full diet may be given. 
 
104 HOME NURSING 
 
 In cases of curettage or scraping of the lining of 
 in curet- the uterus, the patient is usually kept on liquid diet 
 for forty-eight hours, or until the temperature be- 
 comes normal. Douches may be ordered, and a 
 sterilized douche point and boiled water will be 
 necessary unless some antiseptic is to be used. 
 
 Sometimes in operative cases there is complete in- 
 To over- ability to void urine in the recumbent position. This 
 ability To difficulty is due to a nervous condition, which may 
 void urine not manifest itself in any other way, but unless some 
 device can overcome the trouble, the water must be 
 drawn. This should on no account be attempted by 
 unskilled hands, as unless extreme care is observed 
 there is great danger of setting up a distressing in- 
 flammation of the lining membrane of the bladder. 
 Sometimes, if very hot water is placed in the bed- 
 pan, the steam from it relaxes the muscles and the 
 patient can urinate. A hot compress over the genitals 
 or the sound of dripping water may also effect the 
 same result. All these methods should be faithfully 
 tried before resorting to catheterization. 
 
 If there has been a rectal operation it is usually 
 easier for the patient to urinate lying on the abdomen 
 rather than in the usual position. 
 
 In cases of operation for cataract the room should 
 
 Care after be kept- darkened and the patient should not be al- 
 
 ?ion° P f e o r r" lowed to turn the head on either side or to lift 
 
 cataract himself forward in the bed, for fear of jarring the 
 
 eyeball. At night the hands must be tied loosely to 
 
 the bed, giving plenty of freedom but preventing them 
 
 from reaching the head while asleep. The first night 
 
 the patient should have some one sit with him, as the 
 
 nervousness is apt to be very great. Liquid or very 
 
 soft diet must be given for a few days, because the 
 
 effort of mastication might do injury to the wound. 
 
CARE OF OPERATIVE CASES 105 
 
 Another operation which is becoming more com- 
 mon each year is the removal of the tonsils. These On re- 
 are small bodies situated in the back of the throat, of°the 
 and their function in health is a very important one. tonsils 
 They stand as sentinels to arrest the progress of any 
 foreign particles which may find their way into the 
 lungs. These particles, whether dust or micro- 
 organisms, are absorbed and disposed of by these 
 glandular bodies. In that case the system is entirely 
 unaffected by such germs-, which might otherwise 
 cause disease. When the tonsils become diseased their 
 absorptive function may be increased, but their power 
 of disposing of the absorbed matter is impaired, and 
 there is besides this the mechanical obstruction to the 
 throat and nasal passages, due to their enlargement. 
 Hence we find a patient with enlarged tonsils very 
 susceptible to colds and often suffering with other 
 disorders of digestion or catarrhal affections, and 
 generally with marked nervous symptoms. 
 
 With these facts in mind, there need be no hesi- 
 tation in following a doctor's advice as to their re- The care 
 
 T-i • 1 which 
 
 moval. I he operation is an unpleasant but not a follows 
 painful one, and the after-care required is slight, be- 
 yond frequent rinsing of the mouth and throat with a 
 weak solution of peroxide of hydrogen or whatever 
 wash is ordered. There will probably be vomiting of 
 blood and mucus, which has been swallowed during 
 the operation, and, though very disagreeable, it need 
 never seem alarming. 
 
 CONVALESCENCE 
 
 The period of convalescence, as people in general 
 realize, is apt in some respects to be the most trying. Difficulties 
 Whatever excitement the acute stage of the sickness ^scen™* 
 has furnished has tended to make one forget the 
 
106 HOME NURSING 
 
 weariness, and now while fatigue is uppermost even 
 more responsibility is given over to the nurse as the 
 doctor lessens the number of his visits. Convales- 
 cence may be rapid or very gradual, but in either case 
 great watchfulness is needed because the patient's 
 own feelings are no trustworthy guide to the amount 
 his strength is equal to, and no patient is able to 
 realize this, particularly if it is the first illness. 
 
 In surgical cases, unless there has been a heavy 
 
 When drain upon the system and great depletion of strength 
 
 recovery previous to the operation, a speedy recovery may be 
 
 lookecTfor l°°ked f° r - Less caution is usually necessary in the 
 
 matter of diet than must be observed in medical cases, 
 
 but rich and heavy food should never be brought to 
 
 the sick-room. The patient's whims and fancies can 
 
 often be indulged, but it should not surprise, much 
 
 less offend, the nurse if after taking great pains to 
 
 prepare some special delicacy, it is not touched or is 
 
 even set aside with querulous impatience. 
 
 Some persons seem to have less control over 
 irascibii- their feelings than others, and it is true that irritability 
 the °corwa- of disposition sometimes accompanies weakness of 
 lescent body in persons naturally sweet-tempered. If patience 
 is exerted for a few days till a little more strength is 
 gained, the patient will generally realize that he is 
 unreasonable and be able to gain better self-control. 
 Any one of us as a patient is liable to feel this 
 irascibility, and it is well to recognize that while much 
 is excused when bodily weakness has impaired the 
 will, the effort to strengthen it must not be over- 
 looked or indulgence in ill-temper allowed. 
 
 In preparing a tray for an invalid it should never 
 
 Ways of be forgotten that small portions daintily served will 
 
 his food quicken the appetite when a carelessly prepared meal 
 
 may be left untouched, though the patient very likely 
 
CARE OF OPERATIVE CASES 107 
 
 will not realize why he can not eat. It is far better 
 that too little rather than too much be furnished. A 
 half cup of soup served alone and very hot, a deli- 
 cately browned chop with a few green peas placed on 
 a hot plate with a hot cover, a piece of roasted potato 
 rolled in a napkin beside the plate, a bit of bread and 
 a small serving of some light dessert, furnishes an 
 ample dinner for full diet. A simple salad may be 
 added if the patient enjoys it. A single flower or a 
 
 A Nightingale. The Corners Turned Back are to be Fastened as Sleeves 
 
 sweet-scented leaf laid on the tray is always appre- 
 ciated, but one must not make the attempt at orna- 
 mentation elaborate. 
 
 It is most annoying to a patient to be constantly 
 beset with questions as to what he would like to eat. Avoid 
 
 tt 1 i iii- i -,i discussing 
 
 He does not know, and the thing that will give most his food 
 pleasure is that which has not been discussed before 
 him. The nurse should be on the alert to observe 
 and to remember his tastes, and when the right occa- 
 sion comes can often give a pleasant surprise by placing 
 quietly before him some favorite or new dish which 
 has not been spoiled for him by being talked about. 
 
 When a patient begins to sit up in bed a loose 
 flannel jacket or a nightingale should be slipped on. 
 
108 
 
 HOME NURSING 
 
 The first 
 loose wrap 
 
 The first 
 sitting up 
 
 Extreme 
 weakness 
 after 
 
 illness 
 
 Dress for 
 man and 
 woman 
 
 This latter is a wrap that is easily made and very 
 convenient. Two yards of flannel of ordinary width 
 are required. Cut a straight slit six inches deep in 
 the middle of one side, turn back the points so 
 formed for a collar and those of the corners furthest 
 from it for cuffs ; bind or pink the edges, and add 
 buttons and buttonholes for front and cuffs. 
 
 Half an hour is a sufficiently long time for a pa- 
 tient to sit up for the first day. As improvement in the 
 patient's condition is made the time for sitting up can 
 be increased and he can be lifted to an easy chair or 
 sofa for a change. At first he should not be kept up 
 longer than the time necessary to make the bed, when 
 he will probably be very willing to return. 
 
 The extreme weakness that is felt after having been 
 kept in bed for some weeks, even though the illness 
 may not have been severe, is always surprising to one 
 who realizes it for the first time. On no account should 
 the patient be allowed to get up and dress himself, and 
 some one must always be near to help him with his 
 first steps or he will be very likely to fall. Not more 
 than one person should be in the room, unless other 
 assistance is necessary, as it is best to make the con- 
 fusion as little as possible. 
 
 The room should be warmer than when the patient 
 is in bed. To provide against a draught, first place a 
 blanket in the chair, and when he is seated, fold it up 
 over the feet. A footstool is always desirable. The 
 clothing should be sufficiently warm, but not cumber- 
 some. A man will be more comfortable in a warm 
 bathrobe when the time comes for walking about the 
 room and a woman should not be burdened with a tea- 
 gown having a heavy train, but should wear a loose 
 short wrapper. 
 
 A patient should not feel obliged to see all the vis- 
 
CARE OF OPERATIVE CASES 109 
 
 itors who call. Even if he wishes it this is unwise and 
 
 the nurse should protect him against the fatigue which Protect 
 
 - n , r. , thein- 
 
 is sure to tollow too much company, borne people valid from 
 understand perfectly the limitations of a sick person's %lsltor 
 strength and a short and cheery call from such is a 
 benefit, but others with equally good intent make no 
 distinctions and wish to stay on for a lengthy visit as 
 if the patient were well. Two visitors coming together 
 always make it harder for the invalid, as there is more 
 strain in talking, and it is better that they come at 
 different times if possible. 
 
 Place the visitor's chair in a good position near 
 the bed where there will be little effort for the patient Suggest 
 in listening to what is said and be on the watch for ca rier go 
 the first sign of fatigue, then do not hesitate to sug- s[^ 5 rst of 
 gest that the visit must be ended and the patient left f *tigue 
 to rest. If this is done with good nature and in a 
 spirit of friendliness, taking for granted that the good 
 of the patient is the first consideration, the visitor need 
 not feel anv embarrassment. 
 
VII 
 
 ACCIDENTS AND EMERGENCIES 
 
 Shock— Hemorrhage— Bleeding from Nose — Bleeding from .Lungs— Fainting 
 — Fractures — Dislocations — Contusions — Sprains — Chilblains — Frostbites — 
 Toothache— Warts— Cuts— Burns and Scalds— Foreign Bodies— Sunstroke 
 and Heat Exhaustion — Artificial Respiration -^ Insect Bites — Bites of 
 Snakes and Rabid Animals— Poisons 
 
 Simple 
 directions 
 every one 
 ought to 
 be ac- 
 quainted 
 with 
 
 Keep 
 away the 
 curious 
 crowd 
 
 In the city 
 
 EVERY household may expect a certain amount of 
 anxiety and trouble over slight bodily accidents, 
 especially if there are children in the family, and at any 
 time one ought to be prepared to meet these with in- 
 telligence and also so far as it is possible to face the 
 graver emergencies which may come in the same way. 
 It has often been noticed that persons thought to be 
 nervous and unstable in time of alarm show a self- 
 control and power of directing others that is very sur- 
 prising. It is most unfortunate when at such times 
 the mind is able to think clearly, yet is ignorant of 
 how to act. Some simple directions every one ought 
 to be acquainted with follow. 
 
 The flock of well-intentioned but helpless individ- 
 uals who gather about when an accident has occurred, 
 must be kept as far as possible from the patient, so that 
 he may have plenty of breathing space. The assistance 
 of a policeman will probably be necessary in order to 
 keep the crowd away. If the accident has taken place 
 in a house curious neighbors who come ready with sug- 
 gestions must be kept out and not allowed to throng 
 into the room. 
 
 In the city an ambulance can be summoned in a 
 few moments, and if a policeman is at hand he will 
 attend to that, if not some reliable person may be sent 
 (no) 
 
ACCIDENTS AND EMERGENXIES 111 
 
 to the nearest police station or to telephone for the 
 conveyance. 
 
 If the accident occurs on a country road, the first 
 thing to do, if there is no hemorrhage to be arrested, is On a coun- 
 
 t 11 11 try road 
 
 to get the patient ready to be moved to the nearest 
 house. If the patient is insensible, he should be turned 
 on one side and the head raised on a level with the rest 
 of the body so that he can breathe more easily. His 
 clothing should also be loosened, especially about the 
 neck and abdomen. If the patient can swallow, water 
 may be given to drink and the face can be bathed or 
 sprinkled with water, but no stimulants should be 
 given unless it is clear that they are needed. 
 
 SHOCK 
 
 If there is shock or collapse as a result of the ac- 
 cident, it will be shown by a cold and clammy condi- The con- 
 tiom of the skin and extreme pallor or blueness about s iock or 
 the lips and finger-nails. The pulse grows very feeble, collapse 
 if indeed it can be felt at all ; the patient will complain 
 of faintness and the breathing will be irregular and 
 sighing. Such a condition demands prompt action if 
 life is to be saved, and here stimulants are called for 
 without delay. 
 
 Brandy is more useful than wine and should be 
 given in small quantity, watching its effect. If the Alcoholic 
 pulse grows stronger, the breathing deeper, and the ^oiiaple, 
 body warmer, it may be kept up in teaspoon doses 
 every fifteen minutes till there is complete reaction, 
 when it should be discontinued. If there has been no 
 loss of blood, alcoholic stimulants should be used spar- 
 ingly and entirely withheld if no sign of improvement 
 follows the first dose. Strong coffee may be used and 
 is always safe, though not so practicable, because of the 
 delay necessary in obtaining it. 
 
112 HOME NURSING 
 
 If there is bleeding or local injury of any sort, it 
 How to must be treated according to the directions to be given 
 the doctor ^ ater on * ^ written message stating as clearly as pos- 
 sible the nature of the case should be sent to the near- 
 est doctor, as it is never safe to trust to a verbal mes- 
 sage, no matter how reliable the person may be who is 
 to deliver it. 
 
 If it seems advisable before the doctor arrives, the 
 patient may be removed to the nearest house. If there 
 has been an injury to the head of any serious account 
 do not allow him to walk, even if he seems quite able. 
 He must be made to lie down and transported as easily 
 How to as possible. A stretcher can be made of a blind, a door, 
 patient or an y stout board upon which the patient can lie 
 horizontally, and those who carry it should be in- 
 structed not to take it on the shoulder, but with the 
 hands, as there will be less jolting if carried that way. 
 It. is better also if they do not attempt to keep step. 
 
 HEMORRHAGE 
 
 Bleeding from an artery may be recognized by the 
 Bleeding wav the blood spurts out in bright red jets. If a vein 
 from an } s injured the blood oozes forth and is duller in color. 
 
 artery * 
 
 Bleeding from an artery is always serious, because of 
 the quantity of blood that escapes in a short time* 
 owing to the amount of pressure in the blood-vessels, 
 and it must be arrested at once. 
 
 The blood coming through the arteries is being 
 Directions carried away from the heart, while that in the veins is 
 fng the*" returning to it. . For this reason it is plain that bleed- 
 hemor- [ n g f r0 m an artery must be checked by means of pres- 
 sure above the wound, i. e., between it and the heart, 
 whereas that from a vein demands pressure below the 
 wound. 
 
 If a limb is bleeding it should be elevated above the 
 
ACCIDENTS AND EMERGENCIES 113 
 
 level of the heart, and if pressure with the finger is 
 not sufficient to check the flow of blood a handkerchief 
 may be knotted or a smooth stone tied in it and the 
 knot or stone placed directly over the wound or upon 
 the artery above the wound if the bleeding is arterial. 
 Another handkerchief is used to tie around the limb if from 
 in order to hold the compress in place, and through the a hmb 
 knot of this, which should be rather loosely made, a 
 stick should be carried and twisted until sufficient pres- 
 sure is applied to stop the hemorrhage. If one end 
 of the stick is tucked under the edge of the handker- a tour- 
 chief, it will be kept from untwisting. Such an ap- bandage 
 paratus is known as a tourniquet bandage, and should 
 not be left on a limb longer than an hour for fear of 
 gangrene resulting from the stoppage of circulation. 
 
 The limb must be examined from time to time, and ^ r< j in ^ b 
 if it becomes very cold and dark colored the bandage 
 must be loosened. 
 
 The main artery of the arm runs along the inner 
 side of the large muscle in front, keeping further for- Main 
 ward as it nears the elbow. It is most easily found the arm 
 and compressed a little above the middle. 
 
 The artery on the thigh runs a similar course. A 
 little above the knee it passes to the back of the bone. Main 
 For injuries at or above the knee, the compress should *he\l g ° 
 be applied high up on the inner side of the thigh with 
 the knot and stick on the outer side. When the lower 
 leg is wounded, the compress should be placed at the 
 back of the leg just above the' knee. 
 
 If a vein is bleeding, a compress applied directly When a 
 over the wound will be all that is usually required, deeding 
 The tourniquet is not to be used. 
 
 If a bandage can not be readily applied to the part 
 that is bleeding, ice wrapped in a cloth and placed Use of ice 
 over the wound often answers the same purpose. 
 
Remedial 
 measures 
 
 114 HOME NURSING 
 
 If there is bleeding from the palm of the hand the 
 hand should be closed tightly over a wad of cotton and 
 the arm raised and held above the head. 
 
 BLEEDING FROM THE NOSE 
 
 Bleeding from the nose, unless it results from ac- 
 cident to the head, is generally of slight moment, and 
 is occasioned by the effort on the part of Nature to 
 relieve a congested state of the head. The common 
 practice of holding the head over a basin is the surest 
 possible means of increasing the bleeding. 
 
 The nead should be kept erect or thrown back, and 
 a cold compress held to the nostrils. After a few 
 |JJ_ bl e f ed " moments the blood will in all probability stop flowing, 
 the nose an( i the head will feel relieved of pressure. If the 
 bleeding does not stop soon, pressure should be made 
 with the finger on the centre of the upper lip, as this 
 will compress the facial artery. Bits of ice or cloths 
 wrung out in cold water should be laid on the back 
 of the neck, and the arm raised above the head. The 
 lifting of the arm distributes the force of the heart's 
 action and relieves the pressure in the large blood- 
 vessels supplying the head. If bleeding still continues, 
 the nose may be syringed with ice-cold salt solution, 
 vinegar or water. After bleeding has ceased, blowing 
 the nose should be avoided for some time, as it may 
 dislodge some of the clots which have formed there and 
 bring on further bleeding. 
 When the ^ after resorting to these measures, bleeding is 
 should be st *^ uncontrollable, it should be regarded as a hemor- 
 summoned rhage, endangering life, and the doctor summoned. 
 
 HEMORRHAGE FROM THE LUNGS 
 
 Blood which comes from the lungs is usually 
 coughed up and is so mixed with air that it has a 
 
ACCIDENTS AND EMERGENCIES 115 
 
 somewhat frothy appearance. Blood coming from the 
 nose or throat is sometimes supposed to come from 
 the lungs. 
 
 If hemorrhage is really taking place it is a serious 
 symptom, and the patient's condition will soon indi- Serious- 
 
 . . , ness of 
 
 cate the need of wise measures to preserve his strength hemor- 
 and cheek the hemorrhage. The pulse will grow rapid rhage 
 and weak and there may be signs of collapse such as 
 cold hands and feet, blueness about the nostrils and 
 nails, dizziness and ringing in the ears. The patient 
 should be kept absolutely quiet, not even being al- 
 lowed to move his position himself or lift his hand. 
 Bits of cracked ice should be given frequently and Treatment 
 small quantities of cold liquid nourishment. Ice-cold 
 cloths or an ice bag should be placed over the chest, 
 and the head and shoulders slightly elevated. Hot- 
 water bags may be placed at the feet. 
 
 If the arrival of a doctor is delayed, straps or 
 bandages can be applied tightly around the ankles and To c heck 
 
 . the flow 
 
 wrists to check the now of blood passing to the lungs of blood 
 and thus give opportunity for clots to form in the 
 bleeding vessels. This may serve to entirely check the 
 hemorrhage. The bandages should be put on one arm 
 and the opposite leg, left in position not more than five 
 minutes, and the same thing be repeated to the other 
 limbs, one set of bandages being left on till the others 
 are in place. 
 
 FAINTING 
 
 Fainting, which is sometimes confounded with 
 shock, is occasioned by there being an insufficient Treatment 
 amount of blood sent to the head. The patient should jjgrson 
 be laid on his back with the head slierhtlv lower than ^ vl ?° h f s 
 
 ° J fainted 
 
 the rest of the body, the clothes loosened and plenty 
 of fresh air admitted. Cold water may be sprinkled 
 
116 HOME NURSING 
 
 over the face, or the forehead bathed with it. This 
 treatment will usually be enough to restore conscious- 
 ness. Ammonium salts should never be held close to 
 Avoid am- the nostrils of an unconscious person, as bronchitis has 
 salts been known to follow the extreme irritation of the re- 
 
 spiratory tract caused from its use. 
 
 FRACTURES 
 
 Fractures or broken bones are among the more or 
 less frequent accidents to be considered. It is a corn- 
 Have the mon belief that there should be no delay in having a 
 bon e en fracture set, but it is far better that a competent doctor 
 accurately or sur g eon should be found to do it, even if it take a 
 day or two, than that splints should be applied in a 
 clumsy and ineffective manner, which can only cause 
 deformity in the end. 
 
 The essential thing to be done is to place the in- 
 Care be- jured part in as comfortable a position as possible, tak- 
 setting 6 ing care not to handle it more than is absolutely nec- 
 essary, as there is danger of the surrounding tissues 
 being bruised and blood-vessels cut by the jagged ends 
 of the broken bone. Clothing can be ripped along the 
 seams or cut if necessary and slowly removed, begin- 
 ning with the uninjured side. 
 
 An injured limb should never remain unsupported 
 Support- for an instant. If the hands are slipped underneath, 
 infured the one below and the other above the fracture, the 
 limb limb can be gently placed in a natural position and 
 
 should be slightly elevated. Gentle extension is nec- 
 essary in order that the split bones may not rub to- 
 gether. 
 
 Temporary splints can be made of pasteboard, 
 
 Temporary shingles, or some stiff substance which may be padded 
 
 with something soft. A broken leg can be laid on a 
 
 pillow, which is then bound closely around it. If the 
 
ACCIDENTS AND EMERGENCIES 117 
 
 thigh is broken, the splint must extend from the arm- 
 pit to the ankle and should be bound to the leg at fre- 
 quent intervals by means of towels or large pieces of 
 cloth. 
 
 If the upper arm is broken it can be bound to the 
 side of the body. If it is the forearm, padded splints in a 
 should be placed above and below it and a bandage ap- arm 
 plied after making slight extension by drawing gently 
 on the patient's wrist. The arm when bandaged should 
 be hung in a sling which ought to be wide enough to 
 support it from the elbow to the finger-tips. 
 
 For a fractured collar-bone, the patient must be 
 laid flat on his back without a pillow. A pad is placed ^reJcoi- 
 in the axilla and the arm of the injured side is carried lar bone 
 across the chest and bound in place. This position will 
 separate the ends of the bones so that they can not rub 
 together. 
 
 If the ribs are broken, a broad body bandage is 
 applied tightly around the chest to limit its motion. A broken 
 If the patient raises any blood it is a serious symptom, " 
 probably indicating that one of the sharp edges of 
 bone has pierced the lung tissue. 
 
 If a skull fracture is suspected, the patient should 
 be placed in a dark room and kept perfectly quiet on in frac- 
 his back with the head slightly raised and cold cloths the skuii 
 or an ice bag applied to it. No stimulants should be 
 given. Any oozing of blood or serum from the ears 
 is significant and should be made known to the doctor. 
 
 DISLOCATIONS' 
 
 In dislocation the muscular contraction is so great 
 that its reduction becomes more difficult the longer it 
 is delayed. A dislocated joint is always very painful, a disio- 
 but there is little that can be done for the relief of a cated joint 
 patient before the arrival of the doctor. Cold appli- 
 
118 
 
 HOME NURSING 
 
 A dislo- 
 cated jaw 
 
 cations can be made to the injured part, in order to 
 retard the swelling. 
 
 A dislocated jaw may be reduced by simple meas- 
 ures, which should be resorted to if no doctor is near. 
 The thumbs should be placed upon the back teeth, the 
 fingers of each hand under the jaw and considerable 
 pressure be brought downward and backward till the 
 jaw slips into place. When this happens, the teeth are 
 brought suddenly together, so that the thumbs will 
 need to be well protected. 
 
 How to 
 
 treat 
 
 sprains 
 
 CONTUSIONS 
 
 Contusions or bruises are best treated with hot ap- 
 
 Treatment plications of arnica or hamamelis diluted half with 
 
 water. If the skin is abrased, the hamamelis should 
 
 be used in preference to the arnica. A warm bath 
 
 often gives relief after a general contusion. 
 
 SPRAINS 
 Copious douching with hot water, followed by 
 cold, is excellent treatment for a sprained joint. This 
 should be kept up alternately for fifteen minutes two 
 or three times a day if good results are to follow. The 
 sprained joint must be kept perfectly at rest, and a 
 cold compress kept on in the intervals between the 
 douchings. 
 
 CHILBLAINS 
 
 If there is a tendency to chilblains, the feet should 
 Remedies be loosely and warmly clad, and after they have been 
 exposed to cold they should be gradually warmed 
 rather than brought at once to the heat. Sometimes 
 painting with iodine relieves the extreme itching. If 
 chilblains are persistent, the condition should be made 
 known to a physician, as ulcers may develop if the 
 soreness is neglected. 
 
 blains 
 
ACCIDENTS AND EMERGENCIES 119 
 
 FROSTBITES 
 When a part of the body has become frostbitten, it 
 is essential that the circulation be restored very grad- Treat with 
 
 . ice water 
 
 ually, by friction with cloths wrung out in ice water or 
 snow. Sudden heating of a frozen part causes de- 
 struction of tissue and gangrene. 
 
 TOOTHACHE 
 
 Toothache is often relieved if there is a cavity 
 which can be plainly seen by carrying in a wisp of ab- Treatment 
 sorbent cotton wet in pure carbolic. This must be ache from 
 done carefully, in order that the gums immediately a 
 surrounding the tooth shall not be burned with the 
 acid. A toothpick smoothed so that the cotton will 
 not catch on it and be drawn out is a good thing to 
 use. 
 
 It is well to practice first using plain water to 
 moisten the cotton until it can be done skilfully enough 
 to attempt with the acid. The merest fleck of cotton 
 is sufficient to use and is wound lightly on the end of 
 the toothpick and moistened very slightly with the 
 acid. 
 
 A good light is necessary in order to see well 
 enough to carry the cotton easily into the cavity. The 
 same treatment may be used, substituting compound 
 tincture of benzoin for the acid, but its effect is not 
 likely to be so lasting as the latter. 
 
 WARTS 
 Warts can be successfully removed by the use of 
 glacial acetic acid introduced twice a day into the roots To remove 
 of the growth. This can be done best by means of a 
 toothpick without cotton. The acid should be confined 
 to the centre of the wart, which will begin in a few 
 days to crumble away. It may take several weeks for 
 
120 
 
 HOME NURSING 
 
 Need 
 of care 
 of cuts 
 
 a wart to disappear entirely under this treatment, but it 
 is sure to yield in time. The use of nitric acid, though 
 causing the wart to disappear rapidly, is exceedingly 
 painful, whereas the milder acid has no unpleasant 
 effect. 
 
 CUTS 
 
 Small cuts must be properly cared for, because of 
 the danger of their becoming points of infection. It is 
 better that a fresh cut should bleed somewhat freely, 
 in order that any foreign substance which may have 
 found entrance shall be washed out of the wound. If 
 the wounded part is placed in warm water and gently 
 squeezed, it will assist the escape of impurities. After 
 the bleeding is checked, a perfectly clean piece of 
 muslin or linen wet in weak carbolic or other antiseptic 
 solution should be laid over the wound and a bandage 
 applied. 
 
 Nothing in the nature of salves or ointments is 
 No salves needed over a clean wound, and it is better that they 
 should be dispensed with, because they sometimes carry 
 infection unless taken from an absolutely fresh sup- 
 ply. If anything seems to be needed, however, to keep 
 the cloth from sticking to the wound a very little of 
 the carbolized vaseline may be spread on the cloth. 
 
 On no account should cobwebs be used to arrest 
 Never use bleeding from a wound. This old-fashioned device has 
 no doubt accomplished its purpose many times and 
 established the clotting of the blood just as lint is able 
 to do, but in using the former we bring to the wound 
 the dirt and dust which we know to be so disastrous. 
 It is because Nature stands ready to correct our mis- 
 takes that serious consequences do not more often re- 
 sult from our carelessness. The utmost care should 
 be taken to keep even slight wounds perfectly clean, 
 in order to avoid the possibility of serious infection. 
 
 or oint 
 merits 
 
 cobwebs 
 
ACCIDENTS AND EMERGENCIES 121 
 
 Before dressing a cut, the hands of the one doing 
 the dressing should be thoroughly scrubbed and noth- in dressing 
 ing but the dressings touched until the wound is ban- 
 daged. The edges of the wound should be brought 
 neatly into apposition before the wet pad is applied. 
 If the cut is a long one and there is surgeons' plaster 
 at hand, narrow strips of it can be used to hold the 
 edges together. The ends of the cut should always 
 be left uncovered and free for the sake of drainage. 
 
 If for any reason the dressing of a wound has to 
 be cared for at home with an occasional visit from the 
 doctor, he will doubtless give full instructions in regard 
 to it. If, however, he should be careless about direc- 
 tions or they should not be perfectly understood, the General 
 following general method will always be safe and use- dressing 
 ful to adopt. After placing a clean towel on the table, a wound 
 lay upon it the dressings to be used, and, if needed, the 
 little basin in which forceps and scissors have already 
 been boiled. If a solution is to be used, that, too, . 
 should be in a bowl on the table, or if an ointment is 
 to be applied, it should be spread ready for use. A 
 silver table knife may be boiled to use for spreading 
 the ointment. After removing the soiled dressings and 
 placing them in a basin or paper which has been pro- 
 vided for the purpose, the hands should be scrubbed 
 vigorously with a nail brush for several minutes and 
 rinsed in a basin of some antiseptic solution. A piece 
 of sterilized gauze may be used for drying them. 
 From this time on, nothing may be handled but the 
 dressings and instruments until the wound is covered. 
 
 BURNS AND SCALDS 
 
 A scald is an injury caused by moist heat, while a 
 
 burn is occasioned by dry heat. Burns are usually clas- degree" 66 
 
 sified as of three degrees, the first showing mere redness of burns 
 6 Vol. 3 
 
122 HOME NURSING 
 
 of the skin, the second extending through the true skin, 
 and the third involving the deeper tissues. This classi- 
 fication, however, does not indicate anything in regard 
 to the serious nature of a burn, because the extent as 
 well as the depth of the injury has to be reckoned 
 with. A superficial burn which covers a large sur- 
 face, thus interfering for the time being with the true 
 function of the skin, may be more alarming in its con- 
 sequences than a small but deep burn. A burn of the 
 first degree, which involves a third of the surface of 
 the body, is usually fatal, especially in the case of a 
 child. This is largely because of the additional amount 
 of work which is thrown upon the kidneys. 
 
 A superficial burn may be treated with a solution 
 To treat of bicarbonate of soda, which is found in every house- 
 LiaiTurn hold ^ or cooking purposes, or dusted with flour, which 
 is cooling, if the skin is not broken. Much pain may 
 be spared if the air is excluded from a burn and dress- 
 ings should be applied for this reason if for no other. 
 
 When the skin is broken, wet applications should 
 be made. The use of a powder would be irritating by 
 caking upon the raw surface. As soon as the blisters 
 Punctur- form they should be punctured at their base with a 
 Misters large needle which has been held in the gas jet a 
 moment in order to burn off inpurities and make it 
 sterile. The serum that oozes forth can be gently 
 mopped up with absorbent cotton. 
 
 Boracic acid solution, or better still one made of a 
 
 mixture of boracic acid and salicylic acid and known 
 
 Thiersch's as Thiersch's powder, is cleaner to use than the oils 
 
 powder r ' 
 
 and ointments which were much in vogue at one time. 
 If a burn is extensive or very deep, a doctor must give 
 advice about its treatment, but for an ordinary small 
 burn the solution made of Thiersch's powder will be 
 found to keep the burn clean and cause it to heal 
 
ACCIDENTS AND EMERGENCIES 123 
 
 rapidly. The solution is made by adding half a tea- 
 spoon of the powder to a pint of warm water and the 
 dressing should be kept moist. This is best accom- 
 plished by covering the dressing with oiled silk or firm 
 rubber tissue and cutting holes here and there, through 
 which to pour the solution. 
 
 In dressing a burn, all the ordinary precautions of Absolute 
 
 7. 11 1 r i cleanliness 
 
 absolute cleanliness are to be observed as tor the treat- 
 ment of any wound. 
 
 If a burn is severe, complications may be looked 
 for. Brain disturbances, bronchitis, and pneumonia are Serious 
 not uncommon sequelae, and ' if the alimentary tract J^ s burns 
 has been injured the digestive process may be seriously 
 impaired. The danger of shock is always great after 
 a burn of any large extent, and the patient should be 
 kept quiet and warm and stimulants given to keep up 
 the heart's action. 
 
 Great deformity sometimes results in the case of 
 severe burns from the contraction of the skin in heal- J° P revent 
 
 deforming 
 
 ing. Something can be done toward preventing this contraction 
 by a wise adjustment of splints in order to keep the muscles 
 parts in the best position. When the splints are re- 
 moved for dressings the joints should be moved freely 
 to guard against stiffness. 
 
 The diet should be light and liberal in order to keep 
 up the patient's strength, which is having a heavy drain iet 
 upon it while the healing process is going on. 
 
 There would be fewer grave results of accident by 
 fire if more people realized how to act in an emergency, if your 
 If one's own clothes catch fire, lie down instantly and C atch fire 
 roll on the floor, remembering to keep the mouth closed 
 in order not to inhale the flames. If a rug is at hand 
 and can be reached that will help to smother the flames. 
 The first impulse is very naturally to run and call for 
 aid, but nothing that one could do would be more dis- 
 
124 
 
 HOME NURSING 
 
 If an- 
 other's 
 clothes 
 catch fire 
 
 astrous, since the current of air thus set in motion only 
 serves to fan the flames. 
 
 If another person is afire, do not hesitate a moment 
 to knock him down and to wrap quickly about him 
 whatever is at hand in the way of a rug, blanket, shawl, 
 or overcoat, being careful to protect the head first. 
 
 FOREIGN BODIES 
 
 To float 
 away for- 
 eign body 
 on the 
 eyeball 
 
 If a par- 
 ticle is 
 caught in 
 the lid 
 
 If a par- 
 ticle is 
 imbedded 
 in the 
 eyeball 
 
 Any foreign body in the eye causes great pain and 
 discomfort. If the particle is not imbedded in the eye- 
 ball it can often be floated out and into the nasal pas- 
 sage by lifting the lid of the eye outward and down- 
 ward and holding it a moment. This causes the tear 
 glands to secrete freely and also throws the lower eye- 
 lashes against the eyeball in such a way that they act 
 as a brush. If the nose is blown vigorously while the 
 eyelid is being held, the offending particle will usually 
 disappear. 
 
 If a particle gets caught under the lower lid and 
 can be seen there it may be wiped out with the fold of 
 a soft handkerchief. If it is under the upper eyelid, 
 the latter can be folded back over a small pencil or 
 knitting needle, the patient directing his eyes to the 
 floor while the particle is wiped out. 
 
 The eyeball must always be treated very gently and 
 never rubbed hard with the hand. When it is neces- 
 sary to examine an inflamed eye let the index finger 
 hang over the eyebrow and gently draw up the lid 
 without touching the eye, If a particle is imbedded 
 in the eyeball and can be plainly seen, it may some- 
 times be removed, provided the patient is not nervous, 
 by means of a small piece of rather stiff letter paper, 
 creased to form a scoop. This can be used to pick out 
 the particle and will answer very well if the latter is 
 
ACCIDENTS AND EMERGENCIES 125 
 
 not too deeply buried. If this is not successful, the 
 services of a physician will be required. 
 
 Sometimes a fragment of lime gets into the eye and 
 burns into the eyeball. The eye should be bathed at When 
 once in some mild acid, as vinegar or lemon- juice di- in the eye 
 luted to about one teaspoon to a cup of water. This 
 will neutralize the effect of the alkali. 
 
 If it is necessary to put drops into another person's 
 eye a medicine dropper is used for the purpose. If the Using a 
 drops are to be warmed before applying them (and dropper 
 the physician should state whether he wishes this done) 
 the medicine dropper after it has been filled may be 
 passed once or twice over the alcohol flame. The end 
 of the dropper will need to be held up while doing 
 this in order that the fluid may not escape as the glass 
 expands. 
 
 If some hard substance gets into the ear, there may 
 be gentle syringing with warm water unless it is a pea To take 
 or bean which obstructs and which would only swell substance 
 with the water and add to the trouble. If the lobe of [ n ° m ear 
 the ear is gently pulled out and down, the canal is 
 straightened so that the water has freer passage. A 
 medicine dropper placed on the end of a fountain 
 syringe is the best thing to use for ear-syringing. 
 
 If an insect has gotten into the ear, turn the pa- 
 tient on the unaffected side and fill the ear with warm When an 
 oil or glycerine, which will catch the insect and float in the ear 
 it to the outside. Another method is to saturate a 
 piece of cotton with a strong solution of salt or vine- 
 gar and placing it firmly in the ear, have the patient 
 lie on the affected side. After a short time if the cotton 
 is withdrawn the insect will probably be found upon it. 
 
 The ear has a most intricate and delicate mechanism 
 and serious injury, even permanent deafness, may re- ^eSme^t 1 
 suit from careless treatment. The practice of thrusting of the ear 
 
remove 
 
 abnormal 
 
 wax 
 
 126 HOME NURSING 
 
 hairpins and other articles into the ears is a very dan- 
 gerous one, and nothing should ever be introduced 
 further than it is possible to get the little finger. 
 
 Sometimes the natural secretions of the ear fail 
 
 A physi- in their normal function of keeping the wax moist, so 
 that the latter collects into a hard ball and so obstructs 
 the passage as to cause temporary deafness. This 
 condition is easily recognized by a physician and with 
 the proper instruments the wax can be removed with- 
 out causing any distress to the patient. 
 
 If a child gets something lodged in the nostril make 
 
 To dis- hi m take a deep breath, close the mouth and unob- 
 
 lodge a x 
 
 foreign structed nostril and give a strong expiration. The 
 
 the nostril force of the air which has been excluded from the 
 
 other outlets will usually blow out the object. 
 
 A foreign substance that has been swallowed, such 
 as a button, coin, etc., usually passes through the in- 
 testines and no harm results from it. It should always 
 SSV ^ e watched for in the stools. If a sharp object has 
 substance been swallowed it is best not to give purgatives, but 
 lowed. to restrict the diet to solid foods, so that the object 
 may become imbedded in the food and carried along 
 without causing injury. 
 
 SUNSTROKE AND HEAT EXHAUSTION 
 
 The danger of sunstroke is less in the country, 
 what in- w here the air is pure and where people live with less 
 
 creases c r r 
 
 danger of nervous tension, than in the overcrowded districts of 
 the city, where the reverse is true. People also of 
 intemperate habits are more liable to suffer from the 
 excessive heat. 
 
 The terms sunstroke and heat exhaustion are not 
 
 Sunstroke synonymous, the effects being quite different in each 
 
 and treat- J J _ , . , *>■} ' . . „ , 
 
 ment case. In cases of sunstroke the patient usually be- 
 comes suddenly unconscious and the fever runs ex- 
 
ACCIDENTS AND EMERGENCIES 127 
 
 tremely high.. The respiration is very labored, and 
 the pulse rapid and weak. Prompt measures must 
 be taken or the issue will be fatal in many cases. A 
 doctor must be summoned at once, and treatment 
 with ice baths will doubtless have to be kept up. 
 
 In cases of heat exhaustion the onset is more 
 gradual. The patient feels weak and dizzy. He is Heat ex - 
 
 . haustion 
 
 not necessarily unconscious, but shows signs of col- and its 
 lapse. The temperature will be found subnormal, treatment 
 i. e., below 98 Fahrenheit. The pulse is weak and 
 rapid and the breathing much quickened. The treat- 
 ment is the same as for shock, and the patient is kept 
 in a darkened room or in a cool, shady place out of 
 doors with the head low. Aromatic spirits of am- 
 monia, one teaspoonful in a little hot water every 
 half-hour for three or four doses, may be given until 
 the doctor comes. Strong coffee may also be used. 
 In convalescence from heat exhaustion great care, 
 must be taken that there is no exposure to extreme 
 heat. The direct rays of the sun are not necessary to 
 produce heat exhaustion. It may follow exposure to 
 intense heat of any kind, and persons who have once 
 suffered are liable to another attack. 
 
 ARTIFICIAL RESPIRATION 
 
 In accidents from drowning, strangulation, or suf- 
 focation, where the supply of air for any reason has when 
 been cut off from the lungs, artificial respiration must respSon 
 be resorted to, as it is often possible to force the is used 
 lungs to act, and the effort should be kept up till it 
 is evident that it is hopeless, and that conclusion should 
 not be reached short of two hours of faithful work. 
 
 There are several methods of establishing artifi- 
 cial respiration, there being little difference in their 
 value so long as the lungs are made to expand. In 
 
128 HOME NURSING 
 
 a first any case the tongue must first be fastened to keep 
 tabHsStS" it f rom falling back upon the windpipe. This can 
 respiration eas ity be done by holding it down to the chin by 
 means of a rubber band. If the case is one of drown- 
 ing or of strangulation the patient must be turned 
 over on his face and the throat cleared of any col- 
 lection of mucus that may be obstructing it. 
 
 In the method known as Sylvester's the patient 
 Sylvester's i s ^jd on hj s back with the head and shoulders slightly 
 raised and the clothing loosened. Standing at the 
 patient's head and grasping his arms just above the 
 elbows, bring them slowly out from the body and up- 
 ward till they meet over the head. They are held 
 there for two seconds and brought slowly back till the 
 elbows come together on the chest with slight pres- 
 sure. . These movements should be repeated steadily 
 and not more rapidly than sixteen times a minute. 
 
 INSECT BITES 
 
 Mosquito or spider bites can be relieved by lotions 
 
 Small bites of ammonia or salt. The sting of a wasp or bee, if 
 
 left in the flesh, may set up considerable irritation. 
 
 It can be removed by making firm pressure around it, 
 
 BITES OF SNAKES AND RABID ANIMALS 
 
 Prompt action and heroic treatment are demanded 
 
 Speedy when dealing with the bite of a venomous snake or of 
 
 otTZTo- a mad animal. The bleeding of the wound should 
 
 rabid Mte ^ e encouraged. If it is on an arm or leg this should 
 
 be firmly bandaged at once above the point of injury, 
 
 in order to cut off circulation for the time being. 
 
 The wound must then be sucked or cupping glasses 
 
 applied before the poison is taken into the system. 
 
 Finally it must be deeply burned with a hot iron and 
 
 poulticed. If more than half an hour has elapsed 
 
ACCIDENTS AND EMERGENCIES 129 
 
 since the bite the method of burning out the wound 
 is useless. 
 
 Pasteur's treatment by inoculation of virus made 
 from emulsions of dried spinal-cord, not only secures Pasteur's 
 immunity but has also proved itself a curative measure. 
 Both in the Pasteur Institute in Paris and in New 
 York this treatment is being carried out daily with 
 marvelous success. 
 
 POISONS 
 
 Poisons are known either as irritants, substances 
 which corrode the tissue, or narcotics, those which 
 cause insensibility by directly affecting the brain. 
 
 Xo time should be lost in giving emetics when a Treatment 
 poison has found entrance into the body. A table- Jlnt^S- 1 
 spoon of salt or of ground mustard stirred into a cup sons n a ^ e d 
 of tepid water rarely fails to produce vomiting, and 
 this dose should be given repeatedly till free vomiting 
 is secured. After this it is always well to give a pur- 
 gative enema to remove any trace of the poison that 
 may have traveled as far as the bowel. 
 
 Large draughts of water, milk, white of egg, or 
 flour and water should be given to soothe the injured 
 membrane of the alimentary tract if the poison is of 
 an irritating character. 
 
 For all alkaline poisons acids should be given to 
 neutralize their effect, and vice versa for acid pois- 
 oning. 
 
 The treatment necessary for narcotic poisoning in nar- 
 is strong stimulants (black coffee freely administered), poisoning 
 cold effusions and mustard foot-bath. Above all, the 
 patient must be kept awake, and will probably have Have 
 to be walked about the room vigorously. Poisoning advice 
 
 case of 
 
 milk, or cheap ice cream. Emetics and purgatives 
 
 may follow the use of tainted meat, mushrooms, fish, pc 
 
130 HOME NURSING 
 
 must be used freely, and a physician should be sum- 
 moned at once in all cases of poisoning. 
 
 An antidote is a remedy used to offset the effect 
 Definition of a poison in one of three ways. First, mechanically 
 dotes by emptying the stomach and bowels to prevent ab- 
 sorption; second, chemically, by combining with the 
 poison to form a harmless compound ; and third, 
 physiologically by counteracting the effects of the 
 poison on the system. 
 
VIII 
 
 INFECTION AND CONTAGION 
 
 Micro-Organisms and Disease— Transmission of Disease— The Protozoa- 
 Disinfectants — Methods of Disinfection — Typhoid Fever- 
 Erysipelas— Malarial Fever— Dysentery 
 
 MICRO-ORGANISMS AND DISEASE 
 
 IN any discussion on the subject of transmissible 
 disease we have to consider the methods by which 
 it is communicated before we can understand the Science has 
 proper precautions necessary in its care. Science om^view 
 has advanced and is advancing so rapidly in its in- of dlsease 
 vestigations that each year adds to our knowledge 
 and equips us with more effective weapons both in 
 the prevention of disease and in its cure. We are only 
 in the A B C's in our knowledge of the cause of 
 disease, but in so many instances the use of what 
 science has offered us will prevent it, and save life, 
 that we should try to understand some of the scien- 
 tific phraseology and follow the discoveries of the 
 investigators as far as may be. 
 
 The terms microbes, micro-organisms, germs, and 
 bacteria are all used to indicate the microscopical ^Hv°ng 0p " 
 living bodies which are now held responsible for bodies 
 many diseases. 
 
 The bacteria are not animal organisms, but are 
 the lowest form of plant life, and though invisible 
 without high magnifying power, are near relatives of 
 the sea-weeds. They are very complex and wonder- 
 ful in their variety of shape and in the work they do 
 in life, which is by no means exclusively the produc- 
 er) 
 
132 HOME NURSING 
 
 tion of disease. This making of disease is confined 
 to a comparatively small class, bacterial work in gen- 
 eral being of great service to mankind. 
 
 The decomposition and hence the disposal of 
 Work of waste animal and vegetable material is largely carried 
 
 bcictcrict 
 
 on by bacteria. They make possible the renewal of 
 worn-out soil by what is known as "rotation of crops," 
 - and their presence in our bodies often saves us from 
 disease by rendering harmless poisonous matter which 
 would otherwise act as an irritant. In short, life on 
 the earth would be impossible without this form of 
 micro-organism. 
 
 Many of the disease-producing forms have been 
 
 Disease recognized, and the method of destroying them or 
 
 bacteria^ rendering their poisons harmless is the subject of 
 investigation, and has led to the modern method 
 of fighting tuberculosis, to the antitoxin treatment 
 of diphtheria, and to other results which we will 
 discuss later. 
 
 At the same time that scientists were pursuing 
 
 The pro- their studies of bacterial life in relation to disease, 
 the cause of certain disorders was traced to another 
 source. This was another micro-organism, the pro- 
 tozoon, which is the lowest form of animal life. The 
 protozoa have long been the object of microscopical 
 study, because most of them are much larger than 
 the bacteria and their life processes may be followed 
 with comparative ease. Much of the advanced knowl- 
 edge of human structure, needs, and functions has 
 been gained through their aid, and the recent dis- 
 coveries in connection with malaria and yellow fever 
 have brought them into prominence in other than 
 
 The terms scientific circles. The terms microbe, germ, or micro- 
 
 microbe, 
 
 bacteria, and while like bacteria the majority are 
 
 organism are applicable to the protozoa as well as to 
 
INFECTION AND CONTAGION 133 
 
 harmless, unlike them there seems to be no record of 
 especial good to their credit. 
 
 THE TRANSMISSION OF DISEASE 
 
 All infectious diseases are supposed to be trans- 
 mitted bv the agency of one or the other of such living Agents in 
 
 ii- ', • t • i i ii infectious 
 
 bodies ; though their presence has been proved, the diseases 
 specific germ causing the disease has been recog- 
 nized and actually cultivated outside the body in com- 
 paratively few instances. 
 
 The disorder begins with the introduction of the 
 germs into the system, progresses with their develop- 
 ment and multiplication, which is almost inconceiv- 
 ably rapid, and terminates with their destruction 
 when Nature is able to accomplish it, or with the 
 death of the patient when they are victorious. 
 
 The germs causing scarlet fever, diphtheria, 
 measles, and other diseases ordinarily included under Germs 
 contagion are of such a nature that they are com- different 
 municated by simple contact, while a person may re- mtensities 
 main with immunity in the presence of patients suf- 
 fering with malaria, typhoid fever, tuberculosis, and 
 pneumonia unless he is actually inoculated with the 
 poisons producing the disorder. 
 
 The bacterial source of typhoid fever, tubercu- 
 losis, pneumonia, Asiatic cholera, lockjaw, and other 
 less familiar diseases has been proved, and the modern 
 methods of prevention and cure are based on what is 
 known of the condition under which bacterial life 
 thrives or is destroyed. 
 
 The demands which physicians make that their 
 patients shall have sunlight and fresh air, the methods Enemies 
 of disinfection and fumigation employed in infectious \a e 
 diseases are rational, because science has found that 
 germ life flourishes best in warm, dark media, that 
 
134 HOME NURSING 
 
 sun and air are its worst enemies, that continued 
 heat, of boiling water in some cases, and of condensed 
 steam in others, destroys it, as do also certain so- 
 called disinfectants. 
 
 THE PROTOZOA 
 
 The consideration of the protozoa as an agent in 
 The part infection has come into prominence through investi- 
 insects in gations made regarding the part played by insects in 
 disease t k e propagation of disease. These investigations, with 
 experimentation, have been carried out mainly in re- 
 gard to mosquitoes, and the results have established 
 beyond question the fact that the prevalence of mala- 
 ria in certain districts is referable to the presence of 
 these insects rather than on account of climatic con-, 
 ditions pure and simple, and that the protozoa dis- 
 covered in the stomachs of mosquitoes found in such 
 districts are of the same variety as those found in 
 the blood of malarial patients. 
 
 The numerous experiments which have led to these 
 Mosquitoes conclusions are given in an article in the " Popular 
 
 carrying 
 
 malaria Science Monthly" by Professor A. F. A. King, M. D., 
 fever 761 ° W entitled "Mosquitoes and Malaria," and in books upon 
 the same subject by the same author. Equally con- 
 clusive results have been reached in the experiments 
 with mosquitoes infected with yellow fever, though 
 the specific organism causing the disease has not been 
 found. "Mosquitoes: How They Live — How They 
 Carry Disease — How They Are Classified," by L. O. 
 Howard, Ph.D., and later reports on the subject can 
 be obtained by applying to the Department of Agri- 
 culture in Washington. 
 
 The immediate effects of these investigations have 
 been systematic effort in some States to exterminate 
 the mosquitoes by the persistent use. of kerosene over 
 
INFECTION AND CONTAGION 135 
 
 certain swampy districts known as their breeding Efforts to 
 places, and the more general care to exclude them na te the 
 from houses in malarial regions, by careful and m0S( ^ ult0 
 thorough screening. 
 
 The theory of the protozoon origin of other dis- 
 eases is put forward by scientists, but has not been 
 conclusively proved. Other insects which have been 
 known to carrv disease are the common house-flv, the infection 
 
 • from 
 
 small house-fly, and other similar varieties. These house flies 
 flies tend to swarm over sputa or excrement, if it 
 is left exposed, and their feet are so constructed that 
 they must of necessity retain on them minute particles 
 of any soft substance with which they come in con- 
 tact. Food attracts them with equal certainty, and 
 we trace here a direct source of infection. 
 
 All this points to the necessity of careful protec- 
 tion of our homes from these pests, and any other 
 insects which may have come into contact with disease. as a 
 Whenever the poison of a disease lies in the dis- safe & uard 
 charges from the body or in the blood, insects may 
 be powerful agents in its transmission, and the use of 
 screens should be insisted upon as a safeguard. 
 
 DISINFECTANTS 
 
 The following agents for disinfection, together 
 with the general scheme for their use, are recom- 
 mended by the Board of Health of New York City: 
 
 Sunlight, cleanliness, and fresh pure air are pow- 
 erful preventives of disease, and play an equally im- Powerful 
 portant part in their cure, but in dealing with cases fiv^" 
 of infectious disease the aid of agents known as dis- 
 infectants must also be called in. 
 
 After such disease, and also during its course, all 
 the articles of small value which have been used in 
 contact with the patient in any way should be de- 
 
136 
 
 HOME NURSING 
 
 Disposition 
 of articles 
 after an 
 infectious 
 disease 
 
 Carbolic 
 solution 
 
 Care of 
 carbolic 
 
 Solution 
 of corro- 
 sive sub- 
 limate 
 
 Chlori- 
 nated lime 
 solution 
 
 stroyed by fire. Dishes, silver and metal objects not 
 injured by water may be made thoroughly sterile by 
 boiling in a closed vessel for half an hour, and in 
 cities large articles, such as bedding, can usually be 
 taken care of by the Health Department. 
 
 A five per cent solution of carbolic is a very power- 
 ful disinfectant to be used on clothing, towels, bed- 
 ding, etc. It is made by dissolving six ounces of 
 the acid in a gallon of hot water. The pure acid is a 
 very strong corrosive, and even the five per cent solu- 
 tion is too strong for use on the hands. 
 
 If a person is burned with carbolic, pouring alco- 
 hol over the cauterized surface gives instant relief. It 
 is very poisonous when taken by the mouth, should 
 have a poison label plainly upon it, and should be kept 
 out of the reach of children. 
 
 Solution of corrosive sublimate is easily made with 
 tablets, which are dissolved in water. Directions are 
 found on the bottles. It is much less expensive than 
 carbolic acid, but is not as useful. It injures metals, 
 stains clothing, and is not effective in the disinfection 
 of discharges, because it merely incloses the particles 
 which it touches in an albuminous coating; its action 
 on albumen being to cause it to coagulate. In this 
 way the germ is preserved, but not destroyed. It is 
 useful in cleaning woodwork and furniture. 
 
 Chlorinated lime solution is one of the most effect- 
 ive as well as least expensive disinfecting agents. It 
 is prepared by thoroughly mixing six ounces of fresh 
 chloride of lime with one gallon of water. It should 
 be made only about an hour before using. The danger 
 of using this on bedding, clothing, etc., is that it tends 
 to destroy the fabric. If it is employed it should be 
 thoroughly strained through a cloth and diluted one- 
 half. 
 
INFECTION AND CONTAGION 137 
 
 Milk of lime is equally valuable. The solution is 
 made by adding a quart of finely slaked dry lime to 
 four or five quarts of water. It should be remembered 
 that air-slaked lime has lost its disinfecting power. 
 
 Formaldehyde gas is a very powerful disinfectant, 
 commonly used now in the general fumigation of Formalin 
 rooms after contagion. The strongest liquid prepara- infection 
 tion on the market is the forty per cent solution of this 
 gas in water. The five per cent solution is effective for 
 the disinfection of discharges, and of dishes, instru- 
 ments, etc., and a one per cent solution may be used 
 on the hands. Formalin is so expensive that it is rare- 
 ly thought best to use it extensively in the household, 
 but its action is so powerful that it is taking prece- 
 dence over other disinfectants when expense need not 
 be considered. 
 
 FORMULA 
 
 Formalin, 5 per cent : Strong formalin, 5 parts ; water, 35 parts. Or, 
 Formalin, 5 per cent : 4.75 ounces formalin to one quart of water. 
 Formalin, 1 per cent : Strong formalin, 1 part ; water, 39 parts. Or, 
 Formalin, 1 per cent : .95 ounces to one quart of water. 
 Formalin, 1-5000 : Strong formalin, 1 part ; water, 2,000 parts. Or, 
 Formalin, 1-5000: 10 drops of strong formalin to one quart of water. 
 
 Another preparation used in fumigation is gas from 
 burning sulphur. This is not regarded with as much Sulphur 
 confidence in recent years as it was before the wonder- infection 
 ful vitality of disease germs was understood. The 
 advantages of the method are that the fumes are very 
 diffusible, they do not injure furniture, are easy to use 
 and are not expensive. The difficulty in the use of sul- 
 phur is in confining the gas in a room for a long enough 
 time to destroy the germs. 
 
 Three pounds of sulphur for every thousand cubic 
 feet of air space is necessary, the room must be tightly in using 
 closed, and all cracks where air might enter must be sulphur 
 sealed, by pasting strips of paper over them. It is 
 more effective if burned in a moist atmosphere, so the 
 
138 
 
 HOME NURSING 
 
 Not in 
 tubercu- 
 losis 
 
 usual method is to place the dish holding the sulphur 
 on rests in a vessel containing water. It must be re- 
 membered that the fumes blacken metal, and that a 
 liberal application of vaseline will prevent this action. 
 The bacteria of tuberculosis are able to protect 
 themselves from destruction by sulphurous gas by a 
 change in their structure, therefore some other method 
 of disinfection is necessary after this disease. If for- 
 maldehyde gas is available it should always be given 
 preference in fumigation. 
 
 In di 
 fectin'g 
 
 METHODS OF DISINFECTION 
 
 The formalin solution one per cent or the carbolic 
 solution diluted with an equal part of water is to be 
 
 the hands use( ^ * n cleansing the hands. The dry chloride of lime 
 is also of value. If the liquids are used, the hands 
 should be thoroughly washed in the solution and then 
 with soap and water. Especial care should always 
 be given the nails. About a teaspoon of the dry chlo- 
 ride of lime is placed in the palm of the hand, moistened 
 with water, and rubbed thoroughly all over both hands 
 and about the nails. Any disinfectant is irritating to 
 the skin if used for any length of time. 
 
 It is not only the feces, but also the discharges 
 from bladder, mouth, and nose, which must be disin- 
 fected or burned. Expectoration and discharge from 
 disinfected the nose may be received upon cloths or paper and 
 must be burned at once. 
 
 When vessels are used, a solution of lime or carbol- 
 ic, acid must be kept in them, and after use the con- 
 tents must be mixed with the disinfectant and allowed 
 to stand for an hour or more. If carbolic is used, the 
 amount should be twice that of the discharge, with 
 milk of lime four or five times as great. 
 
 It must be remembered that the intestinal dis- 
 
 All dis- 
 charges 
 must be 
 
 Use of 
 
 lime or 
 carbolic 
 
INFECTION AND CONTAGION 139 
 
 charges in diseases where these contain the active Thorough- 
 germ must be broken up, so that the disinfectant will sentiaT 
 be thoroughly mixed with them. They are not disin- 
 fected if the solution is merely poured over them. 
 
 In typhoid fever, the discharges from the entire in typhoid 
 digestive tract and from the bladder are regarded with dysen- 
 suspicion, and subjected to the action of the disinfec- ^^ ^| d 
 tant. In dysentery and cholera, the stool and vomited diphtheria, 
 matter contain the poison, and in diphtheria, scarlet f ev er, and 
 fever, and measles the discharges from the nose and measles 
 throat carry the infection. 
 
 Germs are not scattered while the medium in which 
 they are contained is kept moist. 
 
 The food which is left after the patient has been 
 served must never be taken back to mix with the gar- Disinfec- 
 
 ° tion of 
 
 bage from the household. It should be put in a sep- food 
 arate covered receptacle, and either burned or sub- remnan s 
 jected to the action of a disinfectant. Bacteria thrive 
 especially on milk, and therefore milk should never 
 be left uncovered in the sick-room. 
 
 In any disease, food should be kept outside the sick- 
 room, since it is very liable to become contaminated. 
 
 All washable articles must be put to soak in either 
 a carbolic or lime solution, and left for ten or twelve Disinfec- 
 hours. They can then be washed in the usual way. clothing 
 The boiler containing the disinfectant should be kept 
 in a room adjoining the sick chamber, and should not 
 be removed till after disinfection is complete. 
 
 A pint of carbolic solution or of milk of lime solu- 
 tion should be poured into the closet each time after Disinfec- 
 using. Nothing should be thrown into it or into sinks *°" e °_ £ 
 without disinfection. If it could be assured that it closets, 
 would remain moist and would be held intact in the sewer 
 sewer there would be no danger, because the germs pipes 
 could not be disseminated and the action of other bac- 
 
140 HOME NURSING 
 
 teria would in time render them harmless. Accidents, 
 however, do occur in sewer pipes, and since a leak 
 can give rise to an epidemic of disease, every precau- 
 tion must be taken to guard against the deposition in 
 the pipes of living germs where it is possible. 
 
 During sickness, the cleaning and dusting must be 
 
 Disinfec- done with cloths wrung: out of a i-iooo bichloride solu- 
 tion of ° 
 furnishings tion. At its termination, if the Health Department has 
 
 of room. . ± 
 
 an effective sterilizing plant, all bedding, carpets, cur- 
 tains, etc., can be removed and made entirely germ- 
 free, and it is always advisable, when it is not compul- 
 sory, to have the fumigation carried on by the Depart- 
 ment. In country places, this responsibility must be 
 assumed by the family, and if they are conscientious 
 about it, they can accomplish it effectively. 
 
 The wisest plan in contagious diseases is to strip 
 a room of woolen curtains, carpet, and unnecessary 
 ornaments, and to bring into it for the patient's use 
 and amusement only such things as can be burned or 
 boiled at the termination of the disease. 
 
 Formalin seems to be the most practical disinfec- 
 ts use tant, and knowledge of certain facts concerning it will 
 as i°di? ahn make our use of it rather more intelligent. In order 
 infectant ^0 exert its destructive action on micro-organisms it 
 must have, first : free access to them — hence all cloth- 
 ing, curtains, etc., which are left in the room for disin- 
 fection must be hung up or spread out so that the 
 entire surface is exposed. 
 
 Second : it must be concentrated as far as possible, 
 that is the room must be sealed to hold the vapor, and 
 more formalin, and a longer time is necessary if there 
 is any appreciable escape of gas from an apartment. 
 
 Third : the higher the temperature the more effec- 
 tive and more penetrative is the action of the formalin, 
 therefore the room should be heated either by turning 
 
INFECTION AND CONTAGION 141 
 
 on heat from furnace or boiler, or by building a fire in 
 stove or heater. 
 
 Fourth : a moist atmosphere is conducive to more 
 thorough fumigation, i. e. f steam should be allowed to 
 escape into the room in order to get the best possible 
 results. A space represented by 1,000 cubic feet is 
 supposed to require from two to three fluid ounces of 
 formalin and five to eight hours' exposure. 
 
 An especial apparatus is used by the Health De- 
 partment, bv which the formaldehyde gas is generated Special 
 
 .11 i.iiiii apparatus 
 
 outside the apartment, and introduced through the 
 keyhole till the required amount has passed in, when 
 the pipe is withdrawn and the keyhole sealed. 
 
 Household fumigation must be accomplished with- 
 out the use of special appliances and can be done as fol- 
 lows : The room should be carefully sealed, the temper- 
 ature raised as high as possible with safety to it and Household 
 its contents, and if possible steam should be allowed ™/ fumiga- 
 to escape into it. If the heat of the room is maintained f^^ 11 
 by the use of a stove, a large tea-kettle or boiler of 
 water may be kept boiling. Care must be taken to pro- 
 vide sufficient water for the entire length of time. 
 An alcohol lamp may be placed in the centre of the 
 room, quite away from furniture, on a metal plate, so 
 that there can be no possibility of its tipping over. 
 The forty per cent formalin, three fluid ounces, should 
 be placed in an open vessel and put oyer the alcohol 
 lamp. It is estimated than two ounces of alcohol will 
 be required to generate the fumes of this amount of 
 formaldehyde. After the lamp is lighted, the person 
 who has charge of the fumigation must quickly leave 
 the room, and seal the door. 
 
 The nature of the bacteria makes a difference in Nature of 
 the amount of disinfectant, and the length of time re- factor'^ 
 quired, and whenever the physician can oversee the fumi g ation 
 
142 
 
 HOME NURSING 
 
 Cleaning 
 
 after 
 
 fumigation 
 
 fumigation, it will be done with a greater assurance 
 of success. 
 
 After disinfection, a room should be carefully 
 cleaned, the glass, woodwork, and furniture wiped with 
 a cloth wrung out of bichloride solution, and then thor- 
 oughly washed with warm soap-suds. Cleanliness is 
 no less an essential because it is no longer our sole re- 
 liance. Dirt is the natural habitat of germ life, and 
 the more air, soap and water, and sunshine we let 
 into our homes, the more effectually we guard them 
 from disease. 
 
 The bac- 
 teria 
 causing 
 typhoid 
 fever 
 
 How the 
 poison is 
 conveyed 
 
 TYPHOID FEVER 
 
 Typhoid fever is one of the diseases caused by a 
 micro-organism which has been recognized, cultivated 
 outside the body, and proved to produce the disease 
 when introduced into the system. This organism is 
 found to be one of the bacteria, and its action is con- 
 fined to the intestine and chiefly to a restricted area, 
 where it causes inflammation and ulceration. It must 
 be taken in through the alimentary canal, to cause the 
 disease, but can not be contracted by contact, hence it 
 is not classed with the contagious diseases. 
 
 It may occur at any time of _year, but comes most 
 usually in the autumn. Infection is always due to a 
 previous case of the fever, and the germ is conveyed 
 chiefly through the stools, though all discharges from 
 the nose or mouth, vomited matter and the urine may 
 carry the poison and must be immediately disinfected. 
 Contaminated water supply is a frequent source of the 
 disease, milk also may convey it ; if disinfection is not 
 complete and the excreta is allowed to dry it may be 
 transmitted through the air, or if the attendants are 
 careless about personal cleanliness they may contract 
 it themselves and infect other persons. With all these 
 
INFECTION AND CONTAGION 143 
 
 avenues of infection, typhoid fever is not regarded 
 as a disease which requires isolation, and cleanliness, 
 and rigid and immediate disinfection, are considered 
 efficient safeguards. 
 
 At the outbreak of a case of typhoid, the source 
 of infection should be traced if possible, because the Trace th f 
 
 . . source of 
 
 cases can multiply almost indefinitely, if the cause is infection 
 not removed. Persons of all ages are susceptible to the 
 disease, but it is most common between the ages of 
 fifteen and twenty-five years. 
 
 The period of incubation is generally placed at two 
 weeks, although this varies, as do nearly all of the so- Monitory 
 called typical symptoms. During ' this time there is symp oms 
 usually a feeling of languor, slight pain in the abdo- 
 men, a cough, occasional nosebleed, and an increasing 
 sense of exhaustion, with finally very severe headache. 
 In many cases the symptoms during the first few days 
 are not marked enough to have necessitated the aid of 
 a physician, but if he is called he will probably find 
 that the fever is gradually growing higher each even- 
 ing, till it reaches 103 or 104 . 
 
 During the second week, the temperature remains 
 high, and the pulse rate increases proportionately, and The second 
 all the symptoms are aggravated. The listlessness gen- week 
 erally increases, and with the continued- high tempera- 
 ture delirium is often present. 
 
 The bowels mav be constipated throughout the dis- _ . , 
 
 . . Disinfec- 
 
 ease, or there mav be diarrhoea, but in either case the tion of 
 
 stools. 
 
 disinfection of the stools must be carried out with con- 
 scientious vigilance. 
 
 The tongue and teeth become coated with sordes, 
 which must be removed bv careful washing. It col- Care of 
 
 mouth 
 
 lects very rapidly, but cleanliness is one of the first and teeth 
 requisites in the care of this disease, and with the 
 proper solutions this deposit can be removed. 
 
144 
 
 HOME NURSING 
 
 Character- 
 istics of 
 the disease 
 
 Devices 
 for clean- 
 liness 
 
 Meeting 
 specific 
 needs of 
 the case 
 
 The small cloths and the swabs used to wash out 
 the mouth must be wrapped in a piece of paper and 
 burned and the attendant's hands must be washed 
 in the disinfectant after this or any other service 
 which brings them into contact with the body of the 
 patient. 
 
 The characteristic rash on the abdomen appears at 
 about the end of the first or the beginning of the sec- 
 ond week, and there is generally considerable distention, 
 with tenderness over the right side. During this week, 
 and the third, the weakness and emaciation increase, 
 and the prostration becomes more marked. The pa- 
 tient is often in a deep stupor, lying on his back, with 
 the muscles relaxed, and it is difficult to arouse him 
 enough for feeding, and to turn him for the necessary 
 bathing. 
 
 There are very liable to be at this time involuntary 
 passages of urine and feces, and the bed should be 
 thoroughly protected. Pads made, of thickly folded 
 newspaper covered with waste absorbent cotton and 
 cheesecloth or old muslin can be kept directly under 
 the patient and are easily removed and burned. Often 
 they prevent the bed from becoming soiled, and as 
 they can be at once burned they remove some of the 
 burden of disinfection and laundry. 
 
 The amount of food and water must be kept up, 
 even if the patient has to be fed only a teaspoon at a 
 time, and a stimulant will probably be ordered, for the 
 heart is overworked, and must be taken care of. 
 Unless absolute rest is ordered, as in the case of hem- 
 orrhage from the bowels, a patient must be turned on 
 his side several times a day, supported by a pillow 
 pushed in at his back, and rubbed and bathed to stim- 
 ulate the circulation. In his depressed condition bed 
 sores are very liable to appear, and a form of pneu- 
 
INFECTION AND CONTAGION 145 
 
 monia may be caused if the position on the back is 
 constantly maintained. 
 
 The aim of those caring for a case of typhoid should 
 be chiefly to place the patient under the best possible Aim of 
 hygienic conditions, to supply him with suitable food, i ng the 
 so that Nature can carry on her work of healing, patient* 
 and to keep him from becoming a source of infection. 
 It is to the nurse that the details of this treatment 
 are left, and in no disease is the nursing more 
 responsible for results. Orders must be followed 
 absolutely. 
 
 Rest in bed means that the patient must never sit 
 up even, unless the physician permits it. Liquid diet *?. est and 
 does not allow an occasional deviation, even after con- 
 valescence, unless the change is ordered. 
 
 Baths to reduce temperature are generally ordered. 
 These vary from the simple alcohol sponging to the 
 tub bath, which is in most cases rather too exhausting, 
 and is always impracticable in a private house. The 
 tepid or slightlv warm sponsfinsr is as beneficial as one How to 
 
 • • ,, i , .- rr , 1 • bathe the 
 
 given ice-cold, and the patient offers much less resis- typhoid 
 tance. A very good plan is to have a large rubber patient 
 sheet the length of the bed, and at least half as wide; 
 cover this with a cotton sheet, and spread it under the 
 patient, using the method described in changing bed- 
 ding on pages 31 and 32. Large bath towels may be 
 used to cover him, and a portion of his body is ex- 
 posed at a time. A large face cloth or a sponge is filled 
 with water and the body is rubbed with long gentle 
 strokes, letting the water trickle down on the rubber 
 sheet. With this protection an abundance of water 
 can be used, and the body allowed to dry off, instead 
 of being rubbed with a towel. Such baths are gener- 
 ally ordered every three or four hours, while the tem- 
 perature is high, and one for cleansing will be nec- 
 7 Vol. 3 
 
146 HOME NURSING 
 
 essary each day, for the function of the skin is strong- 
 ly affected by the diseased condition. 
 
 During the fourth week the fever begins to lessen, 
 
 Dangers the brain grows clearer, and all the symptoms subside. 
 
 vaiescence With the decline of the fever the appetite begins to 
 return and the most trying period of the disease com- 
 mences. Additions to the diet must be made with 
 great caution, since many relapses have been caused 
 by injudicious feeding. The hunger is all-absorbing, 
 and the patient is often so unreasonable that it is very 
 difficult to be firm and to remember the dangers. 
 
 ERYSIPELAS 
 
 Erysipelas is an infectious disease, characterized by 
 Character an intensely inflammatory condition, generally confined 
 
 and cause ,. . , .... - . . , ,.,, , 
 
 of ery- to a limited area, ordinarily ushered in by a chill, and 
 sipeas accompanied by high fever. It is believed that the 
 poison gains access to the body through an abrasion 
 or tiny scratch, and an open wound is especially liable 
 to become infected. The affected area is swollen, red 
 and shiny, its margins are distinct and raised, and it 
 extends rapidly. Small blisters form on the surface 
 and fill with fluid by which the germ of the disease 
 may be conveyed. After the inflammation has sub- 
 sided, desquamation takes place, and at this time, too, 
 special care must be taken to prevent the spread of the 
 contagion. Soothing applications will be ordered to 
 its conta- relieve the burning and pain, the diet must be nutri- 
 care a tious and easy of digestion, and very often there will 
 be need of stimulant to support the strength. In order 
 to prevent the transmission of the infection, the pa- 
 tient should be isolated, all dressings used about him 
 must be promptly burned, and his bed-linen must be 
 disinfected. 
 
INFECTION AND CONTAGION 147 
 
 MALARIAL FEVER 
 
 The discovery of the source of malarial infection 
 
 has made more difference in its prevention than in its Protection 
 
 i • • • 1 o£ the 
 
 treatment, although as the investigations proceed re- malarial 
 
 suits along these lines will be attained. The bacteria froITmos- 
 are found only in the blood of patients, so no isolation <i ultoes 
 or disinfection is required. Since infected mosquitoes 
 convey the disease, the patient must be as rigidly pro- 
 tected from them as a person who is hoping to avoid 
 contracting it. The reason why quinine has usually 
 such a powerful effect is believed to be because it is 
 poisonous to that specific germ, causing its destruction 
 or rendering it harmless. 
 
 The chief characteristic of malaria is the periodic at- 
 tacks which are generally described as chills, but which Character- 
 really include three stages : The cold feeling, with malaria 
 shivering and chattering of the teeth, introduces the 
 attack, a period of intense fever follows, after which 
 comes the sweating stage. These attacks recur at 
 regular intervals, which may differ with the disease, 
 returning every twenty-four, forty-eight, or seventy- 
 two hours. While the fever is in progress the recur- 
 rence is uniform, the attacks appearing at the same 
 hour. If it is increasing in severity, the intervals are 
 shortened by half an hour or an hour, and if it 
 is becoming more mild, they are correspondingly 
 lengthened. 
 
 The severity of the chills may be somewhat les- 
 sened if the patient goes to bed shortly before the at- Treatment 
 tack is expected, is warmly covered with blankets, sur- malarial 
 rounded with hot-water bottles, and is given a hot patient 
 drink. When the fever comes on, the covering may 
 be removed, cold drinks will be refreshing, and cool 
 sponging will give relief, and may keep the temper- 
 
148 
 
 HOME NURSING 
 
 Definition 
 of dysen- 
 teric con- 
 ditions 
 
 Care and 
 treatment 
 of the 
 patient 
 
 ature down somewhat. In the third stage the per- 
 spiration must be wiped away with warm cloths, and 
 after it is over and the patient has rested, a warm soap 
 and water bath will be needed. If medication is being 
 given, purgatives must not be given without doctor's 
 orders, as they have the effect of clearing the system, 
 and may thus rid it of the drug before it has done its 
 work. 
 
 DYSENTERY 
 
 An inflammatory condition of the intestinal lining 
 leads to a form of diarrhoea called dysentery. There is 
 usually some abdominal pain and tenderness and slight 
 fever at the beginning of an attack, and a character- 
 istic symptom is the continual desire to strain, which 
 is called tenesmus. Mucus and blood are present in 
 the stools, and the freqtfent movements exhaust the 
 strength of a patient. 
 
 Rest in bed is necessary, fluid diet, which may be 
 rice-water or arrow-root gruel, is ordered, and the pa- 
 tient must be kept warm, and must be on the back as 
 much as possible. Cool compresses applied to the 
 anus often relieve the tenesmus, and starch injections 
 sometimes soothe the irritation of the bowels. The 
 starch is mixed with cold water, then enough boiling 
 water is added to make a thin paste, which will flow 
 easily through rubber tubing, and it is brought to body 
 temperature. 
 
 The injection is usually given with a soft rubber 
 catheter, a funnel receiving the mixture and leading 
 it into the tube, and not more than four ounces need 
 be used. The starch solution should be retained in the 
 bowel, and the irritation is so extreme that any undue 
 pressure would cause it to be expelled, so less, rather 
 than more, should be given. 
 
 The stools have a very offensive odor, quite differ- 
 
INFECTION AND CONTAGION 149 
 
 ent from that of ordinary healthy feces, and this may 
 be somewhat overcome by the free use of chloride of 
 lime. The micro-organism causing dysentery is con- Disinfec- 
 fined to the intestine, so that strict disinfection is nee- the dysen- 
 essary. The rectal tube or catheter, as well as the afte r and 
 bed-pan, should also be disinfected after use, and 
 boiled at the termination of disease, and the same care 
 must be given the soiled linen. It is well to keep the 
 tube in a carbolic solution, which does not injure the 
 rubber, and effectually destroys the germs. The 
 catheter must be carefully rinsed before it is used 
 again, since carbolic, even in a diluted form, is ex- 
 tremely irritating to mucous surfaces. The abdomen 
 should be protected by a flannel bandage, and especial 
 care should be taken with ventilation. 
 
IX 
 
 INFECTIOUS DISEASES 
 
 (CONTINUED) 
 
 Influenza — Pneumonia — Tuberculosis— Forms of the Disease— Heredity- 
 Channels of Infection— General Precautions— Special Precautions for At- 
 tendants — Exercises Beneficial to Those with Tendency to Tuberculosis — 
 Suggestions for Patients— Care of Patients— Cerebro-Spinal Meningitis 
 
 Bacterial 
 origin of 
 influenza 
 
 INFLUENZA 
 
 INFLUENZA has also been proved to be a disease of 
 bacterial origin. Epidemics of influenza are fre- 
 quent, and their results are so varied that it is hardly- 
 possible to predict what course the disease may run. 
 The initial symptoms are usually those of a heavy 
 cold, but with an excessive soreness of the limbs and 
 body, and with a marked mental depression. The 
 particular danger lies in the fact that so often there 
 are serious complications, or that a person is left 
 with a weakness in the system which causes the de- 
 velopment of disease. The infection is probably con- 
 veyed in the nasal and throat discharges, and is 
 received in the air which is breathed. 
 
 No means of prevention has been found effective, 
 but since most of the serious consequences have been 
 caused by too short a period of convalescence, rest in 
 bed would seem to be a necessary precaution. A great 
 Safeguard- deal of relief from the bruised feeling of the body can 
 p2ient be gained by rubbing, and cold or hot compresses gen- 
 erally quiet the headache, so that sleep is possible. 
 The weakness will be found to last for a long time, 
 and the strength should not be forced or taxed un- 
 duly. 
 
 (150) 
 
 How the 
 infection 
 is con- 
 veyed 
 
INFECTIOUS DISEASES 151 
 
 A change of air, strict attention to hygiene, nour- 
 ishing diet, and rest, will be found most helpful in 
 restoring health. 
 
 PNEUMONIA 
 The infectious nature of pneumonia has been un- _ . 
 
 r t Infectious 
 
 mistakably proved, and the importance of careful dis- nature of 
 
 . ... ., . , pneumonia 
 
 intection is now more generally recognized as necessary 
 to prevent the spread of the disease. It has taken the 
 epidemic form in so many instances that even those 
 to whom the results of bacteriological investigations 
 are unknown must be convinced that it is one of the 
 communicable disorders. 
 
 The germ is contained in the sputum, which must 
 therefore be received in moist cloths or in an especially disin- 
 prepared receptacle and burned or disinfected. In all fectl0n 
 cases where there is abundant discharge from the nose, 
 throat, or lungs, whether it be a simple catarrhal cold 
 or tuberculosis, hygiene demands this precaution. The 
 washing of handkerchiefs, so soiled, should never be 
 required of any one, and they may carry latent germs 
 of disease before its presence is recognized in the pa- 
 tient. 
 
 Pneumonia is inflammation of the lung tissues. 
 It generally is confined to the right lung, but both may bacteria of 
 be involved. It is caused bv exposure to cold, or to P ne " monia 
 
 J r work 
 
 sudden variations of temperature, and generally un- 
 healthy surroundings predispose one to it. The bac- 
 teria causing it are confined to the lung substance, but 
 the poisons which they produce are taken over the sys- 
 tem in the blood stream, causing the general constitu- 
 tional symptoms. 
 
 In the first stage, the affected part of the lung be- 
 comes gradually filled with a secretion which in the fhediseale 
 second becomes consolidated. In the third stage, if the 
 
152 HOME NURSING 
 
 disease is progressing to a favorable termination, res- 
 olution, or the "gradual restoration of an inflamed part 
 to a normal condition," takes places. 
 
 The disease commonly begins with a chill, and a 
 sudden sharp pain through the affected side. Its 
 nhf in of P ro g" ress i s ver y rapid, the pulse and temperature 
 pneumonia mounting within a few hours, and the respiration soon 
 becoming labored and shallow, with the characteristic 
 dilation of the nostrils. With the fever so high, and 
 extra activity demanded from the heart and the respir- 
 atory centres, the prostration is extreme. Fluid diet, 
 generally milk and broth, must be given with regularity, 
 in the proportion of a coffee-cup every three hours. 
 The intervals, and the amounts, may have to be les- 
 sened, and if the patient sleeps during the night he will 
 probably not be disturbed. The stomach must not be 
 overloaded, since that throws more work upon the 
 entire system, and the vitality is everywhere at low ebb. 
 The chief danger lies in the failure of the heart from 
 overwork. 
 
 The cough is at first dry and hacking, causing severe 
 
 pain in the chest, and the sputum is scanty. Later, 
 
 Jp° u u t ^ and the cough becomes looser, and the expectoration is 
 
 more abundant, and of a characteristic rusty color, 
 
 caused by the blood which streaks it. 
 
 Between the third and tenth days, the temperature 
 suddenly drops, sometimes from 103 or 104° to 98°, 
 When the or even lower. With this loss of fever, there is usually 
 disappears profuse perspiration and excessive weakness. The pa- 
 tient must be saved long exertion now, and the pulse 
 must be watched carefully. 
 
 The chill of clothing, damp with the perspiration, 
 is very unpleasant, and also the danger of catching 
 cold, which is very slight when the fever is high, in- 
 creases. The exertion of making changes as frequently 
 
INFECTIOUS DISEASES 153 
 
 as would be necessary is unsafe, but if small bath Careful at- 
 tcwels or pieces of thin blanket are heated and laid clothing 
 next the skin over back and front, and changed as soon f^" ° t ur " 
 as they become damp or cold, it will lessen discomfort, 
 restore the heat of the body, and thus serve as a slight 
 stimulant. The nourishment during this stage should 
 be given hot, on account of its action on the heart. 
 The dangers of this period past, the patient goes on 
 to rapid recovery. 
 
 Convalescence is usually uneventful, with a sur- 
 prisingly quick return of strength. A patient recover- Convaies- 
 ing from pneumonia must guard against exposure, as a nd P re- 
 there will be increased susceptibility for some months. Against S 
 
 Young children are very liable to have brain exposure 
 complications in an attack, and if a person has used 
 alcohol to excess his chances of recovery are mate- 
 rially lessened. 
 
 TUBERCULOSIS 
 
 Tuberculosis has been called ''The Great White 
 Plague," and in view of the fact that it is a disease The great- 
 which attacks all ages, in all countries, that it is re- ^modern 
 sponsible for every sixth or seventh death, that yearly times 
 in the United States one hundred thousand persons are 
 swept away by its ravages, it may well be pronounced 
 the greatest scourge of modern times. 
 
 Tuberculosis often accompanies or unfavorably in- 
 fluences other diseases, and the fact that it is latent in Bacterial 
 the system is often the cause of the slow recovery or ongm 
 possibly fatal result of seemingly mild disorders. The 
 disease is of bacterial origin, being caused by the en- 
 trance into the system of a particular form of microbe, 
 known as the tubercular bacillus, from its rod-like ap- 
 pearance when seen under the microscope. 
 
 If this germ finds the soil suitable for its growth, 
 
154 HOME NURSING 
 
 it multiplies rapidly, and causes the formation of tuber- 
 cles upon whatever tissue it attacks. These tubercles 
 
 How the have a tendency to spread and break down, causing, 
 first, interference with the functions of the part af- 
 fected, and second, almost certain systemic involve- 
 ment. 
 
 Tuberculosis may be regarded as an infectious or 
 
 How it communicable disease, rather than a contagious one, 
 
 is com- ° . 
 
 municated prolonged exposure under certain favorable conditions 
 generally being necessary to its transmission. If the 
 sputum and other discharges of tuberculous patients, 
 which contain millions of the dangerous bacteria, are 
 properly taken care of, there is very little danger in 
 being in contact with them. 
 
 Nature has provided two safeguards, for us 
 
 Nature's against the invasion of the disease. The nasal secre- 
 tions when in normal condition are destructive to the 
 germs before they can enter the lungs. Also the blood, 
 we can remember, is composed in part of white cor- 
 puscles, whose province it is to wage warfare against 
 dangerous parasites, and destroy them. 
 
 FORMS OF THE DISEASE 
 
 The most frequent form of the disease is pulmo- 
 
 Acute and nary tuberculosis or phthisis, in which the lung tissue is 
 
 formT C of attacked. The disease may be either acute or chronic. 
 
 the disease j n fa e ear iy stages of the former, the portions of the 
 
 lung invaded by the bacillus become consolidated and 
 
 later break down, leaving cavities. The acute form is 
 
 usually rapidly fatal, but in chronic cases the disease 
 
 is frequently arrested. 
 
 In either, the great danger of infection is from the 
 The dan- sputum, which is charged with many millions of bacilli, 
 lection Tnd which, if once set free and allowed to become dry, min- 
 symptoms gj e w j t j 1 foe <i us t and may be inhaled by susceptible per- 
 
INFECTIOUS DISEASES 155 
 
 sons and set up the disease. The symptoms are cough, 
 expectoration, pains in the chest, loss of appetite, grad- 
 ual but steady decrease in weight, night-sweats, and 
 slight rise of temperature toward evening. Tubercu- 
 losis mar develop in various parts of the bodv, no tis- The dj s- 
 
 • . • rr^, eaSe i 11 
 
 sues being exempt from its invasion. The more com- various 
 mon points of attack are the throat, the uterus, the {-h^Ldy 
 joints and bones, and the skin. Tuberculosis of the skin 
 is known as lupus. 
 
 HEREDITY 
 
 The popular theory of the transmission of tubercu- 
 losis from parent to child is fast losing- its hold upon Predispo- 
 
 • r- • -1111 sition to- 
 
 the scientific world, and experience is day by day bear- ward the 
 ing out the conclusions against it. There is, however, ^nTT 
 a marked tendency or predisposition toward the dis- weak body 
 ease in the offspring of tubercular parents, which 
 must be reckoned with. The child comes into the 
 world with the inheritance of a frail body, in many 
 cases with a narrow chest and poor circulation, with 
 little fondness for out-of-door sports, and it may be 
 with no attention paid to securing for him an active 
 and healthy body. What wonder then that the seeds 
 of disease early find access to his body, and suitable 
 soil for development there, or that he should be thought 
 to have inherited the disease directly from his parents? 
 Especially is this true when one child after another 
 in the same family sickens and dies with the disease. 
 It is, however, the belief held by most of the noted why the 
 scientists of to-day that the tubercle bacillus does not sickens 
 exist at birth in the body of a child born of parents 
 one or both of whom may be victims of tuberculosis, 
 but that it may find ready access by means of the im- 
 paired vitality forced upon the child by such parentage 
 is easily conceded. 
 
156 
 
 HOME NURSING 
 
 How the 
 child may 
 be safe- 
 guarded 
 
 It is a comforting thought following this theory 
 that parents can in very many cases successfully protect 
 their children against the disease once thought to be 
 almost inevitably in store for them. By careful selec- 
 tion of every means to secure the best hygienic sur- 
 roundings and the stoutest and most vigorous state of 
 health, both bodily and mental, many children pass 
 through the precarious period of childhood and ap- 
 proach adult life well equipped for warding off the 
 disease. 
 
 There must, however, be extreme care on the part 
 of the parent, and oftentimes special precautions ex- 
 ercised by the child against the disease. 
 
 The first 
 channel 
 through 
 the lungs 
 
 The sec- 
 ond way 
 of infec- 
 tion 
 
 through 
 the alimen- 
 tary canal 
 
 CHANNELS OF INFECTION 
 
 Infection by the tubercle bacillus may take place in 
 one of three ways : namely, by inhalation, ingestion, or 
 inoculation. 
 
 The first is the commonest way. It is the breath- 
 ing into the lungs the particles of dried sputum or 
 other discharges which have become mixed with the 
 dust. 
 
 These same particles sometimes become mixed with 
 food or drink, and enter the alimentary canal, which 
 forms the second mode of infection. Carelessness in 
 carrying the hands to the mouth after handling soiled 
 linen is another means of communicating the disease. 
 Sometimes a tubercular patient in sneezing or laugh- 
 ing expels a particle of saliva which may contain the 
 bacilli, and one is not safe who is facing him at a 
 shorter distance than three feet, as these particles may 
 be inhaled or swallowed. Another source is through 
 infected milk or meat, particularly the former, which 
 should always be sterilized if it comes from a suspicious 
 source. 
 
INFECTIOUS DISEASES 157 
 
 The third and less common method of infection is The third 
 by inoculation through a scratch or slight wound, through 
 This is liable to occur at any -time when the hands ^wound 
 come in contact with tuberculous matter, hence any 
 abrasion on the hands should always be protected. 
 
 GENERAL PRECAUTIONS 
 
 There are general precautions against the increase 
 of tuberculosis, which can be of great value only when 
 all intelligent people feel their force and combine in 
 checking the ravages of the dreadful disease. 
 
 (i) The better ventilation of schools, factories, The P re - 
 
 v ' caution of 
 
 offices, and public buildings. ventilation 
 
 (2) More attention to the physical well-being and Attention 
 
 . . r j_i to physical 
 
 development 01 youth. well-being 
 
 (3) The selection of better foods and their prepa- Better 
 ration under more sanitary conditions. foods'* 
 
 (4) The limiting of occupations that tend to the sanitary 
 
 development of the disease. Sonsin oc- 
 
 cupations 
 
 PRECAUTIONS FOR ATTENDANTS 
 
 (1) The sputum must be prevented from drying. 
 
 The sputum mug should be partially filled with some care of 
 disinfectant fluid, or, if necessary, moist rags can be and^dTsin- 
 used, and burned before thev have a chance to drv. fection of 
 
 sputum 
 
 Sputum mugs that are cracked or nicked should never mugs 
 be used, as germs will get into the crevices and be- 
 come a source of danger. Any such receptacle should 
 be of metal, china, or glass, so that it can be boiled. 
 A pair of rubber gloves is very useful to slip on when 
 washing these mugs. 
 
 (2) The patient's linen should be placed in a dis- Disinfec- 
 infectant or boiled before mixing with the general body 
 laundry. linen 
 
 (3) Dishes used by the patient should be kept sep- 
 
158 HOME NURSING 
 
 Disinfec- arate from those for family use, and should be boiled 
 
 tion of j. ... 
 
 dishes frequently. 
 
 (4) The patient should be instructed always to 
 Duty of -hold a handkerchief before his mouth when coughing 
 
 the patient . P ° 
 
 or sneezing, so as to avoid any danger from particles 
 of mucus that might be expelled at the time. 
 
 (5) Dust cloths should always be moist, and must 
 Dusting be burned or boiled or soaked in a disinfectant after 
 fng the using. The floor should never be swept, but should 
 ?oom nt ' S ^e wiped, also with a moist cloth. A carpet must not 
 
 be allowed to remain on the floor. 
 
 There are various ways by which one who has the 
 How the care f a tuberculous patient can guard her health, 
 
 home nurse . .. . ° 
 
 of a tuber- and it is most important that every effort toward 
 tient US must maintaining a healthy condition of body and mind be 
 ne^health ma de, if one is to ward off infection successfully. 
 
 A person who is weakened physically from any 
 cause should never be allowed to undertake the nurs- 
 ing in any infectious disease, and there must be regular 
 hours for food and rest if the health is to be main- 
 tained. One should never go hungry to the sick- 
 room, and at all times the body is to be well nourished. 
 Plenty of out-of-door exercise is essential, and at 
 times when this is not practicable it may be substi- 
 tuted by breathing exercises taken before an open 
 window. Deep breathing which admits plenty of 
 oxygen to the lungs is an excellent method of pre- 
 venting tuberculosis. 
 
 EXERCISES BENEFICIAL TO THOSE WITH TEN- 
 DENCY TO TUBERCULOSIS 
 
 The following exercises will be found of very great 
 
 Loose benefit to one having a tendency to tuberculosis or to 
 
 f oth / s "f e a those who may be especially exposed to it. A person 
 
 with tightly fitted neckwear or tight clothing can 
 
INFECTIOUS DISEASES 159 
 
 never breathe properly. There should always be per- 
 fect freedom about the neck, chest, and abdomen. 
 
 Heels together, head erect, chest forward, hips 
 thrown back, the arms hanging at the sides with the First sim- 
 palms turned in. With mouth closed take a deep c ise in 
 inspiration, and hold the breath for a few seconds, ^atiiing 
 then exhale slowly. Next during the act of inspira- 
 tion raise the arms slowly to a horizontal position, 
 keep them there while holding the breath a few sec- 
 onds, and then gradually lower them as the breath is 
 exhaled. The act of expiration should always be a 
 little more rapid than that of inspiration. 
 
 The second exercise is like the first except that 
 the arms are carried up over the head in a vertical Second 
 
 r _ exercise 
 
 position till the tips of the fingers meet over it. 
 
 With the same military attitude as at first, the 
 arms are extended at full length in front of the body Third 
 in a horizontal position and with the backs of the n 'cuit ex- 
 hands meeting as in the act of swimming. The arms ercise 
 are then moved as if dividing the water during in 
 spiration till the hands meet behind the back. The 
 breath is then held for a few seconds, and the arms 
 are carried forward during exhalation. 
 
 The arms should not be allowed to drop out of the 
 horizontal position at any time. This exercise is made 
 easier by rising on the toes during expiration. 
 
 To overcome the habit of stooping, the following 
 exercise is recommended : Military position, hands on To ° ver - 
 hips with thumbs in front, then slowly bend back as habit of 
 far as possible during inhalation. Remain in this stooping 
 position a few seconds while holding the breath, and 
 then rise during the act of exhalation. These exer- 
 cises should not be begun too vigorously. 
 
 It is better to commence with the simple exercises, 
 reserving the more difficult until the others have been 
 
with 
 patient 
 
 160 HOME NURSING 
 
 Never use practiced for several days. They should never be 
 dis^hen taken when one is very tired, and should not be kept 
 tired U p un tii one becomes so. They should be taken 
 
 several times a day, and by their continued use deep 
 breathing will soon become a habit. Breathing exer- 
 Nor with- c i seSj though very useful to tuberculous patients when 
 physician's properly directed, should on no account be taken un- 
 advisedly nor without the guidance of the physician 
 in charge. 
 
 A person having the care of a tuberculous case 
 
 Caution should on no account sleep in the same bed with the 
 
 sleeping patient, nor occupy the same room at night if it is 
 
 possible to avoid it. A couch placed in the hall just 
 
 outside the door of the room can usually be arranged 
 
 for use at night, and is invariably to be preferred. 
 
 SUGGESTIONS FOR PATIENTS 
 
 The matter of expectoration and facilities for the 
 How to disposal of the sputum has received much attention, 
 and ry use and a number of devices have been arranged for the 
 sputum* use °^ consumptives. A very satisfactory receptacle 
 flask f or a patient who is not confined to the bed or chair 
 
 is a pocket flask, which is unbreakable and can be 
 easily cleaned. One made of metal and containing a 
 movable funnel is perhaps one of the best. It can be 
 placed inside an ordinary pocket-handkerchief with an 
 elastic band placed round the neck of the flask, out- 
 side of the handkerchief, to keep it in place, and as 
 it can be easily manipulated with one hand it is used 
 without attracting attention. 
 
 For street use there have been devised some self- 
 
 Pocket cleaning spittoons which it is desirable should be 
 
 cups U for placed freely in all large cities. Pocket receptacles 
 
 street use ma y be obtained at any large drug store or ordered 
 
 if they are not in stock. Patients who refuse to use 
 
INFECTIOUS DISEASES 
 
 161 
 
 portable sputum cups should have a pocket lined with 
 rubber in which they can place the cloths used, and 
 these must be burned before they become dry. 
 
 There are some ways in which a patient can guard 
 against re-infection of himself, and this is very neces- Guarding 
 
 • 11 •<> i • mi -i- against re- 
 
 sary, especially if the case is a mild one and the dis • infection 
 ease confined to a limited area. He should never 
 swallow the sputum to avoid expectoration, as in this 
 
 Pocket Sputum Flask 
 
 way the bacilli are carried directly to the intestines, 
 which sooner or later are sure to become infected. 
 He should always carry two handkerchiefs, one for 
 wiping the mouth and another for the nose, so that 
 there can be no danger of the infection being carried 
 to the nasal passages and thence to the throat. 
 
 As a safeguard for himself and others he should 
 be careful not to caress household animals, which Germ-car- 
 
 rying furs 
 
 frequently carry the germs from one person to an- 
 other in their fur. 
 
162 HOME NURSING 
 
 CARE OF PATIENTS 
 
 The diet of tuberculous patients should be en- 
 vvhat the tirely wholesome, and as hearty as is practicable with 
 ious r pa- the condition of the digestion. Scraped beef, milk, 
 Ihouid eat whole-wheat bread, and raw eggs should be given in 
 abundance. A fresh raw egg can be made very pal- 
 atable if it is dropped carefully into a glass contain- 
 ing a little lemon- juice, sprinkled with a little pepper 
 and salt, and covered with more lemon squeezed 
 over it. Sherry wine is sometimes used in place of 
 lemon- juice. 
 
 In conclusion let us add that the message of the 
 Tubercu- scientific world along the line of the tuberculosis in- 
 curable vestigation is full of cheer and confidence provided 
 there is obedience to simple hygienic rules. This is 
 what the sanatoria are trying, and with already a 
 marked degree of success, to set before us. Tuber- 
 culosis is both a preventable and a curable disease. 
 There is no specific climate necessary for its 
 No specific treatment, although some climates may have a better 
 chmate influence than others upon it. 
 
 There is no specific medicine which can act di- 
 .*o specific rectly upon the germ causing the disease, or upon the 
 poisons which that germ produces. The attitude of 
 the medical world toward the segregation of tuber- 
 culous patients has changed from that of indifference 
 or even hostility to one of hearty indorsement of the 
 methods carried out by the modern sanatoria. 
 
 The principles of treatment there adopted are : Life 
 Principles spent in the open air, the nutrition of the body main- 
 ment eat tained at the highest point, and rest suited to the 
 patient's condition and to the stage of the disease. 
 
 An arrangement for carrying out home treatment 
 on the sanatorium basis is often practicable, when for 
 
INFECTIOUS DISEASES 163 
 
 some reason it is not advisable or necessary to send 
 the patient away. A veranda can be built on, conven- To have 
 ient to the patient's living-room, where *he can rest sanato- 
 dnring the day and can often sleep during the night. rmm 
 This should be covered by a roof or awning, and in 
 most climates it will need to be inclosed in wire 
 netting as a protection against mosquitoes and flies. 
 The reclining-chair may be of willow or an ordinary 
 steamer-chair well cushioned will answer the purpose. 
 
 If the clothing is warm, and hot-water bags are Duringthe 
 used at the feet and about the bodv, a person can live winter 
 
 J ' r months ' 
 
 out of doors in really cold weather. A very good 
 arrangement for protecting one from draughts is a 
 beach-chair with high back and sides, like the old 
 sedan-chairs. If the seat is taken out of this and the 
 head of the steamer-chair is drawn inside it, the head 
 and shoulders can be effectually protected from 
 draughts, and yet the lower part of the body may lie 
 in the sun. This is a better arrangement than shield- 
 ing the patient with an ordinary screen, because the 
 chair is stable and solid and can not be blown over. 
 It may not be necessary for a person to give up 
 all occupation, and to become a helpless invalid. If one's occu- 
 
 . . . pation in 
 
 tuberculosis is recognized in its incipient stage it is case of 
 inclined to yield quickly to treatment. If the patient los" "" 
 has an indoor occupation, if he is working in an 
 atmosphere which is carrying foreign particles into 
 his lungs with every breath he draws, his first duty is 
 to find, another method of earning his living. Every 
 year increases the number of persons who are fight- 
 ing the disease, or a tendency to it, by giving the 
 tangs a chance to expand in the fresh open air and by 
 furnishing the tissues with the best possible nutri- 
 ment, while at the same time the daily occupations of • 
 life are carried on. 
 
164 HOME NURSING 
 
 It is the neglect of the premonitory symptoms that 
 Duty of makes the disease such a menace to patients contract- 
 to himself: ing it, and it is their lack of observance of precau- 
 community ti° ns that makes their presence in the community an 
 actual danger. 
 
 CEREBRO-SPINAL MENINGITIS 
 
 Meningitis is an infectious disease, though the 
 infectious- specific micro-organism producing it has not been 
 meningitis isolated. In the highly malignant form of the disease 
 there is hardly time to recognize the nature of the 
 trouble before the end has come, but when the attack 
 is milder it is less often fatal, but needs untiring and 
 intelligent care. 
 
 The excessive stiffness of the muscles of neck, 
 
 Character- spine, and extremities, the deafness and headache are 
 
 symptoms ver y characteristic of the disease. Dizziness, nausea, 
 
 constipation, restlessness, delirium, and double-vision 
 
 are usual accompaniments, the temperature is not 
 
 necessarily high, and an eruption of the skin appears 
 
 frequently enough to give the disease its name of 
 
 ''spotted fever." It generally occurs in epidemics, 
 
 and attacks both children and adults, although it is 
 
 more common during the first twenty years of life. 
 
 The milder cases run for a period of from two to 
 
 Conva- four weeks, convalescence being rather slow. The 
 
 deafness, dizziness, and muscular stiffness last for 
 
 some time and excitement and fatigue must be avoided. 
 
 The different symptoms receive, individual treatment 
 
 Treatment- as t h e y occur# if the temperature is high, sponge 
 
 individual baths and rubbing with alcohol are given. The pains 
 
 in the spine are treated with either cold or hot 
 
 applications according as the system seems to need 
 
 a depressant or a stimulant, and the restlessness and 
 
INFECTIOUS DISEASES 165 
 
 delirium are often relieved by the use of an ice-bag 
 on the head. 
 
 As soon as the stomach can bear food it should be 
 given with great regularity. Liquids will be ordered Diet 
 while the fever continues, and during convalescence 
 the diet should be abundant and easily digestible. All 
 excitement should be guarded against, and every con- 
 dition that makes for health should be secured. 
 
 An inciting cause of the disease is believed to be 
 poor food and bad air, combined with a depressed state 
 of the system, which furnishes a favorable condition 
 for the growth of the disease germ. One point that 
 we must emphasize in our treatment of the disease The dis- 
 is the fact that it is communicable from person to commu- 
 person. The nasal and throat secretions should be mca 
 disinfected or received in cloths which can be burned, 
 and the utmost care should be taken in regard to per- 
 sonal cleanliness and the care of utensils. Good 
 health, fresh air, and suitable nourishing: food are the Necessary 
 
 safeg«ards 
 
 best safeguards. Mild cases when neglected may 
 leave the system in a condition of increased suscep- 
 tibility to subsequent attacks, or a deficiency in the 
 sense organs causing deafness, loss of the use of the 
 vocal cords, or both. 
 
X 
 
 ACUTE AND NERVOUS DISEASES 
 
 Rheumatism— Tonsilitis— Bronchitis — Pleurisy — Appendicitis— Bright's Dis- 
 ease— Neurasthenia— Hysteria— Epilegsy— Insanity 
 
 Inflamma- 
 tory na- 
 ture of 
 rheuma- 
 tism 
 
 Care 
 of the 
 clothing 
 
 Precau- 
 tion in 
 bathing 
 
 RHEUMATISM 
 
 ACUTE inflammatory rheumatism is a disease 
 characterized by pain and swelling of the joints, 
 accompanied by high fever. Usually one joint after 
 another becomes involved, and in severe cases the 
 pain is extreme, so that even the weight of the sheet 
 on the affected parts is intolerable and the slightest 
 jarring of the bed or change of position causes ago- 
 nizing pain. The disease is usually brought on by ex- 
 posure to damp and cold and generally runs a course 
 of several weeks. 
 
 Profuse perspiration accompanies the disease, and 
 the clothing must be changed as it becomes wet with 
 the increased moisture of the body. For this reason 
 a night-dress opening down the back which can be 
 slipped on and off the patient with the least possible 
 disturbance is essential for such cases. A thin flannel 
 shirt opened down the back in the same way should 
 be worn next the skin unless a flannel night-dress is 
 preferred. 
 
 The advisability of giving the daily bath must be 
 left for the doctor to decide. As the perspiration is 
 always profuse, and has a characteristically strong 
 odor, there should be frequent sponging with warm 
 alcohol. All bathing should be done under cover 
 without the slightest exposure. 
 (166) 
 
ACUTE AND NERVOUS DISEASES 167 
 
 The danger of bed-sores forming should be particu- 
 larly kept in mind. The increased moisture, owing to The dan- 
 profuse perspiration, and the patient's inability to turn bed-s°ores 
 himself are exciting causes which might readily lead 
 to bed-sores if special care is not taken to prevent 
 their formation. 
 
 Rheumatic cases are always liable to heart com- 
 plications and care must be taken not to move a The action 
 
 r of the 
 
 patient suddenly or as he improves to allow him to heart 
 make any sudden exertion. Sometimes even after 
 convalescence seems well established the heart func- 
 tion is still imperfect, and may remain so for some 
 weeks or months, if, indeed, the patient is not left 
 with a chronic weakness of that organ. On this ac- 
 count any orders the doctor may give in regard to 
 rest and careful exercise need not seem unreason- 
 able. 
 
 There is likely to be great irritability of the nerv- 
 ous system and often marked mental depression. Dis- Reguia- 
 taste for food as in all fever cases may be expected, the" diet 
 and ingenuity and untiring patience in preventing it 
 is demanded of the nurse in order to keep up the 
 necessary amount. The diet in rheumatism is always 
 carefully regulated. During the fever stage nothing 
 but liquids in liberal quantity may be given. As the 
 fever declines light diet is allowed, though all foods 
 having a tendency to produce acids in the system must 
 be eliminated. 
 
 In general the following diet list may be useful 
 during convalescence : Eggs in moderation, small A diet 
 
 • • r r • r , , . , r list for a 
 
 quantities of farinaceous foods, toast, stale bread of rheumatic 
 rye or whole wheat flour, milk toast, zwieback, gra- patient 
 ham gems, crackers, and hominy. Vegetables — 
 fresh green varieties, celery, lettuce, watercress, sal- 
 ads, young peas and beans, and spinach. For des- 
 
168 
 
 HOME NURSING 
 
 A bever- 
 age list 
 
 A device 
 for relief 
 
 serts — oranges, lemons, cranberries, apples, apricots, 
 pears, peaches, cherries, jellies, blanc-mange, stewed 
 or roasted fruit. Meat should be taken once a day 
 only, and should be confined to the white varieties 
 chiefly — mutton, chicken, bacon, sweetbread, pigeon, 
 and pig's feet. 
 
 Beverages will be useful during the fever to re- 
 lieve the great thirst, and a plentiful amount of liquids 
 assists toward recovery. Plain soda, toast-water, 
 lime-juice, lemonade, and mineral waters may be given 
 with the doctor's approval. Liquids should be taken 
 through a glass drinking-tube, which it is necessary 
 to wash at once after using in order to keep it clean, 
 unless a small brush is used which serves to properly 
 clean the inside of the tube. 
 
 In cases of chronic rheumatism, pain may some- 
 times be greatly relieved by wrapping the joints in 
 cotton wool. If there is a slight rheumatic tendency 
 and the joints feel stiff and painful in the morning, 
 the use of cotton over the affected part frequently 
 puts an end to the trouble. 
 
 Marks of 
 tonsilitis 
 
 TONSILITIS 
 
 Inflammation of the tonsils often follows exposure 
 to cold, fatigue, or foul and poisonous air. Although 
 not usually in itself a serious affection, it is extremely 
 prostrating and is attended by high fever, severe 
 headache, and general soreness of the limbs and back. 
 The tonsils themselves become enlarged, so that talk- 
 ing is difficult and the voice sounds thick. The glands 
 about the neck are also more or less swollen. The 
 white spots seen on the tonsils may be confused with 
 the gray patches of diphtheria, though the distinction 
 is usually recognizable to a practiced eye. No posi- 
 tive diagnosis, however, is likely to be made if there 
 
ACUTE AND NERVOUS DISEASES 169 
 
 is any doubt in the matter until a "culture" has been 
 taken from the throat and subjected to examination 
 under the microscope. This is now a routine measure 
 with many physicians whenever the throat is affected. 
 The patient should be- kept in bed and on liquid 
 diet, and a gargle prepared for the relief of the in- Care and 
 
 , . . r i i -rr • , • treatment 
 
 named tissue of the throat. If no special prescrip- of the 
 tion is given by the physician one made of hamamelis patient 1C 
 diluted half with water is useful because of its slightly 
 astringent property. If the area of white patches is 
 large in the throat a solution of peroxide of hydrogen 
 one part in six of water will aid in cleansing the 
 throat. 
 
 Special care must be observed to keep an even 
 temperature in the sick-room, especially when the 
 patient begins to sit up, as relapse sometimes brings 
 with it serious complications. All dishes used by the 
 patient should be kept separate from those of the 
 family. 
 
 The fever in tonsilitis is of short duration, but it 
 is often several weeks before a person regains his 
 usual strength after an attack. 
 
 BRONCHITIS 
 
 Bronchitis may follow a cold or occur as a symp- 
 tom in the progress of other diseases. There is a Signs in 
 feeling of tightness and soreness across the chest, a of bron- 
 hard, dry cough often coming in severe paroxysms, chltls 
 and, as in tonsilitis, the weakness and aching of the 
 head, back, and limbs is marked. The fever does not 
 run as high as in tonsilitis. In an ordinary case of 
 bronchitis the cough may be expected to loosen in 
 three or four days, and expectoration becomes freer, 
 giving great relief. 
 
 n The bowels should be kept open and free action 
 8 \c\ 3 
 
170 
 
 HOME NURSING 
 
 Condition 
 and care 
 of the 
 patient 
 
 of the skin secured by means of the bed-bath and 
 alcohol rubs. It is especially important that the air 
 of the room should be kept pure and the temperature 
 not above 70°, and that there be plenty of nourish- 
 ing food. The patient must avoid sudden change of 
 temperature in going from room to room when con- 
 valescence begins, as the susceptibility to cold is in- 
 creased. 
 
 PLEURISY 
 
 £? pleura OF injury 
 
 The term pleurisy indicates an inflammation of 
 
 what the the membrane or pleura which envelops the lungs. 
 
 pleura is ^[ s me mbrane is so arranged as to fold back, form- 
 ing also a lining to the chest cavity. In health it 
 secretes a certain amount of fluid which serves to 
 lubricate the two surfaces, so that they slide easily 
 against each other as the chest rises and falls in 
 breathing. 
 
 Inflammation often occurs as a complication of 
 
 infiamma- pulmonary disease or it may follow cold, exposure, 
 The membranes become dry and no longer 
 rub smoothly against each other, and this causes sharp 
 pain on inspiration. This condition may terminate in 
 a restoration to the normal state in a few days or 
 continue for some weeks. 
 
 Counter-irritants in the form of a hot-water bag 
 or a mustard plaster, if applied immediately upon the 
 first indication of pain, may sometimes ward off an 
 attack and a broad band of adhesive plaster carried 
 entirely around the chest to constrict its movements 
 gives considerable relief. 
 
 Sometimes the temperature continues to remain 
 
 Conditions high and the breathing more or less difficult, though 
 the pain lessens or may entirely disappear. These 
 symptoms may mean that the space between the two 
 
 Counter- 
 irritants 
 
 rf the 
 fever 
 
ACUTE AND NERVOUS DISEASES 171 
 
 surfaces of membrane is filling with fluid and their 
 separation has caused the pain to diminish. This con- 
 dition may subside gradually and the fluid become 
 absorbed or pus may form and an operation become 
 necessary. 
 
 APPENDICITIS 
 
 Appendicitis is an inflammation confined to a certain 
 part of the intestines known as the vermiform ap- Causes of 
 pendix. The disease was commonly called "inflam- citis 
 mation of the bowels" before modern surgery showed 
 that the origin of the trouble is in the appendix or 
 small appendage on the right side of the intestines. 
 Inflammation may be due to blows, falls, great physi- 
 cal exertion, a strain, improper food, or to a small 
 hardened mass — rarely to a foreign body — which may 
 collect and obstruct the opening to the appendix. 
 Sometimes it is associated with rheumatism, influ- 
 enza, or typhoid fever. 
 
 There are several forms of the disease recognized 
 as acute, chronic, or recurrent. Sometimes it hap- Several 
 pens that grave symptoms are obscured and the the'disease 
 patient may not seem very ill, though in reality the 
 condition is most serious. For this reason the advice 
 of a physician should always be sought if there is 
 any indication of the following symptoms : 
 
 The pain may be sharp and colicky or dull and 
 aching. It is at first diffuse, but usually becomes Grave 
 localized on the right side of the abdomen over the symptoms 
 region of the appendix. Nausea and vomiting is usual 
 and constipation is more common than diarrhoea. 
 There is apt to be tenderness over the right side, and 
 sometimes a distinct tumor can be made out. The 
 temperature is not a safe guide, as it may be found 
 normal when other symptoms are grave. The charac- 
 
172 
 
 HOME NURSING 
 
 Three 
 
 courses 
 the inflam- 
 mation 
 may take 
 
 The ques- 
 tion of 
 operation 
 
 Cautions 
 
 teristic position of the patient is to lie flat on the back 
 with the right leg drawn up. 
 
 The attack may come to an end in one of three 
 ways — by resolution, in which ease the symptoms 
 gradually subside so that in a week or ten days the 
 patient is entirely recovered; by abscess formation 
 with increased pain and more extensive tenderness 
 over the abdomen, or with a lessening of the pain 
 and general symptoms if the abscess has become 
 thoroughly walled off; or there may be a rupture of 
 the appendix followed by a general peritonitis. 
 
 The question of operation must of course be left 
 to the decision of the doctor and surgeon, but in 
 general it may be said that unless operation is too 
 long delayed it is rarely attended with serious results, 
 and that however mild the attack there is always 
 danger of alarming conditions developing so rapidly 
 that operation comes too late. 
 
 The patient must be kept in bed and on a strictly 
 liquid diet. No instructions can be given for treat- 
 ment, but it will be remembered that in any inflam- 
 matory condition the application of heat must be used 
 with caution. 
 
 BRIGHT'S DISEASE 
 
 Causes of 
 
 Bright's 
 
 disease 
 
 Character- 
 istic 
 
 changes 
 in the 
 disease 
 
 Acute Bright's disease or kidney trouble, present- 
 ing albumen in the urine, may be brought on by ex- 
 posure to cold, as a result of extensive burns, or as 
 a sequel of some of the infectious diseases,, especially 
 scarlet fever, typhoid, or diphtheria. It may also 
 occur during the course of pregnancy. 
 
 The most characteristic changes are indicated by 
 the urine, which diminishes in quantity and becomes 
 albuminous. There is usually a puffiness about the 
 ankles and eyelids, which may spread over the entire 
 
ACUTE AND NERVOUS DISEASES 173 
 
 body. Headache and gastric disturbances are usual, 
 and only the most easily digested foods can be taken. 
 
 It is evident that in any disease of the kidneys 
 the waste of the body is not being properly removed, Treatment 
 and the defective work of those organs must be sup- normal 
 plemented by increasing the activity of the skin. Hot ^"he " 
 baths are given and drugs to induce free perspiration Sidneys 
 and to increase the amount of urine. The bowels 
 should be kept freely open also. Every means must 
 be utilized to restore the normal function of the kid- 
 neys. 
 
 Increase of the dropsical condition and failure to 
 
 •secrete the normal amount of urine are discouraging Hopeful 
 
 i t 1- • i Slgns 
 
 symptoms, whereas the reverse conditions may be re- 
 garded as hopeful signs. 
 
 When giving the hot bath the room should be 
 warm and entirely free from draughts, as any ex- Giving 
 posure is particularly dangerous. The patient should 
 be put at once after the bath between warm blankets 
 with abundant covering and hot-water bags at feet 
 and sides. A warm drink will also aid in producing 
 perspiration. After half an hour the covers may be 
 taken off gradually and the patient wiped dry with 
 warm towels. 
 
 NEURASTHENIA 
 
 Neurasthenia or nerve- weakness is a condition in- 
 dicating lack of power of the nerve centres of the cause of 
 body. The common cause for neurasthenia is over- "^nit 
 work combined with anxiety. Some persons having 
 large expenditure of nervous force have little power 
 of creating nervous energy, and wherever the daily 
 expenditure of nerve force is greater than the in- 
 come of nervous energy the result must plainly and 
 inevitably be nerve-weakness or neurasthenia. There 
 
174 
 
 HOME NURSING 
 
 Symptoms 
 of mental 
 overwork 
 
 Physical 
 symptoms 
 
 Recovering 
 from neu- 
 rasthenia 
 
 Changing 
 the meth- 
 od of 
 living 
 
 may be a local or a general neurasthenia, the former 
 often leading to the latter; hence any nervous dis- 
 order, even when confined to a particular part of the 
 body, must be regarded as serious because of the possi- 
 bility of its resulting in a general nervous break- 
 down. 
 
 Some of the symptoms of mental overwork are 
 increasing reluctance to take up daily duties, weak- 
 ness of memory, insomnia, and a feeling of weight 
 or constriction about the head. Sometimes for the 
 time being there is an abnormal desire to work, ac- 
 companied by vigorous brain activity and an almost 
 complete inability to rest or sleep, which heralds a 
 serious and sudden collapse of nervous energy. 
 
 There is usually, though not always, great de- 
 pression accompanying general neurasthenia, and the 
 patient becomes increasingly morbid until his condi- 
 tion seems to border on insanity. The feet and hands 
 are often clammy and cold and there may be profuse 
 perspiration following the least excitement. Short- 
 ness of breath and rapid pulse, itching, neuralgia, and 
 nervous headaches are symptoms of this disorder. 
 
 Recovery from a condition of neurasthenia is 
 always very gradual, and must be gained chiefly 
 through rest and proper food. The special method 
 of treatment adopted must depend largely upon the 
 degree Of the nerve exhaustion. In attempting to rest 
 an excited, worn-out brain the effort must be to re- 
 move all anxiety and brain-work while still endeavor- 
 ing to keep up the interest of the patient and to estab- 
 lish the general health of the body more completely. 
 
 To secure this the method of living must be en- 
 tirely changed as far as mental atmosphere is con- 
 cerned. All brain-work is to be excluded and fresh 
 air and exercise in some form is to be added to 
 
ACUTE AND NERVOUS DISEASES 175 
 
 proper feeding and rest. Quiet travel when properly 
 directed affords one of the best means of obtaining 
 the desired change in cases where the general 
 strength will permit. An ocean voyage which pro- 
 vides mental qu>et, fresh air, and an escape from An ocean 
 business or domestic activities, or camp lite, which beneficial 
 may add the element of exercise in any amount de- 
 sirable for the patient, are means which probably 
 afford the shortest road to complete recovery. 
 
 To persons of slender means to whom the luxury 
 of travel must be denied it should be borne in mind 
 that cessation from mental work is an absolute re- 
 quirement, whereas such a modification of the method 
 of living may be made possible as to take the place 
 of the complete change of scenery which is desirable. 
 For severe cases the so-called "rest-cure" which has 
 been instituted by Dr. S. Weir Mitchell is frequently "The rest- 
 most beneficial. The principles of this cure -are "ab- 
 solute rest, forced feeding, and passive exercise." 
 Complete isolation from friends and relations is 
 usually insisted upon, and as far as possible entire rest 
 of both body and mind is secured. Extreme care is 
 exercised in the feeding of patients, and massage and Need of 
 electricity are relied upon to provide the required ^e^ 6 
 amount of exercise. The daily routine is so arranged food 
 as to take up the patient's time and attention in order 
 that the confinement may not seem intolerable. 
 
 Under the guidance of a wise physician and with 
 the co-operation of the family and of the patient 
 himself, an approach to this method of treatment can 
 be made in the home by arranging a daily schedule 
 to include stated periods of rest, exercise, and frequent 
 regular feedings. 
 
 Wherever there is a derangement of the nervous 
 system it should be understood that the nerves them- 
 
176 
 
 HOME NURSING 
 
 Supplying selves are suffering from a lack of proper nutrition, 
 nutrition which we can in part supplement by a judicious over- 
 feeding, provided the waste of the body is eliminated 
 at the same time. The proportion of fats is always 
 increased in the food recommended for nervous pa- 
 tients. This need is supplied by a diet of milk, butter, 
 cream, and the fats of meat, of which bacon is the 
 most digestible. 
 
 At the present time the expense attendant upon 
 The reduc- treatment at most sanatoria necessarily shuts out a 
 penses in large class of patients, but as the success of the new 
 methods gains footing in the popular mind we shall 
 have public sanatoria as we have general hospitals 
 for the relief of those who can not afford expensive 
 treatment. Special rates are already made at some 
 of the well-known sanatoria. 
 
 HYSTERIA 
 
 Hysteria 
 an actual 
 malady 
 
 Those 
 most apt 
 to suffer 
 from 
 hysteria 
 
 Very few people other than doctors and nurses 
 recognize that the term hysteria stands for an actual 
 malady. The person who exhibits hysterical fits or 
 who is morbidly emotional and defective in will-power 
 is suffering no less truly from a disordered state of 
 the nervous system than is the neurasthenic or insane 
 person, and the establishment of curative measures is 
 equally important in both cases. 
 
 Hysteria is more common among women than 
 among men, because of their more excitable and sensi- 
 tive nervous system. It develops more often between 
 the ages of fifteen and twenty-five years, and the ten- 
 dency is greater among young people whose parents 
 belong to the nervous type or whose education and 
 mode of life tends largely to indoor, luxurious living 
 rather than to the more robust out-of-door life. The 
 
ACUTE AND NERVOUS DISEASES 177 
 
 disease may also follow as a result of overwork, dis- 
 sipation, or a long period of severe pain. 
 
 The manifestations of hysteria are very varied. 
 The unnatural craving for sympathy which is one of strange 
 the characteristics of the disease leads to such warp- JJons of* 
 ing of moral purpose that simulation of almost every h y stena 
 known disorder is the common practice of hysterical 
 patients. It is very difficult for one to realize that 
 this deceit results from the fact that the emotional 
 nature dominates and that morbid ideas have full 
 sway — the dread of a certain disease, for instance, 
 being so intense as to cause a patient to feign its 
 symptoms. We may regard a person in this condition 
 as in some measure irresponsible for her acts because 
 of the tremendous power the imagination has over 
 conduct. 
 
 Some of the common symptoms to be observed 
 are retention of urine or the passage of abundant and Common 
 
 . 1-1 • rin symptoms 
 
 light-colored urine, neuralgia, the sensation of a ball of hysteria 
 in the* throat (globus hystericus), paralytic disturb- 
 ances, and spasms of one kind or another. Beast 
 mimicry, in which the sounds and movements of the 
 lower animals are imitated, is observed among children. 
 The treatment of hysteria is both preventive and 
 curative. The results of inheritance may be largely J f re t ^ e ment 
 overcome by careful education of the child, and an difficulty 
 effort to secure a normal physical development to- 
 gether with a healthy and robust nervous system. 
 Self-control must be demanded of the child, and a 
 spirit of unselfishness cultivated which may offset in 
 a large measure the self-centred interest which is so 
 marked a characteristic of the disease. When the 
 disease is once established it is often treated like neu- 
 rasthenia, with which it is closely allied. Hysterical 
 fits need no treatment and the less notice a patient 
 
178 
 
 HOME NURSING 
 
 Withhold- 
 ing sym- 
 pathy and 
 teaching 
 fortitude 
 
 gets on such occasions the quicker will the paroxysm 
 subside and the less frequent will they become. 
 
 In general it is safe to say that sympathy must be 
 rigidly withheld and all effort directed toward teach- 
 ing the patient how to gain a proper self-control. If 
 complaints do not reap sympathy they will gradually 
 cease. Sometimes the hysterical attacks are made to 
 result very disagreeably to the patient and are so 
 broken up, as when a physician arrests a paroxysm 
 by the injection of a drug which causes vomiting. It 
 is possible by some such treatment, if wisely admin- 
 istered, to effect a complete cure of the attacks. 
 
 "Reflex 
 epilepsy' 
 
 EPILEPSY 
 
 The cause of epilepsy is very little understood. 
 
 The attacks are occasioned by some disturbance of the 
 
 Cause of nerve force occurring irregularly without any apparent 
 
 not known cause, and are attended by loss of consciousness and 
 
 more or less convulsive seizures. 
 
 What is known as "reflex epilepsy" manifests very 
 similar symptoms and may follow injury to the head 
 in which the skull has become indented, causing pres- 
 sure upon the brain. In the latter case a certain 
 measure of relief is sometimes gained by means of 
 operation, if that is thought advisable after consulta- 
 tion. Convulsions resembling epilepsy sometimes ac- 
 company affections of the eye and ear, and may cease 
 upon the removal of the exciting cause. Also the 
 convulsions of hysteria may be confused with true 
 epilepsy. 
 
 In typical epilepsy the onset is abrupt and usually 
 accompanied by a peculiar sharp cry. The pupils are 
 widely dilated, the face livid, and the involuntary pas- 
 sage of urine is usual. The duration of the attack is 
 seldom more than a few minutes. 
 
 In typical 
 epilepsy 
 
ACUTE AND NERVOUS DISEASES 179 
 
 Hysterical patients rarely do themselves any in- 
 jury, whereas an epileptic may injure himself in fall- How the 
 big, or bite the tongue badly if not prevented. The attack"* 
 movements of hysterical patients are more co- dlffers 
 ordinated, the pupils never dilated, and the attack 
 is always longer than in true epilepsy. 
 
 Attacks of epilepsy occurring in the night may 
 go long unrecognized, but should a person complain 
 frequently of soreness of the limbs on waking, head- 
 ache, exhaustion, and possibly wetting of the bed, 
 such attacks would be suggestive and should be 
 watched for. 
 
 Very little can be done for a person who is having 
 an epileptic seizure beyond loosening the clothing Car e of 
 
 the epilep- 
 
 and placing a folded towel between the teeth to pre- tic patient 
 vent biting of the tongue. This should be done at 
 once, as the jaw soon closes tightly and it will then be 
 too late to save the tongue from injury. If the person 
 is in bed he should be rolled over to one side and the 
 mattress protected from the involuntary passage of 
 urine which may accompany the attack. 
 
 The younger the age at which epilepsy shows it- 
 self the greater the likelihood of serious impairment Variation 
 of the mental system, and the more frequent and effects of 
 severe the attacks the more speedy is the intellectual e P lle P s y 
 ruin liable to be. There are, however, notable excep- 
 tions to this general statement, for cases are on record 
 of patients who, though suffering from a severe form 
 of epilepsy, have for years been able to carry on an 
 active life in business without any noticeable mental 
 defect. 
 
 As the tendency to epilepsy is transmissible from The epi- 
 parent to child, there can be no question as to the moral ™ 
 moral right of epileptics to marriage, and it should m ^ ry to 
 never be considered. 
 
180 
 
 HOME NURSING 
 
 INSANITY 
 
 Two forms 
 of insanity 
 
 Mania 
 
 Condition 
 of mind 
 
 Physical 
 condition 
 accom- 
 panying 
 this 
 
 Inducing 
 sleep by 
 baths 
 
 In the cities where people are so closely crowded 
 into homes, the care of the mentally diseased is very 
 naturally given over to the institutions specially de- 
 signed for them. In the country, however, there is 
 more effort made to attempt home treatment, and 
 occasionally, with the aid of a good physician and 
 untiring nurses, this can be successfully done. 
 
 The two forms of insanity, mania and melancholia, 
 demand quite different care. A patient suffering from 
 an acute attack of either form may be regarded as a 
 hopeful case for complete recovery. 
 
 Mania is sometimes preceded by a period of de- 
 pression varying in length of time from a few days 
 to a few months before the true condition presents 
 itself. 
 
 The final state of mind is one of exaltation and 
 the patient becomes so excited by his fantasies and de- 
 lusions as to disregard his bodily wants. He becomes 
 noisy, incoherent, Often violent, so that it may be 
 necessary to resort to mild restraint. A maniacal 
 patient seldom commits suicide, but his homicidal 
 tendencies are often marked. There is almost com- 
 plete insomnia, the bowels are constipated, and the 
 skin dry and hot. The appetite seems good, though 
 it is usually difficult to make the patient attend enough 
 to eat. Bodily activity is absolutely untiring, and the 
 care of such patients is most exhausting. 
 
 A certain amount of sleep is sometimes induced 
 by means of warm baths, particularly the prolonged 
 warm bath at a temperature of no°, which may be 
 continued for an hour and a half or two hours if the 
 patient is not too restive. Rest in bed is required so 
 
ACUTE AND NERVOUS DISEASES 181 
 
 far as it is possible to secure it, and massage or 
 electricity may be ordered. 
 
 The hair, teeth, and mouth should receive careful 
 attention, as in- the case of anv helpless patient. Nour- Careand 
 
 ' * nourish- 
 
 ishment is often confined to liquid overfeeding, and it mem 
 may be necessary to resort to nasal feeding if the 
 patient is unmanageable. 
 
 If the patient becomes very violent and restraint 
 is demanded, he should be sent at once to some good Modern 
 
 ° methods 
 
 institution where his needs are perfectlv understood in >. nsti - 
 
 r -_ tutions 
 
 and regarded. The period no longer exists when the 
 care of the insane in institutions is conducted with 
 cruel indifference. Modern methods of treatment 
 aim at the recovery of the greatest possible number 
 of cases. Restraint is now reserved for the extremely 
 violent patients only, and when it becomes necessary 
 to resort to it such means are used as will give the 
 patient the least possible feeling of restraint. 
 
 As the period of gradual improvement begins, 
 every effort is made to divert the patient's mind and 
 to give him employment which will interest him. 
 
 In melancholia the condition of the patient is quite 
 different. He is seized with persistent and torturing Jhoita dif- 
 depression of spirits, is constantly "hearing voices," £™ 1 
 which startle him, and are doubtless very real to his man,a 
 imagination. The skin is pallid and cold. There is 
 continual headache and usually constipation and aver- 
 sion to food. 
 
 The feeding of patients suffering from this form Impajr . 
 of insanity must be even more carefully regulated 5}|"s5on 
 than in cases of mania, as the digestion is often much %£°™~ g 
 impaired. The diet should be of nourishing liquids, ™^ ]an - 
 eggs, and cereals, with some further variety as the 
 physician may allow it. Overfeeding must be very 
 cautiously carried out. 
 
182 
 
 HOME NURSING 
 
 Careful 
 guarding 
 of the 
 
 melan- 
 cholia 
 patient 
 
 Do not 
 
 discuss 
 delusions 
 with the 
 patient 
 
 In case 
 of forced 
 feeding 
 
 Sympathy 
 of the 
 nurse 
 with the 
 patient 
 
 Suicide is of frequent occurrence among patients 
 suffering from melancholia, and it is never safe to 
 leave one unguarded even for a moment, for while 
 the back is turned the fatal deed may take place. 
 Everything that could possibly be used as a means 
 of taking life must be removed from his surround- 
 ings. 
 
 In extreme cases the "rest-cure" treatment is ad- 
 vised, and in the milder cases it is best that half a day 
 should be spent in bed. . 
 
 It is worse than useless to attempt to discuss the 
 delusions of a patient with him during the acute stage 
 of the disease, and the less attention that is paid to 
 them the better for the patient in the end. 
 
 The apathy of such patients is often extreme, and 
 forced feeding may become a necessity because of the 
 patient's determined desire to starve himself either 
 from fear of poisoning or because he may consider 
 himself unworthy to eat. The most humane method 
 of feeding is through the nose by means of a soft 
 rubber catheter, which is inserted through the nostril 
 into the gullet for about a foot and a half. The food 
 is then poured into the tube by means of a funnel to 
 which it is attached. 
 
 A person suffering from melancholia is not in- 
 jured by sympathy with his physical or mental 
 troubles, as in the case of hysteria, and a wise nurse 
 can often gain much through* sympathy, inspiring 
 hope, and encouraging effort. 
 
PART II 
 MOTHERHOOD 
 
THE PHYSIOLOGY AND HYGIENE OF 
 PREGNANCY 
 
 Indications of Pregnancy — Quickening — Dress— Need of Fresh Air- 
 Exercise —Food— Bathing— Sleep and Rest — Heredity 
 
 THE ordinary woman understands too little of the 
 physiology of the organs which come to their full 
 development during pregnancy. In discussing the intelligent 
 question of motherhood we can hardly expect to take f our 
 an intelligent point of view unless we know not only necessary 
 the structure and use of these organs, but also their 
 relation to other organs and parts of the body. 
 
 The lower part of the abdomen, protected by its 
 bony girdle, gets its name from the Greek word mean- 
 ing basin. The womb, or uterus, is suspended in this 
 cavity, and is kept in its position by ligaments. This ^ pe ° f " 
 suspension and control make the organ freely movable the uterus 
 and also explain the reason for displacements and 
 falling of the womb, which often follows childbirth 
 when due care is not taken. 
 
 A full bladder tips the uterus backward, a full 
 rectum throws it forward, and when the ligaments why a 
 become weakened from any cause it is more difficult rest is 
 for it to resume and hold its correct position. This aft^chiki- 
 is the case directly after childbirth, and is one of the birth 
 reasons why a long rest in bed is such a necessity, 
 and why so many women who have not taken the 
 proper care are broken down and old before their 
 time. 
 
 The uterus itself is somewhat pear-shaped. The Shape of 
 larger end points upward and the lower end, which 
 
 (185) 
 
186 MOTHERHOOD 
 
 is called the neck, extends down into the vagina, 
 which is the external opening. 
 
 From the upper angle of the uterus, on either side, 
 Function is found a canal called the Fallopian tube, through 
 Fallopian which the tiny eggs — the ova — pass on their way to 
 ovarie S and the uterus. These germ cells live in the ovaries, 
 which are small bodies lying below the Fallopian 
 tubes, also on either side of the uterus. The connec- 
 tion between the two is through the fringe-like ends 
 of the tubes, which grasp the ovaries at the time the 
 ova are discharged. 
 
 These then are classed together as the generative 
 organs, and their function or use is the development 
 of the germ cell, or egg, into life, by its union with 
 the corresponding germ cell, or semen, from the male 
 parent. 
 
 At puberty the ovaries begin their work of dis- 
 Changes at charging ova, once each month, into the cavity of the 
 pu er y uterus. These ova, unimpregnated, pass away in the 
 menstrual flow. 
 
 The monthly sickness involves no adjustment of 
 The ner- the pelvic organs, and no change of their position, as 
 tem at pregnancy does, yet we can realize how closely con- 
 Sckness nected different parts of our bodies are by the wonder- 
 ful mechanism of the nervous system. ' Nearly every 
 one is conscious of mental depression or some nervous 
 disturbance during the menstrual period, and many 
 persons have definite physical accompaniments, like 
 headache or enlargement of the glands in the breasts. 
 The same thing is true in more marked degree at 
 At the the time of the "change of life," when these organs 
 menopause are losing their function. The menstruation becomes 
 more and more irregular and finally ceases. Some- 
 times the flowing is so profuse as to be alarming, at 
 such times, and sometimes decreases in quantity. 
 
THE HYGIENE OF PREGNANCY 187 
 
 The constitutional disturbances are, however, the 
 most trying, and as a rule the more vigorous and The con- 
 normal a woman has been, the less trying will this disturb- 
 period be. The flashes of heat that sweep over the ances 
 whole body from time to time are very characteristic, 
 and the increase in the size of the abdomen is to be 
 expected. If there is any chronic disease it is very 
 liable to be exaggerated at this time, and there may 
 be pain in the head and back, loss of appetite, or im- 
 paired digestion. Depression of spirits is very com- 
 monly felt at this time, and an unreasoning apprehen- 
 sion about the outcome of this trying period. 
 
 Rest, quiet, nourishing food, and considerate care 
 are the chief helps, and before long- the system adjusts Helpful 
 
 1 111 1 t r 1 1 • 1 treatment 
 
 itself to the altered demands. If the disorders are and care 
 serious ones the advice of a physician should be 
 asked. 
 
 Most of the symptoms manifested in both these 
 cases being quite apart from any affection of the Evidences 
 pelvic organs must lead us to see how unified our f our 
 systems are, and from that to understand the reason systems 
 for many of the minor ailments of pregnancy. 
 
 It is, however, the hygiene rather than the ills of 
 pregnancy that we are considering. 
 
 We can not, of course, expect perfect physical 
 conditions during this state, unless we have a perfect Perfect 
 
 i • i" 1 i i • i • 1 physical 
 
 physical development, which is rare among the women deveiop- 
 of this generation, and in this land of little leisure, 
 where equal demands are made on the nervous and the 
 bodily strength. 
 
 Mr. Dooley says: "Th' difFrence between Chris- 
 tvan Scientists an' doctors is that Christyan Scientists 
 think they'se no such thing as disease, an' doctors that 
 they ain't anny thing else." 
 
 We may run some risk in adopting the Christian 
 
 rnent rare 
 
188 
 
 MOTHERHOOD 
 
 Child- 
 bearing 
 is a 
 normal 
 process 
 
 If a wom- 
 an leads 
 a normal 
 life no 
 radical 
 change 
 necessary - 
 
 The physi- 
 ological 
 changes 
 do not 
 interfere 
 with or- 
 dinary 
 duties and 
 exercises 
 
 Whole- 
 some and 
 joyous liv- 
 ing adds 
 to the * 
 child's 
 inheritance 
 
 Science point of view in matters of general health, 
 but in this question of pregnancy it is certainly the 
 saner attitude. This is a matter which we can not 
 emphasize too strongly. Child-bearing is a normal 
 process. The organs of generation are fulfilling their 
 natural use, and the nearer women approach the 
 highest ideal of health, the more absolutely normal 
 will childbirth become. 
 
 Nature has wonderfully accommodated these or- 
 gans and the entire mechanism of the body to this 
 function, and only asks to be given fair play. If a 
 woman's life is normal, healthful, and wholesome, 
 which ought to be one and the same thing, the fact 
 that she is to bear a child need bring about no radical 
 change. It should not be necessary for her to give 
 up her daily occupations or to alter her mode of living. 
 
 The housekeeping cares, even the actual work, and 
 the ordinary exercise in the open air, the pleasures and 
 duties that commonly form a part of the day, should 
 keep their place. Other duties and pleasures will 
 come in, to be sure, and the bodily changes during 
 the nine months will bring the necessity of adapting 
 her life in a measure to the new conditions, but most 
 of these bodily or physiological changes are normal, 
 and do not indicate disease. 
 
 The more wholesomely and joyously a woman can 
 live during this period, the more naturally will the 
 changes and the adjustment to them come, and, fur- 
 thermore, we must believe, the better inheritance will 
 she give her children. 
 
 INDICATIONS OF PREGNANCY 
 
 The first indication of pregnancy is the cessation 
 of the monthly flow. The blood which would have 
 come away as menstrual discharge is used to supply 
 
THE HYGIENE OF PREGNANCY 189 
 
 the ovum in it's development. This is not what is Cessation 
 called a positive sign, because with some women of the first 
 exceedingly nervous temperament an emotional ex- indlcatl0n 
 citement, or unusual physical weariness, or slight ill- 
 ness temporarily interferes with the regularity of the 
 monthly sickness. Interruption may also be caused 
 by more serious disease. In rare cases the flow con- 
 tinues more or less regularly throughout the entire 
 course of pregnancy. But ordinarily its cessation 
 may be regarded as an indication that impregnation 
 has taken place. 
 
 The glands which are to secrete the milk become 
 enlarged, and this growth is accompanied by sensa- Changes 
 tions of weight and tingling or pricking in the breasts, milk 
 The areola or circle about the nipple gradually be- fhe" breast 
 comes darker in color, and later a secondary disk 
 appears surrounding the first. Milk can sometimes 
 be pressed from the breasts some weeks before de- 
 livery, and in the case of a woman who has never 
 borne a child this is considered a valuable sign. 
 
 Nausea is a very usual trouble at this time, though 
 it is not universal. It occurs generallv on rising or The mom- 
 
 infif sick* 
 
 immediately after the first meal, and may or may not ness 
 be accompanied by vomiting. It usually begins about 
 the fourth week, and may last two months or longer. 
 Occasionally it is so persistent that medical advice 
 and treatment are necessary. 
 
 The uterus sinks a little in the pelvic cavity dur- 
 ing the early weeks, and draws with it the bladder, Changes in 
 which in turn pulls the umbilicus inward. This causes abdomen 
 the navel, and in fact the abdomen generally, to ap- 
 pear unusually flat. 
 
 By the third month the uterus has risen enough to Gradual 
 be felt if the hand is placed on the lower part of the ment^i 
 abdomen just above the pubic bone. From this time the uterus 
 
190 MOTHERHOOD 
 
 on the enlargement increases at the rate of one and 
 one-half to two inches every four weeks, until during 
 the last month the uterus almost reaches the cartilage 
 at the end of the breast-bone. 
 
 At about the middle of pregnancy a physician can 
 
 Beatings determine by the help of the stethoscope the beating 
 
 fetal of the child's heart. This establishes beyond a doubt 
 
 heart the existence of pregnancy, though failure to hear the 
 
 sounds does not negative the diagnosis. The heart of 
 
 the child in the uterus is quite independent of the 
 
 mother's, so the two can never be confused unless 
 
 the frequency of the mother's is increased by disease. 
 
 The fetal heart beats from 130 to 150 times a minute. 
 
 As a rule the larger the child the slower the heart 
 
 action. Boys are usually larger than girls, and so 
 
 False the conclusion has been drawn that the sex can be 
 
 regarding determined by the rapidity of the heart beat. This 
 
 !ngof eat " reasoning is not at all reliable, however, and the same 
 
 heart etal ma y ^e sa *^ °^ most °f tne attempts which are made 
 
 from time to time to determine sex before birth. It 
 
 is quite as well to disregard entirely such methods, 
 
 for they succeed only often enough to convince the 
 
 credulous that they are infallible. 
 
 QUICKENING 
 
 This is the term used to express the activity of the 
 The quick- child in the uterus. It was formerly supposed that 
 the child until those movements were felt by the mother there 
 was no life, but of course conception itself, the union 
 of the two germ cells, depends upon the living princi- 
 ple within them. 
 
 Quickening is first felt about- the middle of preg- 
 
 its effect nancy. It is often recognized by the mother before 
 
 m P o°ther he tne examiner can detect it, and it may at first give her 
 
 very unpleasant sensations, such as nausea or faint- 
 
THE HYGIENE OF PREGNANCY 191 
 
 ness. Later in the course of pregnancy the activity is 
 often so marked that the examining physician can eas- 
 ily see as well as feel them, and the mother sometimes 
 suffers pain from the violence of the movements. 
 
 Absence of this sensation does not prove that 
 pregnancy does not exist. The child may be dead, 
 or it may be quiet during the entire term. If there Signifi- 
 
 11 • • • • r 1 cance of 
 
 has #een activity and it ceases, especially if the absence of 
 mother has had an attack of illness, a physician sus- quic emng 
 pects the death of the fetus. 
 
 Toward the end of pregnancy, however, the 
 growth of the child may, and usually does, prevent 
 freedom of movement, so that a woman need feel no 
 alarm if she is conscious of little or no quickening 
 during the last two months — unless there has been 
 sickness of severity enough to warrant the death of 
 the child in the uterus. 
 
 There are diseases which present symptoms so 
 nearly like those of pregnancy that even physicians 
 are sometimes misled. In intenselv nervous or hys- False , 
 
 J . J signs of 
 
 terical women many of the signs are so closely simu- pregnancy 
 lated that they deceive every one. The cessation of 
 the menses, the sympathetic stomach disturbance, and 
 even the abdominal enlargement are present. 
 
 If suspicion arises in the mind of the physician, 
 he will probably administer ether, and make an ex- 
 amination while the patient is under its influence. Examina- 
 
 tion by 
 
 The muscles are then relaxed, and the true condition physician 
 can be ascertained. There may be a distention of the 
 uterus or of the abdominal cavity, from gas or fluid, 
 in which case most of the reliable attendant signs 
 are lacking. 
 
 After long experiences, such as a woman gains Shape of 
 by repeated pregnancies, the shape of the abdo- me/char- 
 men is a very significant sign, and its characteris- 
 
 actenstic 
 
192 MOTHERHOOD 
 
 . tics are such that there is generally little difficulty 
 in diagnosis. 
 
 The outlines of the pregnant uterus are very 
 smooth, and its shape is even. There is a peculiar 
 elongation in the enlargement of the abdomen, and 
 on pressure it seems very stiff and elastic. Generally 
 the uterus can be felt to contract, especially if a cold 
 hand is laid over it. 
 
 It is hardly too much to say that in doubtful cases 
 
 even a very clever physician can rarely make an un- 
 
 Positive qualified statement about the existence of pregnancy 
 
 aSTsTn's before the middle of the period. Then rarely is there 
 
 not mani- hesitation, because the probability of pregnancy as 
 
 fest the , , r i . • r ,1,1 
 
 first the result of the marriage union of a normal, healthy 
 
 man and woman is so great, but mistakes in diagnosis 
 are so severely criticised that it seems only fair to call 
 attention to the fact that the positive, unmistakable 
 signs are not manifest during the first weeks. 
 
 DRESS 
 
 For the first two months in a normal pregnancy, 
 few changes need be made. After this, the clothing 
 will begin to feel tight, and it must be loosened. Cor- 
 sets should be discarded, in order to remove pressure, 
 both from the breasts and the uterus, which is steadily 
 must*!* mounting in the abdominal cavity. The corset waist 
 anTskirts ma y ^ e substituted to give the accustomed warmth, 
 hung and to serve as a support for the skirts, which should 
 
 shoulders be fastened to it, or suspended from the shoulders. 
 Princess gowns, or those made with jackets, having 
 full vests, are very practicable, as they emphasize the 
 size of the figure less, besides being more comfortable 
 than the ordinary costume. 
 
 Now, more than ever, one should be protected from 
 the cold, and yet the clothing should be light in weight. 
 
THE HYGIENE OF PREGNANCY 193 
 
 High shoes should be worn, to give extra support to 
 the ankles, and the stockings should be held up by Warm, 
 straps at the side, never by round elastics, which, if i 00 se 
 effective, constrict the legs, and interfere with the clothing 
 circulation, often causing varicose veins. 
 
 NEED OF FRESH AIR 
 
 The essential fact to bear in mind is that the body 
 is doinsr work for two instead of one. As the blood The mo f n - 
 
 ° ... ers body 
 
 flows through the arteries, carrying nourishment to doing 
 the various parts, it loses its life-giving properties, and breathing 
 it must take its way back through the veins to the for two 
 lungs, to be re-vitalized by the pure air. This work 
 of the circulation in taking oxygen to the tissues is as 
 important a part of respiration as the familiar act 
 whereby the lungs alternately inhale air and expel it. 
 
 For the little new life, which has its being through 
 the parent, this internal respiration constitutes the imperative 
 
 . . < . • , , "eed of 
 
 entire process, for it has no communication with the fresh air 
 outside world. This means that the rooms should be 
 well ventilated, so that with each breath the lungs may 
 be filled with fresh air. 
 
 Inside chambers, having no windows opening out- 
 of-doors, are never suitable for sleeping rooms, and f t ^ y of 
 now when every atom of vital power needs to be vital 
 saved and used they are especially to be condemned, needs to 
 Remember that a fire, gas or a lamp will use up oxy- e save 
 gen, so that more ventilation is needed when they are 
 burning. 
 
 EXERCISE 
 
 The exercise in the open is equally important if it 
 
 serves only to fill the lungs a few times with fresh air. 
 
 Walking is a safe exercise, and may be followed up 
 
 during the entire term. Driving, unless it must be 
 
 9 Vol. 3 
 
194 
 
 MOTHERHOOD 
 
 over very rough roads, is equally beneficial. It must 
 
 Howmus- be remembered that absolute rest is not a wise general 
 
 erc^ehls prescription for the pregnant woman. She needs oc- 
 
 vaiue cupation to keep her healthy minded and happy, and 
 
 labor is usually less painful when the muscles have 
 
 been kept in good working order. 
 
 Sometimes trifling discomfort, particularly in a 
 
 young woman, makes h'er fail to realize this, and she 
 
 ■is inclined to lie down when physically she is quite 
 
 able to take moderate exercise. The open air, with 
 
 The open its change of scene and diversion of the mind, is her 
 
 air a ° • 
 
 safeguard safeguard, for if she makes an invalid of herself, and 
 keeps her mind full of unpleasant possibilities, the in- 
 validism will tend to become a fact, and the nervous 
 apprehension will result in hysteria. 
 
 FOOD 
 
 Nourish- 
 ing and 
 sufficient 
 food to 
 meet the 
 strain 
 upon the 
 body 
 
 What 
 proper 
 food is 
 at this 
 time 
 
 The same fact— that double duty is being laid upon 
 the system — must also be borne in mind when we take 
 up the question of diet. If the ordinary food served in 
 the family is carefully chosen, for its nutritive value, 
 and properly prepared, there is no reason why any 
 deviation from it should be made. The tissues are 
 under tremendous strain with repairs of the old and 
 construction of the new. Since our food is the source 
 of our bodily heat and energy, and since by means of 
 it our bodies are built up and maintained in health, we 
 can see that the stomach must now be given proper and 
 sufficient material for its work. 
 
 Proper material means wholesome, digestible food. 
 It does not mean an excessive amount of stimulant 
 like coffee or tea, which gives an artificial vigor, and 
 lessens the desire for food. Neither does it stand for 
 a specified diet of any one kind. The system needs now 
 
in 
 
 excess 
 
 THE HYGIENE OF PREGNANCY 195 
 
 more than ever the variety in food that will bring to 
 each part the nourishment it especially requires. 
 
 The claim that the use of a strictly vegetable diet 
 will assure an easy labor is only a theoretical supposi- The fan 
 tion, based on the idea that the bones of the child about a ' 
 would then be less well developed. If this were true, J^ etable 
 it would seem a more far-seeing plan to choose food 
 which would keep the mother robust and able to endure * 
 the extra pain of bringing into the world a well-nour- 
 ished, sturdy child. 
 
 Rich, fatty foods, fried dishes and pastry or sweets 
 in excess are to be avoided, not only during pregnancy. Avoid 
 but at all times. We all recognize that these things are dishes, 
 bad for children, and in the majority of households, sweets' 
 where the children eat with their parents, it is well 
 nigh impossible to restrict their fare. The simpler 
 method is to choose healthful, digestible food, and to 
 exclude altogether the forbidden fruits. 
 
 During the course of pregnancy, there are frequent- 
 ly abnormal longings for some one kind of food. It is c i rati r fyil J g 
 often perfectly possible and legitimate to indulge this jong- 
 
 o « ings of 
 
 appetite. Sometimes it may mean that the system appetite 
 needs the acid of certain fruit, or other material which 
 the desired food contains. It will be found, however, 
 that gratification is not always essential, and it is not 
 wise to let the longing hold too important a place, for 
 the more constantly it is kept before the mind, the 
 more fixed it becomes. When the appetite is diseased 
 and demands such things as slate pencils, chalk, or 
 starch, the physician can generally correct it with 
 drugs. 
 
 It seems to be necessary at all times, in season and 
 out of season, to urge the free use of water. This fi ts from 
 applies in health and in disease, to the pregnant woman ^water 
 no more than to every one. Water is cleansing inside 
 
196 MOTHERHOOD 
 
 as well as outside. It helps sweep away the waste 
 matter which is disposed of by the kidneys. It reg- 
 ulates the body-heat by its effect on the sweat glands, 
 and it is a great aid in correcting constipation, one of 
 the special ills of pregnancy. 
 
 BATHING 
 The reasons for frequent bathing have already been 
 Repetition given in the chapters on Home Nursing, but I should 
 of rea- jj^ e to rev i ew them here. We are constantly shedding 
 
 sons for J & 
 
 bathing tiny scales of scarf-skin. The sweat glands are also 
 continually pouring out their fluid, the perspiration, 
 in greater or less abundance, and the oil glands are all 
 the time adding their secretion. 
 
 These pores serve an important purpose in keeping 
 
 stoppage our bodies in a state of health. If this mixture of oil, 
 
 pores ie f perspiration, and scales of skin is allowed to accumu- 
 
 the skm j ate t j ie mou th s f the pores will be more or less 
 
 stopped and their work will be interrupted. 
 
 The oil-glands keep the skin smooth and flexible. 
 in h< winter S Through the sweat glands the heat of the body is reg- 
 and in ulated. In winter, when extra heat is needed in the 
 
 summer , . 
 
 body to resist the cold, the openings of these pores are 
 narrowed, and very little perspiration is secreted. In 
 warm weather, on the contrary, perspiration is poured 
 out in quantities, and the heat of the body is reduced. 
 This statement in itself proves the importance of 
 giving these glands free play, which cleanliness cer- 
 tainly will do. 
 
 . The tepid bath is the safest for the pregnant wom- 
 
 The tepid an. The cold plunge or shower is liable to prove too 
 
 safest great a shock to a system which is carrying a double 
 
 load, and the healthful reaction is less likely to follow. 
 
 A hot bath may have a tendency to stimulate the uterus 
 
 before it is time and may bring on miscarriage. 
 
THE HYGIENE OF PREGNANCY 197 
 
 SLEEP AND REST 
 
 If the simple, healthful life is an accomplished fact, 
 and not a pleasant theory, the question of sleep will 
 generally take care of itself. The exercise in the open 
 air gives one the desire for sleep ; the bath, if taken at 
 night, quiets the nerves and relaxes the muscles, and 
 insomnia is rarely a serious difficulty.. Various de- 
 vices to induce sleep are found in a preceding chapter. 
 
 The importance of rest is not at all appreciated by 
 the American woman. She regards Nature as an im- Th e impor. 
 
 . tance of 
 
 pertinent mentor if Nature ventures to step in and rest to the 
 make demands in return for the many burdens that mother 11 
 are laid upon her. 
 
 Our bodies always have a right to consideration, 
 but never more than when the well-being of another 
 life is dependent upon them. Physical and mental 
 health are all-important to the expectant mother, and 
 she should take her rest as conscientiously as she does 
 her work. 
 
 Even if sleep during the day is impossible, relaxa- 
 tion with the clothing loosened will refresh her and J he <i uiet 
 should have its plan in the routine of each day. The 
 nights will be more restful if the days are not over- 
 crowded, and an hour in a quiet room, with the mus- 
 cles resting, and the mind unoccupied as far as may 
 be, will do much toward keeping the nine months a 
 normal period. 
 
 We are too much afraid of resting. We feel that 
 the lagging nerves must be spurred on, and that it 
 is weak yielding if we obey their warning, and stop 
 when they call. Consequently we do apply arti- 
 ficial stimulants in the way of excitement and the Falsity of 
 strength of our wills, and we do not feel conscious of stimuia- 
 failing nerve power until after the strain is off. Then tlon 
 
198 
 
 MOTHERHOOD 
 
 A rule 
 of living 
 for the 
 pregnant 
 woman 
 
 "The gos- 
 pel of re- 
 laxation" 
 
 we awake to the fact that our reserve is gone, and we 
 find ourselves much less useful members of society, and 
 much less happy women than we might have been. 
 
 The pregnant woman should keep early hours, oc- 
 cupy a bed by herself and sleep eight or nine hours 
 out of the twenty-four. 
 
 There is "power through repose," and relaxation is 
 a safeguard that not only brings more complete rest 
 in our unoccupied moments, but will lessen pain or dis- 
 comfort to a remarkable degree. Pain gains its hold 
 through our tense rigid muscles and nerves. The non- 
 resistant is a "more elusive foe than the aggressive, and 
 in health or disease, under normal or abnormal con- 
 ditions, the "gospel of relaxation" is the gospel of 
 healthful living. 
 
 About 
 
 ante-natal 
 
 influences 
 
 Birth- 
 marks 
 
 HEREDITY 
 
 The question comes up in the mind of every expec- 
 tant mother as to how much she can influence the phys- 
 ical and moral well-being of her child before birth. 
 Sentimentalists tell her that she can impress the grow- 
 ing life within her through the influence of her own 
 mind ; that she can "mark" the child with beauty, with 
 love for music, with a cheerful or a despondent dis- 
 position ; that she can give him a bent toward a given 
 end by turning her energies in that direction during his 
 fetal life. 
 
 As a matter of fact, the deformities and birthmarks 
 that sometimes disfigure a baby result from some ex- 
 citing circumstance which took place before the child 
 was fully formed in the uterus. After this, the de- 
 velopment of the child has proceeded so far that 
 no external event except actual violence can affect 
 the physical make-up. 
 
 The mechanism of the nervous system is more com- 
 
THE HYGIENE OF PREGNANCY 199 
 
 plex and more delicate, but it seems hardly possible 
 that mental processes of the mother should be able to 
 react at all on the nerve centres of the child. 
 
 The essential fact is that her general well-being does The moth- 
 tell directly on the child through its influence on the era* weii- 
 quality of the blood supply upon which his develop- Jj""^ J£ e ls 
 ment depends. child 
 
 This is true before birth, when his life is literally a 
 part of hers, but is almost as important a fact, when the I1Is ? nd 
 fact that she furnishes his food supply is their only affect the 
 vital connection. Even then we find the nervous and ^Sk Y to° 
 physical condition of the mother reflecting directly the chlld 
 upon him, as her bodily ills or emotional excitement 
 affect the secretion of milk. 
 
 All this goes to show that she can help in giving Thus she 
 him the inheritance of a healthy body which will in- }. e]ps \° . 
 
 J J the inhen- 
 
 crease his chances for full normal mental development, tance of 
 and it is to this end that she may best devote her en- body 
 ergies. 
 
 Biologists have investigated, discussed, and dis- 
 agreed upon the subject of heredity, and many the- 
 ories that were held true in years gone by are now 
 believed to be without foundation. 
 
 In spite of the differences of opinion on many tech- 
 nical points the general supposition at the present time Direct 
 
 - , . r . , . , , . transmis- 
 
 on the subject of inheritance seems to be that there is sion of 
 in most cases no direct transmission of disease. This f r0 m Se 
 means that the child of a consumptive parent, for in-3S5nJe 
 stance, is not necessarily born a consumptive. It does 
 not mean, however, that he is no more liable to develop 
 tuberculosis. Disease is not transmitted, but the weak- 
 ness of a part, with a tendency to become diseased, 
 may be. 
 
 Heredity, then, is a question of inherited tendencies, 
 rather than of definite characteristics, and may be over- 
 
200 
 
 MOTHERHOOD 
 
 Heredity 
 is inher- 
 ited ten- 
 dencies 
 
 The birth- 
 right of 
 every 
 American 
 child 
 
 balanced by hygienic surroundings and wholesome 
 living. This puts more responsibility rather than less 
 upon the shoulders of the parent, both as regards 
 bringing children into the world with the handicap 
 of inherited weakness and as to their care after birth. 
 If the first responsibility is assumed, the second 
 should not be shirked. Especial advantages in the way 
 of proper exercise in pure air, good food, and watch- 
 ful care are demanded, and no effort should be spared 
 to give to a child its proper birthright — the chance of 
 development into normal, healthy, efficient manhood 
 or womanhood. 
 
II 
 
 AILMENTS OF PREGNANCY 
 
 Nausea— Constipation— Increased Salivation — Varicose Veins and Hemor- 
 rhoids — Decay of Teeth — Palpitation — Sciatica — Pruritus — Irritation of 
 Bladder— Abdominal Bandage— The Physician— Midwives— Advice of 
 Friends— Receipts for Special Diet 
 
 I HAVE asked you to take the attitude of regarding 
 pregnancy as a normal state, indicating the devel- 
 opment of organs and the fulfilment of the purpose for 
 which they were largely made.* Now in seeming con- 
 tradiction to this, I suggest in the heading of the chap- 
 ter that there are ills which we must consider. 
 
 If all women had always lived in accordance with hadMived 
 Nature's laws, if they had never w r orn clothing that ^ n it £ c< g^ d 
 changed the shape of their bodies, if their food had al- ture ' s laws 
 ways been wholesome, so that the digestion was un- 
 impaired, and if they had plenty of vigorous out-of- 
 door exercise, so that all the muscles were supple and 
 well developed, probably child-bearing would be an in- 
 cident rather than an end in their lives, and children 
 would be given a fairer start and less of a handicap in 
 inherited weakness. 
 
 Since, however, it is not perfectly normal woman- 
 hood which we have to consider, we shall find certain 
 ailments which are almost universal accompaniments of 
 pregnancy. These ills, the nausea, the discomfort of 
 increasing size, and the intestinal difficulties, seem 
 
 * Scientists now believe that the ovaries play an important part 
 in the organism, in helping to establish and maintain vital force, 
 quite aside from their function of reproduction. 
 
 (201) 
 
202 
 
 MOTHERHOOD 
 
 Uterine 
 growth 
 during 
 pregnancy 
 
 Ailments 
 this 
 growth 
 induces 
 
 Freeing 
 the mind 
 from un- 
 necessary 
 alarm 
 
 sometimes like unnecessary burdens, till we realize 
 what a wholesale adjustment to new conditions there 
 is throughout our bodies, and see how wonderfully 
 Nature has planned. 
 
 The normal size of the uterus is three inches long 
 by one and a half wide. Its weight is about one ounce. 
 In nine months these dimensions change to twelve' 
 inches in length by nine inches wide, and the weight 
 to two pounds, not including the contents. This in- 
 crease means growth, we must remember, not a mere 
 stretching of elastic tissue, so that the contents of the 
 uterus may be accommodated, as is shown by the fact 
 that the walls are thicker, rather than thinner, toward 
 the end of pregnancy. 
 
 As the position of this organ changes, the other 
 organs in the abdomen must adjust themselves. The 
 uterus presses backward against the rectum, and con- 
 stipation results ; it pushes forward against the blad- 
 der, and there are difficulties in the retention or the 
 passing of the urine ; as it rises in the abdominal cavity, 
 the stomach is affected and we have the nausea of 
 "morning sickness," while later the heart is forced to 
 accommodate itself to the new conditions, and retal- 
 iates by palpitation. 
 
 This is the rational point of view, and if the woman 
 who is to become a mother keeps these physiological 
 changes in mind, she will understand better many of 
 the ills attendant on pregnancy, and will be saved un- 
 necessary alarm. We can very well balance up our 
 physical ills in two columns of cause and effect, and 
 this period is no exception to the general rule. 
 
 We have already remarked that nausea, constipa- 
 tion, irritation of the bladder and palpitation follow in 
 natural sequence the increasing size of the uterus. 
 
AILMENTS OF PREGNANCY 203 
 
 NAUSEA 
 
 The nausea usually passes away in a short time. 
 If it persists, various experiments in diet must be tried, if nausea 
 Often liquid food and rest in bed will entirely correct 
 the trouble. It is usually the early meal which the 
 stomach refuses to retain, and sometimes if this meal 
 is prepared and served in an unusual way it will be 
 digested. 
 
 Prepare it entirely out of the sight of the patient, 
 and serve' it very early in the morning, before it is fh^rfak- 
 time for her to get up. After she has eaten it, imme- fast vef y 
 
 ° . early 
 
 diately darken the room, and leave her to sleep again. 
 If extreme care in diet fails to overcome the nausea, 
 it may be worth the attempt to give the patient the 
 first solid food she craves. Sometimes a diet that 
 seems entirely unsuitable may check nausea, which ap- 
 pears almost to have become a habit. Ices and ice- 
 cream may be given, and the latter, especially if made ices and 
 with a custard, furnishes considerable nourishment, devices 
 Pop-corn sometimes can be retained and will help cor- 
 rect the trouble. A mustard plaster over the stomach, 
 an ice-bag at the back of the head, or bits of ice taken 
 by the mouth, are other devices that may be tried. 
 
 An entire change of surroundings will often effect 
 a sudden and complete cure, and it is advisable if the Break in 
 nausea does not readily yield to the ordinary treatment t0 med life 
 to go away from home' and one's immediate family, 
 to make an absolute break in the accustomed life. 
 
 As the stomach becomes used to the increased pres- 
 sure, and to the extra demands made on its blood sup- 
 ply, it generally resumes its normal function. If, how- 
 ever, none of these devices is successful, and the 
 strength seems to be failing, the patient can be nour- 
 ished for weeks by nutrient enemata. 
 
204 
 
 MOTHERHOOD 
 
 CONSTIPATION 
 
 of consti 
 pation by 
 diet 
 
 Constipation is liable to be manifest throughout the 
 Correction nine months. Much can be done to correct it by means 
 of diet and exercise, and this method should be used 
 before drugs are resorted to. Fruits, cereals, coarse 
 bread, like graham or rye, help the action of the 
 bowels, because of the amount of fibre, which, not being 
 acted upon by the digestive juices, serves as a slight 
 irritant to the intestinal wall. 
 
 If one will stop to consider, one can easily find a 
 varied dietary which tends to relieve constipation. All 
 the cereals (except rice), graham, rye, corn, and brown 
 bread, fresh meats and fish, vegetables and fruits of 
 all kinds, certainly offer a choice of which one need 
 not tire, while toast, cooked milk, soda crackers, tea, 
 and spirituous liquors, sweets, nuts, cheese, and rice 
 are distinctly constipating and should be avoided. 
 
 Add to all this, and above all this, the free use of 
 drinking water. If water is distasteful, the increase 
 of salt in the food will give a desire for it. It should 
 be added that hard water is extremely constipating. 
 Boiling it will remove in part at least the substances 
 which make it hard, and this should always be done if 
 soft water is not available. It may be brought to boil, 
 cooled, then put in bottles and chilled. Long boiling 
 gives it a disagreeable taste. 
 
 Exercise helps in all normal functions, and a gentle 
 circular rubbing of the abdomen, with an increase of 
 pressure over the left side, sometimes stimulates in- 
 testinal activity. 
 
 If the trouble is obstinate and persistent, drugs or 
 injections should be used, for it is of the utmost im- 
 portance that the system be kept in order and the 
 wastes of the body be removed. 
 
 What to 
 avoid 
 
 Free 
 
 drinking 
 of water 
 
 Exercise 
 
AILMENTS OF PREGNANCY 205 
 
 INCREASED SALIVATION 
 
 A patient is sometimes troubled with an excessive 
 secretion of saliva, which may continue for a few 
 weeks, but which sometimes persists throughout preg- 
 nancy. It is not a dangerous ailment, but may be a sugges- 
 troublesome one, especially when the glands become ^°" e s f f j° r 
 tender and the gums are swollen and recede from the mouth 
 teeth. Astringent mouth washes, such as hamamelis and laxa- 
 or tannin, generally relieve somewhat, and if the se- 
 cretion of the intestinal tract is increased by saline 
 laxatives (Rochelle or Epsom salts) the excessive sali- 
 vation may be checked. 
 
 VARICOSE VEINS AND HEMORRHOIDS, OR PILES 
 
 Both these conditions are caused by undue pres- 
 sure upon the large veins, causing dilation of the 
 branches below them. 
 
 In the condition known as varicose veins those 
 vessels in the legs become much swollen, as the word 
 
 . ,. , 1 • 1 Varicose 
 
 varicose indicates, and their course becomes tortuous, veins and 
 This trouble is in itself very painful, and may lead 
 to a serious difficulty if not remedied. This difficulty 
 is rupture of the vein and consequent hemorrhage. 
 
 To guard against this possibility a bandage or 
 elastic stocking should be constantly worn if the veins 
 appear prominent. The bandage may be of flannel, thTieg" 1 * 
 cut on the bias, and should be evenly and closely ap- 
 plied, beginning at the ankle. 
 
 Very gentle rubbing, always away from the ex- 
 tremities, and toward the heart, sometimes relieves 
 the pain or feeling of pressure, and if the skin feels of h rubbin ef 
 dry, or as if tightly stretched, oil may be used for 
 this rubbing. This is equally useful treatment for the 
 abdomen as the tension becomes great. 
 
massage 
 is not 
 effective 
 
 206 MOTHERHOOD 
 
 It is a very good plan to give the breasts also a 
 
 Prepara- little preparatory treatment, consisting either of alco- 
 
 ment of hoi bathing, which toughens the skin and makes it 
 
 the breasts | egs sens jti ve when the nursing begins, or of a gentle 
 
 rubbing with oil, always toward the nipple, which 
 
 should be pulled out with the fingers if it is not 
 
 prominent. A baby will often' refuse to nurse if the 
 
 breasts have very small or sunken nipples, and this 
 
 treatment carried on for a few weeks before delivery 
 
 will put the breasts in good condition, make the skin 
 
 more flexible and less liable to chap, and will save 
 
 much discomfort. 
 
 It is often the pressure of tight corsets which has 
 Methods made the nipple flat, and if the massage treatment is 
 e not effective it can be drawn out with a breast pump 
 or similar apparatus. Take a large-mouthed bottle, 
 fill it with boiling water, then empty it and quickly 
 invert over the nipple. As the air in the bottle cools 
 a partial vacuum will be formed, and will cause the 
 nipple to be drawn out Another still more simple 
 method is to place the bowl of an ordinary clay pipe 
 over the nipple and, with the stem between the lips, 
 draw out the air. Very little effort exhausts the air 
 and pulls the nipple well out. 
 
 If this practice is regularly observed, the nipples 
 Valuable can t> e brought into' much better condition before the 
 results to baby is born, and the amount of worrv and work that 
 
 baby and •* 
 
 mother is saved is not appreciated until one has suffered the 
 annoyance of having a hungry baby entirely unable 
 to take the breast. 
 
 Hemorrhoids or piles are caused also by the con- 
 
 The cause gested condition of the veins. Those vessels in and 
 
 rhoids" 10 about the rectum become swollen, and small tumors 
 
 appear, which may protrude on the outside or may be 
 
 entirely internal. Constipation is often the cause, 
 
AILMENTS OF PREGNANCY 207 
 
 though sometimes the trouble is present when the 
 bowels are in normal condition. 
 
 Rest in bed generally corrects the congestion. It 
 may, however, be persistent, when it is intensely pain- Methods 
 ful, and is often accompanied by a nervousness which relief 1 " 1 
 can not fail to react on the entire system. Com- 
 presses wet in witch-hazel, diluted one-third with 
 water, either cold or warm, give relief, and if the 
 hemorrhoids are internal an injection of about a tea- 
 cup of this witch-hazel solution retained in the bowel 
 is often helpful. An ointment made of witch-hazel 
 tends to contract these small tumors and thus to re- 
 lieve the pressure on the nerves. 
 
 Diarrhoea and constipation have an equally bad 
 effect upon the condition of pregnancy, and an especial 
 effort should be made to keep the bowels well regu- 
 lated. 
 
 DECAY OF TEETH 
 
 That this trouble should accompany childbirth is 
 not surprising when one considers what demands are 
 made upon the vitality of the mother. 
 
 It seems to be universally true that dental difncul- Demand 
 ties follow the pregnant state, and often the nervous sy S °tem he 
 condition of the woman is such that repairing - treat- l f a £ s , t0 . 
 
 r ° difficulties 
 
 ment is impossible. Such temporary work as can be with the 
 done is, of course, advisable, to save pain, and to pre- 
 serve the teeth. 
 
 Otherwise Friar's Balsam, Compound Tincture 
 of Benzoin, often gives relief. Iodine may help, and Reliefs 
 in cases of neuralgia hot dry applications are sooth- 
 ing. It may also be comforting to remember that 
 these difficulties, like the unpleasant moth patches or 
 pigmentation of the skin, pass away with the birth of 
 the child. 
 
208 MOTHERHOOD 
 
 PALPITATION 
 
 This is more often present during the later months, 
 
 th*e USe ai° f w ^ en tne uterus has risen so high in the abdominal 
 
 pitation cavity that by its pressure it interferes with the action 
 
 of the heart. Very little can be done to relieve this 
 
 condition, but it is usually of short duration. 
 
 Coughing and labored breathing during pregnancy 
 Cough- a i so n eed occasion . no alarm. In the early months 
 
 ing and * 
 
 labored they are doubtless nervous or sympathetic troubles, 
 ing and later they are due to the pressure of the enlarged 
 uterus. 
 
 SCIATICA 
 
 Pain in the sciatic vein which runs down the 
 Causes of under side of the leg from the thigh is sometimes 
 caused by pressure due to constipation or to a dis- 
 placement of the uterus. If brought about by the 
 former, laxatives and thorough rectal irrigations con- 
 taining oil or glycerine, to empty the bowel com- 
 pletely, is the treatment suggested. Constipation 
 should be especially guarded against. 
 
 PRURITUS 
 
 A general itching of the skin, with no sign of erup- 
 The cause tion, is a nervous disorder which is very trying, and 
 
 of the ' . , T . J ° , 
 
 itching may be a great strain on the system. It is aggravated 
 relief 3 a ^ the periods when the menses would ordinarily 
 occur. Baths in water containing baking soda relieve 
 the itching, particularly if followed by a thorough 
 rubbing with vaseline. Bismuth, zinc oxide, or starch 
 may be used to powder the skin, and linseed oil or 
 lime-water may be applied on a cloth. It is a condi- 
 tion which is difficult to cure, but which usually ends 
 with the birth of the child. 
 
AILMENTS OF PREGNANCY 209 
 
 IRRITATION OF THE BLADDER 
 Irritation of the bladder is usually caused by pres- 
 sure of the enlarging womb during the first months Remedial 
 of pregnancy. Mucilaginous drinks, such as flax- 
 seed tea or slippery elm, will sometimes relieve the 
 pain, and keeping the bowels open assists by freeing 
 the bladder from additional pressure. 
 
 ABDOMINAL BANDAGE 
 
 Sometimes the abdomen is so large that moving 
 about is difficult, and there may be considerable pain 
 felt on walking. A fitted bandage can be used in such 
 
 The use 
 
 Abdominal Bandage 
 
 cases, and may give great relief. Regular abdominal 
 bandages can be purchased at shops where surgical of ,c a b U 
 or hospital supplies are kept, but they are very ex- j^ 1 " 3 * 
 pensive, and it is possible to cut and fit them at home, 
 using one of the paper patterns. Unbleached muslin, 
 lasting, or twilled cotton are suitable materials, and 
 the bandage should be closely fitted so that it will 
 actually support the dependent abdomen. 
 
 These, then, are some of the minor ills that may 
 complicate the state of child-bearing. They may be 
 extremely uncomfortable and they may restrict one's 
 
210 MOTHERHOOD 
 
 method of living, and clamor till they draw attention 
 to themselves, and divert one from the desired state 
 Minor ills of healthy-mindedness. But after all these ailments 
 nancy Cg are temporary, none of them lasting beyond the nine 
 and P not ry montns > and most of them merely incidental during 
 alarming that time. None of them need occasion alarm, if 
 
 if ordi- . . 
 
 nary care ordinary care is taken, as in the case of the varicose 
 veins to bandage the legs, or in constipation to cor- 
 rect the difficulty and keep the system in order. 
 
 THE PHYSICIAN 
 
 There are symptoms, however, which need to be 
 
 when the regarded, which if noticed in time and reported to a 
 
 mother" good physician may be relieved, but which may result 
 
 choose her * n alarming disease if allowed to run their course. It 
 
 physician [ s on this account that I should advise the young 
 
 mother to choose her physician and put herself under 
 
 his care during the first months of her pregnancy. 
 
 Certain symptoms, such as persistent headache, 
 
 Symptoms spots before the eyes, scanty, high-colored urine, a 
 
 for special x J J ° 
 
 treatment dropsical, appearance, or flowing before term, should 
 always be reported as soon as they are noticed, be- 
 cause they may be indications for special treatment. 
 The urine is a valuable guide to the physician in 
 The urine diagnosis, and frequent examinations of it are ad- 
 as a guide yjg^j^ Three pints in the twenty-four hours is the 
 normal amount, and often if the quantity diminishes 
 it is only because the patient is not taking enough 
 fluid, and it can be brought up by increasing the daily 
 supply of water. 
 
 It is perfectly feasible for a woman to have a 
 its prepa- little oversight in regard to the quantity passed, and 
 ration for j ts appearance, and if she finds either out of the nor- 
 
 examina- x x ' 
 
 tion mal she should at once send a specimen to her phy- 
 
 sician for examination. A pint graduate-glass can be 
 
AILMENTS OF PREGNANCY 211 
 
 used for a measure, and the amounts recorded, or a 
 large bottle or jar can be substituted. The pint or 
 half-pint measure can be indicated on the bottle by 
 strips of cloth, paper, or adhesive plaster pasted on. 
 The receptacle for the urine should be washed and 
 scalded each day. In sending a specimen to the Sanitary 
 doctor special care should be taken to wash the bottle necessary 
 and the cork very thoroughly, as impurities added in 
 this way may interfere with the result of his examina- 
 tion. A physician is then capable of judging whether 
 the condition is a serious one, and he can relieve the 
 minds of his patient and of her friends, besides giving 
 the essential remedies. 
 
 • MiDWIVES 
 
 I have spoken of engaging a physician, and have 
 not considered any alternative. There ought to be 
 none, and yet midwives do a flourishing business, in The dan- 
 spite of the increase of knowledge upon the subject f;tt7 e US 
 of proper care in confinement. If we could trace Jj °^ dge 
 back the histories of the cases of blood-poisoning fol* wives 
 lowing childbirth that are brought to our hospitals — 
 which, in fact, has been done — we should find a sur- 
 prising proportion of them laid at the door of the 
 midwife. A little knowledge is a dangerous thing in 
 the practice of medicine no less than in philosophy, 
 and this is where the danger lies. 
 
 Childbirth is so nearly a normal process that 
 many women pass through the ordeal safely with 
 assistance only in regard to separating the child from 
 the after-birth. The trained and licensed midwives 
 do understand fairlv well the after-care of mother and And their 
 
 ' 1 -1 i i e' • consequent 
 
 child, but most of them are entirely unequal to any inability 
 emergencies, and so suspicious of any lack of confi- emergcn- 
 dence in their ability that they often will not confess cies 
 
212 MOTHERHOOD 
 
 lack of knowledge till the trouble has become com- 
 plicated. 
 
 Any medical student who has served his term in 
 Principles a hospital understands the principles of absolute sur- 
 cai^iean- gical cleanliness and the importance of carrying them 
 regarded" ou * * n c o n fi nemen t cases. But with many midwives 
 these principles are unappreciated or disregarded, and 
 while they may be clear-headed, capable, and vigor- 
 ous in normal cases, their lack of technical knowledge 
 makes their presence in the lying-in chamber a men- 
 ace rather than a safeguard. This is probably truer 
 of the older women of this class than of the younger 
 ones, who have much more thorough training, but it 
 is impossible that they should have the technical skill 
 of the reliable physician. 
 
 ADVICE OF FRIENDS 
 
 If it is wise to consult a physician it is equally ad- 
 Do not visable not to consult one's friends and neighbors. 
 
 consult ■ . 7^ 
 
 friends or So many well-meaning and kindly women have a 
 neig ors mor ^^ j ove f or ^ abnormal that they treasure all 
 the grewsome tales they have heard and retell them — 
 in even more grewsome detail — for the benefit of the 
 young expectant mother, who may be puzzled by per- 
 fectly natural symptoms. 
 
 I was called the other day to see a small boy who 
 A touch- had pneumonia. The mother met me at the door, in 
 mg story tears ^ anc j as j wen t into the room she said sadly, "I 
 am afraid Donald is leaving me." One or two neigh- 
 bors were standing about in the little room, looking 
 their sympathy. . 
 
 I went to the bed where the child was lying. His 
 pulse was full, regular, and not as fast as the day 
 before, and the little hand I held in mine was moist 
 and cool. His eyes were closed, not half-opened as 
 
AILMENTS OF PREGNANCY 213 
 
 sick children's often are, and his breathing was deep it was 
 and easy. It was returning health, not death, that heaith, ing 
 had quieted his delirium and had put him to sleep. not death 
 
 His mother told me afterward that she had not 
 been so alarmed when he became quieter till a friend 
 had come in and, on looking at him, had shaken her 
 head and said, "This is the end," and had gone out 
 without more words. It was absolutely unnecessary 
 alarm, and, even if his condition had been serious, 
 nothing would have been gained. The mother, who 
 needed all her strength and alertness, was undone 
 and helpless. 
 
 This is somewhat far afield from our subject, ex- 
 cept to show that the judgment of the untrained 
 person may better be withheld, especially when it 
 finds no helpful expression. 
 
 Cheer and hopefulness take us out of many a 
 slough of despond, and the prospective mother, par- 
 ticularly at the birth of the first child, should have a hopefulness 
 double portion. It is a strange road that she treads, prospective 
 and there are dark places where she needs the mother 
 friendly hand and reassuring word to give her 
 courage. 
 
 SPECIAL RECEIPTS— IN NAUSEA 
 
 This is one of the most digestible forms of milk, Koumiss 
 and can often be retained by a very delicate stomach 
 when other foods cause nausea. 
 
 Dissolve one-third of a yeastcake in lukewarm 
 water. Stir the water into one quart of milk of the 
 same temperature. Add one tablespoon of sugar 
 and fill bottles within one and one-half inches from 
 the top. Cork and invert the bottles, and let them 
 stand at a temperature of 8o° F. for six hours. The 
 corks should be tied securely unless bottles with 
 
214 MOTHERHOOD 
 
 patent stoppers are used. Chill and serve on the 
 following day. 
 
 If the digestion is impaired it may be well to give 
 Peptonized partially predigested milk, which will relieve the 
 stomach of a part of its work. 
 
 It must be understood that the digestive ferment 
 used in such a preparation continues its action as 
 long as it is kept at a favorable temperature. Con- 
 sequently the milk must be taken very shortly after 
 it is made, or must be kept very cold, when the proc- 
 ess is retarded ; or it must be quickly raised to the 
 boiling point, which entirely destroys the activity of 
 the ferment. 
 
 Put two tablespoons of cold water in a goblet or 
 glass; dissolve in this the powder contained in one of 
 the Fairchild peptonizing tubes, then add fresh cold 
 milk to fill the glass; stir the mixture thoroughly, 
 and drink at once. 
 
 Warm milk may be used instead of cold, when 
 the process of digestion will be carried a little further. 
 
 If the milk with the powder is brought rapidly 
 to the boiling point, further digestion will be checked 
 and the sweetness will be retained. The difficulty 
 is that the flavor of the milk may change unless this 
 is very carefully prepared. The bitter taste which 
 develops does not indicate any harmful change in the 
 milk, but it may be less pleasant to drink. 
 
 To two cups of blood-warm milk add one dessert- 
 junket spoon of liquid rennet. This should stand in a 
 moderately cool place, until it sets in a curd, when 
 it may be chilled. It may be varied by the addition 
 of sugar, and flavoring in the form of coffee, co- 
 coa, or wine. It may be served with or without 
 cream. 
 
AILMENTS OF PREGNANCY 215 
 
 men 
 water 
 
 Half a pint of cool water and the white of an Aibu 
 egg are shaken thoroughly in a sealed jar. A little 
 salt, sugar, or lemon-juice may be added to make 
 the dish palatable. 
 
 Cut half a pound of steak about three-quarters of 
 an inch thick from the top of the round. . Wipe the Broiled 
 meat, remove the fat, and sear over hot coals, in a essence 
 pan or in boiling water. 
 
 After continuing this cooking for about three 
 minutes, cut the meat in small pieces and gash two 
 or three times on each side. The juice may be 
 pressed out either with a lemon-squeezer or with a 
 
 A Meat Press 
 
 machine especially made for the purpose. Season 
 with salt and serve cold. If it is reheated the juice 
 is very liable to coagulate. 
 
 Cut in one-third inch strips a small piece of 
 steak from the top of the round. Scrape, season with Scraped 
 salt and pepper, and spread over thin bread-and- sandwiches 
 butter sandwiches. Remove the crusts and cut in 
 triangles or fancy shapes. 
 
216 MOTHERHOOD 
 
 SPECIAL RECEIPTS— IN DIARRHCEA 
 
 Mix two teaspoons of Bermuda arrowroot in cold 
 Arrowroot water, to form a thin paste. Add to one cup of boil- 
 
 gruel 
 
 ing water, and cook ten minutes. Season with salt 
 and add cream if desired. 
 
 The addition of half a stick of cinnamon gives a 
 little more character to an insipid gruel, and the spice 
 tends to restrain the action of the bowels. 
 
 A little caution should -be used in giving an excess 
 of starches in liquid form, because they do not re- 
 main in the. mouth long enough to come into contact 
 with the digestive fluid, and so are passed along to 
 the intestines, giving them an extra amount of work. 
 If this caution is kept in mind and the liquids are 
 held in the mouth for a moment and mixed with the 
 saliva, their digestion will at least begin. 
 
 Scald two cups of milk and add one Boston cracker 
 Cracker rolled and sifted. Cook in a double-boiler for five 
 grue minutes. Salt to taste. 
 
 Cut bread in thin slices, put in a pan and -dry 
 Toast water thoroughly in a slow oven. Break in pieces, add an 
 equal portion of boiling water and let it stand for 
 one hour. Strain and season. 
 
 Wash thoroughly a dozen and a half of clams. 
 Clam-juice Cook in a covered kettle with three tablespoons of 
 water, till the shells open. Remove the clams and 
 strain the liquor through a double cheesecloth. 
 
 SPECIAL RECEIPTS— IN CONSTIPATION 
 
 The coarse breads, as I have said, are especially 
 beneficial in constipation. Bran biscuits recommend 
 themselves on this account, though they are not a 
 particularly palatable article of food. The graham 
 
AILMENTS OF PREGNANCY 217 
 
 biscuits depend solely upon the heat for their light- 
 ness, and should be simply two crusts if they are 
 properly made. 
 
 Mix together one pint of bran, half a pint of flour, Bran 
 and one even teaspoon of baking soda. Add this to 
 half a pint of milk and six tablespoons of molasses. 
 Bake in gem-pans. 
 
 Two cups each of graham flour and cold water. Graham 
 
 * ° biscuits 
 
 Mix well, add half a teaspoon of salt, and drop into 
 hot buttered gem-pans. Bake in a very hot oven. 
 
 10 Vol. 3 
 
Ill 
 
 PREPARATIONS FOR CONFINEMENT 
 
 Preparations for the Mother— Baby's Wardrobe— List of Clothes— The 
 Nursery Furnishings 
 
 PREPARATIONS FOR THE MOTHER 
 
 IT IS well to begin the preparation of necessary 
 things early, because their making often seems 
 more of a burden later, when the increased weight 
 and size make it difficult to move about. 
 
 It is perfectly possible to keep the mother and all 
 cieanii- her surroundings clean and comfortable during and 
 comfort after delivery, and it is equally possible to make that 
 
 possible 
 during 
 
 period one of discomfort and uncleanliness. Much 
 
 and after depends upon the preparation she has made, and 
 
 upon the understanding of those who care for her. 
 
 She should have five or six dozen — more rather 
 
 The num- than less — napkins or sanitary pads for herself. 
 
 makiag These should be burned after use, and therefore 
 
 sanitary should be made either of old linen or soft muslin, or 
 
 pads f cheesecloth and absorbent cotton. These latter 
 
 will cost about four cents apiece if made at home. 
 
 The cheesecloth or gauze should be cut in half-yard 
 
 squares, and folded with absorbent cotton inside. 
 
 With pieces of cheesecloth one-half yard wide 
 it is quite possible to make the napkins without sew- 
 ing. In the larger drug stores one can buy rolls of 
 absorbent waste, which serves as well as the regular 
 absorbent cotton and is ten cents a pound less in 
 price. The pads should be made of two grades, two 
 dozen two inches thick being needed for use while 
 (218) 
 
PREPARATIONS FOR CONFINEMENT 219 
 
 the discharge is profuse. The others may be half the 
 thickness. 
 
 These pads should be sterilized by steaming for 
 an hour, and then drying in a hot closet. The best How to 
 plan is to wrap these in packages containing six, in the Vani- 
 squares of muslin. Then they can be conveniently tary pads 
 sterilized and only one bundle opened at a time as 
 they are needed. If a regular steamer is not avail- 
 able the dressings may -be wrapped in bundles and 
 suspended from the cover of a wash-boiler — hang- 
 ing just over the water. After the hour's boiling 
 they may be taken out and dried without removing 
 the wrappings. 
 
 If quantities of old sheets are kept on hand, the 
 regular bed-linen can be saved, and the washings Use of old 
 made considerably smaller. One sheet may be used 
 on the bed at the time of delivery, and burned after- 
 ward. Others can be cut in squares, folded, and 
 laid under the patient as a protection to the draw- 
 sheet. Small pads are more easily washed, and can 
 be changed when soiled with less inconvenience to 
 the patient. 
 
 Pads to use under the mother during labor are 
 made of cotton or jute or other absorbent material. Use of 
 They should be about three inches thick and two or l^dl 1Z 
 three feet square. If several of these are prepared 
 they can be used to absorb the discharges and to 
 protect the bed. They should be sterilized with the 
 other dressings. 
 
 The majority of physicians require an abdominal 
 binder as a support for the contracting uterus, and How to 
 for comfort as well. This should be made of un- abdominal 
 bleached muslin, a straight double band about four- binder 
 teen inches wide and long enough to go about the 
 body, lapping several inches. Three will be enough 
 
220 
 
 MOTHERHOOD 
 
 The use 
 of short 
 night- 
 gowns 
 
 The rub- 
 ber sheet 
 
 and its 
 substitute 
 
 The need 
 of a bed- 
 pan 
 
 if they can be washed often. It is generally con- 
 sidered necessary to wear them about five days, 
 although sometimes the comfort of a firm support 
 around the body is so great that they are kept on 
 till the patient leaves her bed. 
 
 Unless short night-dresses are very distasteful 
 and uncomfortable, it will be found extremely con- 
 venient to cut off the skirts of two or three old 
 gowns, open them down the front, and use them 
 for the first two or three days after confinement. 
 The discharge is profuse, so that if the night-dress 
 is pulled down behind it will surely be stained, and 
 the frequent changing is rather an exertion at the 
 first, while the short gown can be slipped on very 
 easily, with no straining at all. It may be necessary, 
 if one of these garments is worn, to keep a small 
 piece of cotton blanket or outing flannel spread di- 
 rectly over the knees, since the exposure is unusual. 
 
 A nightingale, or loose dressing jacket, and bed- 
 room slippers will be needed. 
 
 A rubber or oilcloth sheet to protect the mattress 
 should be three feet wide and long enough to stretch 
 across the bed and tuck in or pin at the sides. The 
 oilcloth is less expensive, and serves equally well, 
 though it very quickly becomes cracked and worn. 
 A pad of newspapers may be used in an emergency, 
 and answers the purpose very well if made thick 
 enough and carefully placed. 
 
 A bed-pan is needed, and it is well to avoid the 
 old make, very low front and having an outlet in 
 the back, for it is almost impossible to use it without 
 spilling the contents in the bed. The regular douche- 
 pan is very satisfactory from the nurse's standpoint, 
 but some patients find it exceedingly uncomfortable. 
 The "Eureka," a small pan, or the "Perfection," are 
 
PREPARATIONS FOR CONFINEMENT 221 
 
 both comfortable and convenient, which make their 
 price less objectionable. 
 
 A fountain syringe is also a necessity, and the 
 
 "Eureka" Bed-pan 
 
 douche-points should, if possible, be of glass, with tai n 
 three outlets in the tip, since these are superior in s y"nge 
 
 tr ' r and glass 
 
 every way to those of hard rubber. It is easy to tell douche 
 
 points 
 
 "Perfection-;' Bed-pan 
 
 when these are clean and they can be made perfectly 
 sterile by boiling. 
 
 THE BABY'S WARDROBE 
 
 In the preparations for the baby it should be kept 
 in mind that the object of clothing is to protect the Protect 
 little body without impeding motion. A baby is D ody ayS 
 almost constantlv moving:, and bv this exercise the w,th ° ut 
 
 °' -' impeding 
 
 muscles are growing strong and are gaining their its motion 
 full development. Consequently clothing that re- 
 stricts is just as injurious in its way as insufficient 
 food. 
 
 Simplicity is the next note to sound, for while 
 
222 
 
 MOTHERHOOD 
 
 Let the 
 
 baby's 
 
 clothes be 
 
 simple; 
 
 never 
 
 elaborate 
 
 Daintty 
 materials 
 
 Varieties 
 in flannel 
 
 The flan- 
 nel bands 
 
 Substitutes 
 for the 
 bands 
 
 daintiness associates itself instantly with babyhood 
 it is the simple rather than the elaborate daintiness 
 which the clothing should express. The washing for 
 a baby is no small consideration, and for this reason, 
 if for no other, many frills and embroideries should 
 be avoided. It is much more essential that a baby's 
 clothing should be kept clean than that his petticoats 
 should be trimmed or that there should be tucks and 
 embroidery on his dresses. If one wishes to spend 
 a deal of time and money in preparation it is pos- 
 sible to put both into the quality of the fabric and 
 the exquisiteness of hand-work. 
 
 Nainsooks and dimity are the dearer materials, 
 while Lonsdale or the fine-barred muslin makes less 
 expensive dresses. 
 
 The flannel, too, may range from the silk and 
 wool stuff, at a dollar a yard, to outing cloth, at ten 
 cents, and one can pay seventy-five cents apiece for 
 silk and wool shirts, or make them of flannel for 
 about ten cents. 
 
 There should be four flannel bands, eighteen 
 inches long and five inches wide. It is better to have 
 them unhemmed, so that they may fit smoothly, for 
 a baby's skin is so easily chafed and creased that 
 all ridges and roughnesses in the clothing should be 
 avoided. 
 
 The bands may be left with raw edges for after 
 washing the flannel fulls, so that there is little 
 danger of raveling; or they may be finished with 
 button-holing, which certainly makes them more at- 
 tractive. Physicians differ as to the desirability of 
 their use, and tight bandaging is no longer approved, 
 the use of knitted bands, like little sleeveless shirts, 
 being substituted for the flannel ones after the cord 
 is off, and there is no need of a dressing. 
 
PREPARATIONS FOR CONFINEMENT 223 
 
 The diapers may be of cotton or linen diaper 
 cloth, or of Canton or cotton flannel, the latter being The dia- 
 rather the most inexpensive. These should be cut how to 
 square, as they can then be folded more easily. It ma e 
 is a good plan to make them in two sizes, small ones 
 for first use being eighteen inches square, and the 
 larger ones twenty-six inches. The small ones can 
 be used to supplement the larger size when the baby 
 is older, and they are much less clumsy at first, 
 when all the clothing is hopelessly ample. 
 
 It is wise to have some small pieces not larger 
 than six inches square to use till the bowels have 
 
 Baby's Band 
 
 discharged the first black, tarry substance that fills Small 
 them at birth. These may be old pieces of napkins oiTtaMe 
 or table linen, and can be burned, as washing them jj" e e " t ^ t 
 is extremely difficult. 
 
 As a matter of fact a great deal of labor can be 
 saved if these pieces are always put inside the diaper 
 to receive the discharge from the bowels. Thev may „ . 
 
 ° J J Such use 
 
 be made double, and can be more easily rinsed out also later 
 and washed than the bulkier napkins. There should 
 be between three and four dozen diapers, the number 
 depending upon the facilities for washing. 
 
 Ribbed shirts of silk and wool are very dainty 
 and very expensive, and the all-wool shirts shrink a The baby's 
 little in time, even with very careful washing. Cot- 
 
224 MOTHERHOOD 
 
 ton and wool is more serviceable and less expensive 
 although hardly as warm. The only kind left to con- 
 sider seems to be the little flannel sack with long 
 sleeves, which can be cut after the pattern of the 
 night-gowns, or even more simply, as shown in the 
 cut. These sacks are very satisfactory, though of 
 course they add somewhat to the work of prepara- 
 tion. Four of these little garments are enough, for 
 they are very easily and quickly washed and dried. 
 A little Most of the mothers of the present generation 
 
 sleeved use d to wear little fine linen or muslin shirts, low- 
 ne d ked W " nec ^ e< ^ an d short-sleeved, in their own babyhood, 
 garment and very often they will have one or more of them 
 days in their possession. While we can not advocate their 
 
 Baby's Shirt 
 
 use as a regular habit, they are often of service dur- 
 ing the summer if the baby is troubled with prickly 
 heat or any such eruption. 
 
 Remembering our statement that freedom of 
 Condemna- motion is an important point to consider in preparing 
 oidpinning tne baby's wardrobe, we must at once condemn 
 and^tti- ^ e old-time pinning blankets and petticoats with 
 coat with bands. They are awkward to put on, and it is almost 
 their sub- impossible to make them secure without pinning them 
 too tight. It is much better for the baby and easier 
 for the mother to put on dress and petticoat to- 
 gether, and this is quite possible if the latter is made 
 like a sack gown without sleeves, buttoning behind. 
 There should be four of these made, as I said 
 
 stitute 
 
PREPARATIONS FOR CONFINEMENT 225 
 
 above, either of silk and wool, all-wcol. or outing 
 flannel. They can be made dainty to any degree, The mak- 
 with embroidery about the hem and with the edges sack gown 
 of neck and arms eye-scalloped and button-hole 
 stitched, or they can be plain and simple, but they 
 should if possible be finished with flat seams, opened 
 and cat-stitched, so that there will be no ridges to 
 make the baby uncomfortable. The skirt need not 
 be longer than is necessary for warmth. Thirty- 
 two inches from neck to hem ought to be sufficient 
 
 Band Skirt 
 
 length. Only one of these need be worn at a time, 
 and no white skirt is needed. 
 
 The little dresses may be made by a simple sack 
 pattern, or with yokes. The yoked gown gives more The sim- 
 opportunity for trimming, but the sack seems more dresses e 
 suitable for the first slips. These can be finished 
 with a bit of lace in neck and sleeves, and they do 
 not represent the amount of labor in the making and 
 after that the trimmed dresses do. Cleanliness, let 
 me emphasize again, is the essential, 'and anything 
 which makes that more possible should be considered. 
 
 The number of dresses, as is true of all the articles, 
 depends upon the amount of work, time, and money T e h r e n f um " 
 that the mother is able to give. One can keep a baby s° wnB 
 
226 
 
 MOTHERHOOD 
 
 fresh and clean with very few changes, if frequent 
 washing is possible, but slips wear out quickly, and 
 it may be as well from an economic standpoint to 
 have a generous supply. Eight is a good number, 
 and of these the plainest can be used in the summer 
 for night-gowns when the flannel ones are too warm. 
 They should be only a trifle longer than the petti- 
 coats. 
 
 Here we have the baby dressed, with due regard 
 for both comfort and health. The little band, put on 
 
 Petticoat 
 
 Dress 
 
 A dress 
 for baby- 
 founded 
 on com- 
 fort and 
 health 
 
 A flannel 
 night-gown 
 
 firmly, but not too tightly, the shirt and diaper, then 
 the petticoat and dress, all supported from the shoul- 
 ders, complete a costume which provides for the 
 necessary activity of a growing child, which can be 
 adjusted without discomfort to him or inconvenience 
 to the mother, and which can he kept in order with 
 comparatively little labor. 
 
 At night a flannel night-gown should replace the 
 petticoat and dress. Outing cloth is quite suitable 
 for this, for the change is as much on the ground of 
 fewer coverings as of more warmth. The one loose 
 
PREPARATIONS FOR CONFINEMENT 227 
 
 dress gives a little more room for relaxation, and it 
 will also be found that it will save laundry work. A 
 slip and petticoat can be aired and often can be used 
 again if they are not worn during the night. 
 
 Socks are rather unnecessary unless one finds 
 it difficult to keep the house warm enough and the Socks if 
 haby's feet are inclined to be cold. It is almost im-f e etare yS 
 possible to keep a premature baby sufficiently warm, cold 
 and socks are very useful in such a case. 
 
 A warm coat for winter and a thin one for sum- 
 mer are necessary, for a baby should not be deprived ^J^J? 
 of his fresh air out of doors at any season. The a summer 
 coat may be made of cashmere, or silk and wool 
 flannel, or of eider-down or corduroy. Thinner stuffs 
 should be lined and padded for winter weather. 
 
 Close caps to match the coat in weight, and in 
 winter in material also, can be bought ready-made, The little 
 or can be made in the home. Nothing is daintier close cap 
 than the little old-fashioned embroidered caps that 
 our grandmothers used to make for their babies, and 
 some young mothers are fortunate enough to have 
 those among their possessions. 
 
 If a covering is required for warmth in the early 
 morning or when for any reason the baby is exposed, A loose 
 a loose flannel wrapper or little kimono will be very wrapper 
 convenient. These should be made ample, and the 
 material may be soft cashmere, outing flannel, nun's 
 veiling, or challis. The kimono pattern is as pretty 
 as any, with the hem of folded silk. Feather-stitch- 
 ing and French knots make an attractive finish. 
 
 Bibs are useful from the first of a baby's life, 
 especially if vomiting or regurgitation is common, The little 
 and they are quite essential later when teething be- 
 gins and the saliva flows almost constantly from his 
 mouth. They can be bought for very little, but if 
 
228 MOTHERHOOD 
 
 simply made they will be even less dear if done at 
 Their home. A quilted cotton lining is necessary, or a 
 layer of wadding may be laid between lining and out- 
 side and quilted together. The outside may be of 
 lawn, cambric, or stout diaper cloth, and may be 
 trimmed or plain. The dainty linen bibs, lace- 
 trimmed and embroidered, are largely decorative, 
 though perhaps they offer a little protection to dress 
 or cloak if no such calamity as drooling or vomiting 
 occurs. About twelve bibs will be necessary. 
 
 The "Gertrude" patterns are very satisfactory, 
 
 in using but the outfit bearing that name includes both a long- 
 
 trude" er sleeved flannel slip and a petticoat or sleeveless slip 
 
 patterns as we u With a band, shirt, and flannel skirt coming 
 
 from the shoulders a baby does not need another 
 
 woolen garment. 
 
 Several squares of flannel made from one width of 
 The baby's the goods may be bound with wash ribbon or silk 
 
 blankets & J 
 
 tape, and are very useful to wrap the baby in for 
 
 his bath or to put about him in bed. 
 
 A large piece of old blanket should be provided 
 The blank- to put him in immediately after birth. He may be 
 birth m kept wrapped up in this till he is oiled and dressed, 
 
 and then the blanket can be burned if it has been 
 
 badly soiled. 
 
 In caring for a baby one of the most practicable 
 a knitted coverings is a blanket about crib-size loosely knitted 
 Shetland f Shetland wool. It may be doubled, and is still 
 
 wool 
 
 blanket soft enough to wrap about the little body when one 
 is carrying him from room to room. It is very con- 
 venient as an extra bed covering,' and tucks in about 
 the small person very cosily in his carriage. 
 
 The towels should be either of soft old damask 
 
 The baby's or f cotton diaper which has been washed till the 
 
 towels . „ . . . a 1 • i • 
 
 stiffening is quite out. A dainty towel is made by 
 
PREPARATIONS FOR CONFINEMENT 229 
 
 finishing the ends with button-holed scallops instead 
 of the commonplace hem. 
 
 A sponge can not be kept absolutely clean, and 
 it is much better to use a soft cloth. A bit of old a soft 
 flannel or woolen shirt answers the purpose yery ter than 
 well. The pores of a sponge gather dirt and form a sponge 
 a breeding-place for germs, and, in spite of care, it 
 can not be kept free from all trace of living organ- 
 isms except by impracticable methods of steriliza- 
 tion. 
 
 LIST OF CLOTHES 
 
 8 Bands 4 Night-gowns 
 
 48 Diapers 2 Wrappers 
 
 4 Shirts 3 Blankets 
 
 4 Knitted Bands 2 Caps 
 
 4 Sleeveless Flannel Slips 2 Cloaks 
 
 8 Dresses 12 Bibs 
 
 Borated talcum powder is a reliable sort to use 
 on a baby. Cornstarch may be substituted, but Powder 
 owing to its tendency to absorb water it is liable H°[i e body 
 to become caked on the skin and is not so readily 
 removed. 
 
 The soap should be a pure castile or ivory. There 
 are few purer soaps on the market than the ivory, Need of 
 
 • , r mi P ure soaps 
 
 and it possesses the advantage of being easily ob- 
 tained and of little cost. 
 
 There should be safety-pins of three sizes, and 
 care should be taken to buy those with sharp points. The kinds 
 
 There are often a good many thicknesses to pin 
 through, and there is much less danger that the pin 
 will slip and prick the baby's flesh if it goes in eas- 
 ily. If the pins fasten from either side a good 
 deal of labor is saved, and every little counts in the 
 care of children. 
 
 of safety 
 pins 
 
230 MOTHERHOOD 
 
 Ten cents' worth of boracic acid powder will 
 The baby's serve for a wash for eyes and mouth, and it is con- 
 and infuse venient to have a special cup or bowl for the solution. 
 The cup may be of white enamel, which is easily 
 cleaned, and may be put over the fire or gas flame 
 if a little hot water is needed. Small squares of soft 
 muslin or handkerchief linen or bits of absorbent 
 cotton can be used to wash the eyes and mouth. The 
 cotton is rather more convenient, but if it is not at 
 hand the little squares answer the purpose. 
 
 THE NURSERY FURNISHINGS 
 
 It is far better to have a separate bed of some 
 The baby's sort for the baby than to keep him with the mother. 
 
 separate J « 1 , . 
 
 bed There are of course elaborate bassinets, but as we 
 
 are aiming at moderation in the cost of our prepara- 
 tions we may dismiss those with a word. They are 
 dainty in their design and decorative as room fur- 
 nishings, and are convenient besides, but at best they 
 are of temporary use, for a baby soon demands more 
 space asleep and awake, and if they are to remain 
 looking fresh they must be renovated before many 
 months. 
 
 A clothes-basket makes a cosey bed for the little 
 one, and it may be set on a standard to bring it to a 
 convenient height, but it is soon outgrown unless 
 the baby is abnormally small. A crib is most satis- 
 The crib factory and it is really as well to buy that at the first 
 clothing so that all the bed linen may be made for it, and 
 there need be no thought of changing it till the child 
 is quite grown. It should be made up like an ordi- 
 nary bed, with sheets and blankets, and a very flat 
 pillow, which may be made of two or three layers of 
 absorbent cotton sewed into cheesecloth and covered 
 with a little case open at each end. This pillow raises 
 
PREPARATIONS FOR CONFINEMENT 231 
 
 the baby's head enough, and may be destroyed if it 
 becomes badly soiled or soaked. 
 
 A square of rubber should be kept over the lower 
 sheet. Pads of canton flannel made of several thick- The rub- 
 
 i i~ i i j Der square 
 
 nesses and quilted firmly, or of absorbent cotton and 
 cheesecloth, can be easily washed, and with the rub- 
 ber square thoroughly protect the mattress. No 
 spread is necessary for the little baby, but when he 
 is old enough to be out of his bed a part of the day 
 a dimity coverlet is suitable. 
 
 In buying a bath-tub it is well to follow the sug- The metal 
 gestion made with regard to the bed, and to get one 
 large enough to serve for some years. The tin tubs 
 meet every demand, except, perhaps, the aesthetic, 
 
 White Enamel Bath-tub for Baby 
 
 which is better satisfied with those of white enamel. 
 The latter are much more expensive than the tin 
 tubs, but will also last longer. 
 
 A very convenient but not especially durable tub 
 is the one made of rubber sheeting fastened on a The rub- 
 folding frame. It stands at a good height and i„g tub* ' 
 when not in use takes up very little room. If the 
 rubber becomes cracked in any way the tub is quite 
 useless, but with care they often last as long as those 
 of tin. Their durability depends largely upon the 
 care that is given them. If they are used as catch- 
 alls, some hard or sharp object is very likely to punc- 
 ture the rubber. If they are not dried properly after 
 use, or if they are kept in a very cold room part of 
 the time, they soon crack. 
 
 It is possible, of course, to fit out the baby with 
 
232 
 
 MOTHERHOOD 
 
 most elaborate toilet paraphernalia. A white enamel 
 The white tub, bowl, and soap dish, with powder puff and pin 
 fittings tray also in white, may stand on a round white table. 
 This brings the tub at the right height for the mother 
 sitting in a low chair, and gives room when the bath 
 is over for the basket containing various other baby 
 belongings. 
 
 A small clothes-horse painted with white enamel 
 White fur- j s extremely useful, and with the crib and a white 
 
 nishings . 
 
 chiffomere or bureau complete the nursery furniture. 
 
 Rubber Tub 
 
 The basket may be elaborately decorated with 
 The baby's frills of muslin over colored silk or sateen, or it 
 and its may be quite unadorned. But it should contain a 
 pincushion stocked with threaded needles, a spool 
 of thread, a thimble, and a pair of blunt-pointed scis- 
 sors. The brush and comb, little studs or pins for 
 the dresses, and the bands rolled ready to put on, 
 may also be kept in it. It is possible to get on with 
 very few accessories, but on the other hand we must 
 remember that preparation and equipment that make 
 
PREPARATIONS FOR CONFINEMENT 233 
 
 for case and convenience are economic from the 
 standpoint of time, labor, and nerve strain. 
 
 If the baby has these individual belongings much 
 less time will be spent in looking up the little gar- Gain from 
 ments and putting them together before the bath is equip- 
 given, and the spotlessness of white enamel is in [^"baby* 
 itself an incentive to cleanliness and order. It takes 
 much less time also to keep such ware in good con- 
 dition, and, besides, non-absorbent materials are much 
 more sanitary to use about a baby. 
 
 The belongings of the child should never be used ^" ar b ^ g ' 
 by any other member of a household. He is usually things 
 very susceptible to disease and can be protected from ers* use 
 it to some extent if ordinary care is taken. 
 
 In choosing a room that shall be given up to the 
 baby's use it must be kept in mind that the larger in choos- 
 part of his life during babyhood is to be spent there, baby's 16 
 He needs fresh air and sunshine more than any plant room 
 does, in proportion as his organism is more complex 
 and delicate. YVe may not see results as immediately 
 in the child, but he can not live in an ill-lighted, ill- 
 ventilated room without feeling the effects of this 
 vital lack. 
 
 The homes where a nursery can be set apart are 
 comparatively few. but this rule applies to any part Xeed of 
 of the house where the baby lives. He should never and sun- 
 be allowed to sleep in an inner room, or in one which lg * 
 is not constantly receiving a supply of pure air. The 
 windows may be darkened while he takes his naps, 
 but he should spend his waking hours in sunlighted 
 rooms. 
 
IV 
 
 LABOR 
 
 Duration of Pregnancy— Preparations for Confinement— Stages of Labor- 
 Contractions ot the Uterus— Emergencies— After-treatment 
 of Mother— After-treatment of Baby 
 
 DURATION OF PREGNANCY 
 
 THE duration of pregnancy is two hundred and 
 eighty days. The usual method of computation 
 is to count back three calendar months from the date 
 of the cessation of menses, and then add seven days. 
 The meth- This gives a date that approximates the correct time 
 computing as closely as possible. Example : Menstruation ceased 
 date of June I ; counting back three months brings us to March 
 ment i ; and adding seven days gives us March 8 as the 
 
 probable date of confinement. Children may be born, 
 and live before the end of that time, and there are 
 records of pregnancies which lasted as long as twelve 
 months. 
 
 During the last two weeks there are usually some 
 Premoni- premonitory symptoms, which may serve as a guide, 
 torysymp- j£ j t k as k een impossible to make an accurate reckon- 
 
 toms ot x 
 
 confine- ing. The uterus sinks in the pelvic cavity, the abdo- 
 men consequently diminishes in size, and the palpi- 
 tation and difficulties in breathing are consequently re- 
 lieved. The increase in pressure on the lower bowels 
 and bladder are greater, however, and there are fre- 
 quent evacuations. 
 
 The provisions for the support and nourishment of 
 Marvels of the child in the uterus are very wonderful, and it may 
 pregnancy , k e we u |- consider for a moment the marvelous ar- 
 
 (234) 
 
LABOR 235 
 
 rangement by which it is retained there for the term 
 of nine months and expelled at the end of that time. 
 
 In the first place, the after-birth, or placenta, is at- Nature's 
 tached to the uterine wall, and is brought into close Intent ° US 
 contact with the uterine blood-vessels, so that the blood gence , m 
 
 nourishing 
 
 stream of the mother supplies its vessels, and, through and P r °- 
 
 i r i r * , m 1 • tectingthe 
 
 it, the circulatory system of the fetus, as the child is unborn 
 called during its life within the womb. This nourish- a y 
 ment by the blood of the mother is accomplished 
 through the cord which extends from the navel of the 
 fetus to the placenta, and is simply three large blood- 
 vessels inclosed in a jelly-like substance. Finally the 
 fetus itself is floated in a membranous sac of liquid, 
 which effectually protects it from external shock. 
 
 The causes that normally bring about the birth of a 
 child, at the end of nine months, are not fully under- At full 
 stood. The statement most generally accepted is that men t the 
 the uterus has reached its full development, and the "f"^ 8 
 pressure of its contents stimulates it to contractions ; uterus 
 
 * contract 
 
 but there is doubtless besides an increase in the irrita- and the 
 bility of the muscular tissue, and a consequent quick- born 1S 
 ening of the sensitiveness in the nerve-supply at this 
 period, which are not wholly comprehensible phenom- 
 ena. Whatever the exact source of this stimulation 
 may be, its effect is to cause the muscles of the uterus 
 to contract with so much force that the membranous 
 sac is ruptured, the after-birth is loosened from its at- 
 tachment to the wall of the womb, and the child, with 
 these accompanying membranes, is expelled. 
 
 During the course of pregnancy, there may be an 
 occasional pain through the abdomen, but these are " Fals ,^ 
 usually spoken of as "false pains," and can be relieved 
 by a cathartic or an enema. The true pains are first 
 felt in the back, and though it is quite possible to be 
 misled in regard to false pains, when labor has really 
 
236 MOTHERHOOD 
 
 begun there is rarely any doubt about it. A true labor 
 Character pain is a contraction of the uterus, followed by a pause, 
 labor" 6 during which there is relaxation. These pains come 
 pains at regular intervals, at first very short, while the in- 
 
 tervals are long, but gradually growing longer and 
 more severe, till they follow each other with almost 
 no pause at all. 
 
 PREPARATIONS FOR CONFINEMENT 
 
 When the premonitory pains begin, there are cer- 
 tain preparations which will help to some extent at 
 the time of delivery, and will make the period in bed 
 rather more comfortable. Often slight pains are felt 
 The bath many hours before the birth of the child, so that there 
 when the is time enough for the bath to be taken, and for the 
 pafrls are ^ed to be made, before it is necessary to lie down. It 
 felt is a distinct advantage for the bowels to be thoroughly 
 
 evacuated, and an injection of warm soap-suds should 
 be given, unless they have already moved by the action 
 of a cathartic. 
 
 Arrange the hair in two braids, which may be 
 The hair pinned up out of the way if necessary. After the 
 gown" 18 bath the night-dress should be put on, with a loose 
 bath wrapper over it, so that there need be no delay 
 in getting to bed, and no complicated garments to 
 loosen when the severe pains begin. Long stockings, 
 reaching well above the knees, may be kept on for 
 protection and warmth. 
 
 The maternity bed is made very like the one pre- 
 The mater- pared for an invalid, as described in foregoing pages, 
 mty bed ^ it . g ^ ^ w bedstea( ^ ft } s a g- reat convenience to have 
 
 it set up on blocks a foot and a half high. Any car- 
 Disadvan- penter can make them, with a slight depression for 
 lobbed a the casters, so that the bed will stand firmly. At the 
 
 time of delivery, the doctor can work over the patient 
 
LABOR 237 
 
 much more easily if he can stand more nearly erect, 
 and it is also a great advantage for the nurse to have 
 the bed high. The lifting and rubbing, combing the 
 hair and bathing are very difficult for a person of 
 even average height, over a low bed, and the muscles 
 of the back are under constant strain. Because of this 
 the patient is more conscious of the effort, and so is 
 indirectly affected by the attendant's discomfort. 
 
 The lower sheet, rubber, and draw-sheet are put on 
 in the usual way, but at the time of confinement an Value of 
 extra oilcloth or rubber and a sheet are to be spread, oil or rub- 
 f rom the top of the draw-sheet to the foot of the bed. ber sheet 
 This securely protects the mattress and lower sheet, 
 and after the birth of the child, can be entirely re- 
 moved, leaving the patient on a clean bed. 
 
 Before the doctor comes, plenty of water should 
 be put on to boil, and soap and towels for his hands Necessi- 
 must be ready. There should be a vessel to receive conven- 
 the after-birth, and two basins of agate or enamel ware ^doctor 
 will be needed. The bed-pan and fountain syringe and 
 a fresh jar of pure vaseline must be at hand. 
 
 It is well to be provided with two large bowls 
 of some sort, large enough to hold the baby. Some- Bowls for 
 times if the labor is prolonged, it is difficult to estab- case The 
 lish the baby's respiration at first. The lungs have b f b / t ' ion r - s s " 
 never been of use till he comes into the world, and the difficult 
 first gasp of air he takes has to open little air-sacs that 
 have never before been expanded. If the breathing 
 is delayed, a sudden shock, like a plunge into warm 
 and then cold water, is general^ effective, and it is 
 well to be prepared for this possibility. 
 
 Other necessaries are disinfectants — carbolic and 
 bichloride — a bath-thermometer, a clean nail-brush for other 
 the doctor's use, and some sort of tape — Dutch tape or necessanes 
 bobbinet — for tying the cord. It is well to inquire 
 
238 
 
 MOTHERHOOD 
 
 from the doctor just what supplies he will bring him- 
 self, as it may save a useless duplication. 
 
 The three 
 stages of 
 labor 
 
 Character- 
 istics of 
 pains 
 of the 
 first period 
 
 Discour- 
 agement 
 
 Encour- 
 agement 
 
 Nourish- 
 ment 
 
 One fun- 
 damental 
 prin- 
 ciple of 
 nursing 
 
 STAGES OF LABOR 
 
 Labor is commonly spoken of as being divided into 
 three stages, the breaking of the water usually indi- 
 cating the end of the first. The second terminates with 
 the birth of the child, and the third with the expulsion 
 of the after-birth. 
 
 During the first stage, the pains are very severe, 
 comparable only to the most intense suffering during 
 menstruation, and are caused by the contractions of the 
 uterus as it seeks to rid itself of its contents. These 
 pains are rhythmic, coming at very regular intervals, 
 and with increasing frequency. It is better for a wo- 
 man to walk about between them, because the exercise' 
 stimulates the uterus to more frequent contractions. 
 
 This is the most discouraging period, because the 
 pain seems so unavailing, and because, especially at 
 the birth of the first child, it may last for many hours. 
 
 The cheering voice and the encouraging word are 
 especially helpful just here, for though the pain must 
 be borne alone, there are little devices that make the 
 burden lighter. A drink of water now and then is 
 grateful, even if the need of it is not realized, and 
 if the labor is prolonged the nourishment should not 
 be neglected. A cup of soup or milk will keep up the 
 needed strength, and prepare the woman for the sec- 
 ond stage, when there is definite work for her to do. 
 
 And just here let me emphasize one fundamental 
 principle of nursing : When food is to be administered, 
 it should not be mentioned until it is ready to place be- 
 fore the patient. 'Nine times out of ten it is refused, 
 because the mind has had to make the choice, and 
 dwell upon it while it is being prepared. A woman 
 
LABOR 239 
 
 will rarely ask for food in the midst of her labor pains, 
 but she will generally take some simple nourishment 
 if it is brought to her, and she will feel better for it. 
 
 After the "waters'' have "broken," which signifies 
 that the sac of fluid in which the baby has rested has Care of 
 been ruptured by the pressure downward against the at the end 
 neck of the uterus, the mother should at once lie down. ^st'Sage 
 This expulsion of the fluid generally indicates that the 
 mouth of the uterus has either opened or become 
 softened and ready to open ; and this opening marks 
 more exactly the end of the first stage than the rupture 
 of the sac of w r ater, though the latter is commonly an 
 accompaniment, and the only apparent sign. Before 
 lying down in the bed, the night-dress should be drawn 
 well up about the hips, so that it may not be soiled by 
 the discharges. Care must be taken to keep the breasts 
 protected and the entire body sufficiently warm. 
 
 With the beginning of the second stage, the char- 
 acter of the pains changes, and though they may be Character 
 more severe, they seem always easier to endure. They of the^ec- 
 are spoken of as "bearing-down pains," and now the ond stage 
 woman can help along by the straining effort which 
 she will instinctively make, and by taking a rest in the 
 intervals of quiet. 
 
 The nurse or attendant can help her, too, first, by 
 giving her something to pull on, like the ends of a How the 
 sheet, which has been thrown over the bed-post ; sec- help at 
 ond, by placing a box on the foot of the bed, so that thls time 
 she can brace against it with her feet, and third, by 
 pressing the hands firmly against the small of the back. 
 In the period between pains, it is very grateful to have 
 the face wiped with a damp cloth, especially if this 
 stage of labor is prolonged. 
 
 Immediately after the birth of the child the pains 
 cease, and there is an interval of from twenty min- 
 
240 MOTHERHOOD 
 
 The third utes* to half an hour before they begin again to bring 
 
 labor or about the expulsion of the placenta. The placenta 
 
 after-birth g^Qy}^ k e received in a vessel prepared for it, and it 
 
 Need of must not be thrown away or disturbed until the physi- 
 
 the doc- c i an has examined it. He can tell by its shape and the 
 
 tor s ex- _ j r 
 
 amination appearance of its surfaces whether or not it has come 
 
 of the 
 
 placenta away entire. 
 
 If any portion of it remains in the uterus, that or- 
 gan must not be allowed to contract firmly until every 
 portion of the membrane has been expelled. After the 
 doctor has finished his examination, it should be 
 wrapped in thick paper and burned. 
 
 Immediately after the birth of the child there may 
 Chilis be a slight chill. This is due in part to nervousness, 
 fabor and ar, d m P art to ^ e ^ act th at ^ e presence of the child in 
 when the trie u terus has increased the bodily heat of the mother. 
 
 milk comes J 
 
 There is liable to be another chill on the third day, 
 when the milk comes into the breast. A chill at any 
 other time should be promptly reported. 
 
 CONTRACTION OF THE UTERUS 
 
 As soon as the uterus is empty, it should begin to 
 contract, which prevents hemorrhage, and is the be- 
 ginning of its return to normal size. The attendant 
 Helping should place her hand over the abdomen after the 
 to contract placenta has been expelled, and by making a kneading 
 motion over the uterus she can help to its contraction. 
 If it can be felt as a hard firm ball, just below the 
 navel, it is in proper condition and need occasion no 
 uneasiness. 
 
 After-pains are due to contraction of the uterus 
 To what after the birth of the child and the expulsion of the 
 a:e e due ainS placenta. They do not occur after the birth of the 
 first child, but are often very severe in later confine- 
 ments, and sometimes last for three, or rarely for four, 
 
LABOR 241 
 
 days. They are unaccompanied by fever or by any 
 alarming symptoms. 
 
 EMERGENCIES 
 
 At the birth of the first child there is generally 
 little danger of a rapid delivery, so that the possibility ^ ^ e . 
 of the woman's being alone or with an attendant only al °ne how 
 is slight. But in any case this need not be regarded retard 
 as a terrifying calamity. The progress of labor can labor 
 be retarded a little if she restrains her tendency to 
 bear down during pains, and expels the air from her 
 lungs with her mouth open, which relaxes the muscles. 
 If the child is born, she needs only to see that his head 
 is lifted up so that he can breathe properly, and that 
 there is no tension on the cord. An attendant, whether 
 or not a nurse, can lift the baby up, put a clean padwhattodo 
 under him, see that he cries enough to establish respira- child tin 
 tion, and cover both child and mother till the doctor comes 
 comes. 
 
 If the labor has come on precipitately, and the doc- ^[^ ^ nsi * 
 tor can not be summoned, the nurse must assume the * he nu f se 
 
 .,.-.-. 1 , lf the doc- 
 
 responsibihty of cutting the cord. tor is not 
 
 When it has quite ceased pulsating, a piece of presen 
 
 bobbinet, which should have been previously sterilized 
 
 with the other dressings in a package by itself, may 
 
 be tightly tied around the cord in two places, one 
 
 ligature being about four inches and the other two 
 
 inches from the body of the child. In making the 
 
 knots, which should be extremely firm, care must be Directions 
 
 taken to keep the hands absolutely steady, as sudden Jj£ ^ g 
 
 tension on the navel might result in rupture or even 
 
 a fatal hemorrhage. 
 
 After the two ligatures are made, the cord can 
 
 be cut between them with blunt-pointed scissors, and Cutting 
 
 the baby can be rolled in his blanket, and left without 
 
 any fear of harm. _. , 
 
 ' ii Vol. 3 
 
242 MOTHERHOOD 
 
 The flowing directly after delivery will be profuse, 
 Action in but should it seem in any degree alarming, the con- 
 flowing dition of the uterus should be at once investigated. If 
 delivery ^ * s not ^ rm anc * hard feeling, as I have said, like a 
 hard round ball in the abdomen, it is not contracting 
 as it should, and that will explain the increased flowing 
 of blood. If it is kneaded with the hand, or if a little 
 cold water is dashed over the abdomen, it often con- 
 tracts at once, firmly enough. 
 
 Putting the baby to the breast also tends to bring 
 The baby a b ou t contractions, and both these expedients should 
 
 helping to r 
 
 muscular be tried, though a doctor should be summoned if any- 
 thing in the nature of a hemorrhage occurs. 
 
 Special tenderness over any portion of the abdo- 
 men, an offensive odor to the' discharge, or a return of 
 the bright red color after it had become dark should 
 be reported. 
 
 Sometimes in a very difficult confinement, when the 
 
 Cause of child is large, or the outlet is narrow, the tissues are 
 
 lacerations tom during . the birth. The laceration may be in the 
 
 neck of the uterus or in the tissues about the vagina, 
 
 and often a physician will proceed with their repair 
 
 without a question. 
 
 If he does leave it to the patient, she should have 
 Repair of n0 hesitation in choosing to have it attended to at once. 
 tion at° e ' In that case the operation is a very simple one, and is 
 bestcourse almost invariably successful, as the parts unite very 
 quickly. Very unpleasant consequences follow the 
 neglect of such an injury, the nerves being so closely 
 involved that there is much sympathetic disturbance, 
 such as headache and pain in the back, besides the 
 actual discomfort of the laceration. A secondary re- 
 pair means a much longer time spent in healing, and 
 an extra period in bed with the attendant weakness. 
 
LABOR * 243 
 
 AFTER-TREATMENT OF THE MOTHER 
 
 After the placenta has come away, and the contrac- Cause of 
 
 11" 1111 ^ ie c ' u ^ 
 
 tion ot the uterus is assured, the woman should be 
 
 closely covered, given a warm drink, and allowed to 
 
 rest, for a nervous chill, described on foregoing page 
 
 240, is likely to follow. This is caused in part by 
 
 the evaporation of perspiration from the skin after the 
 
 cessation of muscular activity, and is no occasion for 
 
 alarm. It lasts a short time, and is relieved by the 
 
 application of heat. 
 
 After the patient has been bathed, the abdominal Full 
 
 binder put on, and the soiled clothing removed from to the 
 
 the bed, she will probably fall into a light sleep, when mother 
 
 the attention of the nurse may be turned to the baby. 
 
 AFTER-TREATMENT OF THE BABY 
 
 The first task is to make a thorough examination First see 
 of the child to see that it is normally developed. The ^ud * s he 
 presence of external defects is at once remarked. The normally 
 
 developed 
 
 mouth should be inspected, because cleft palate and 
 tongue-tie interfere with suckling, and can be corrected 
 at an early age. The navel, of course, receives especial 
 care, and the genitals and passage into the bowels Examina- 
 should be observed, to make sure that there is no im- sp° e n ci fi f c 
 pediment to the performance of natural functions. It P arts 
 must be ascertained that the opening into the canal 
 leading into the bladder is present, and that the rec- 
 tum and anus are normal. 
 
 Rarely in girl babies the passage into the vagina 
 is found to be entirely closed by a membrane called the 
 hymen, which stretches entirely across it. When this 
 is the case, a very slight operation is necessary, and The 
 may be done at once. The doctor has already applied of^e"* 
 the dressing for the cord, which is simply a layer of cord 
 
244 MOTHERHOOD 
 
 sterilized absorbent cotton, or pad of gauze. Over this 
 he has put on the bandage, which should not be re- 
 moved without his approval. It is not safe for any 
 one who does not understand the principles of surgical 
 cleanliness to attempt to do this dressing, since serious 
 consequences, even blood-poisoning, might result from 
 lack of proper precautions. 
 
 The baby will be found to be covered with a white 
 Removing cheesy substance, which was necessary as a water- 
 cheeky 1 e proof protection, since the medium in which he lived 
 coating was £ u -^ rat h er t j ian a } r# Albolene, olive oil, or pure 
 
 vaseline may be used to remove the substance, and 
 it is well to rub the ointment thoroughly over the sur- 
 face of the body some little time before the bath is 
 given. If this can be done, the warm soapy water will 
 wash off all trace of it. 
 
 Particular care must be taken to remove the cheesy 
 Particular coating from the creases of the body, under the arms, 
 this as in the groins and about the genitals, as it is very irri- 
 coating ta ti n g if allowed to remain. The scalp, too, needs es- 
 pecial attention, since after this substance hardens it 
 is much more difficult to remove, and if it remains, it 
 collects dirt, and becomes unsightly, if not diseased. 
 
 After a thorough application of the oil, the baby 
 may be wrapped in a warm woolen blanket, and left 
 for several hours, if need be, without harm. It some- 
 Letting t } mes happens that the mother needs especial care, and 
 resteer if the baby is warm enough, and if his eyes are pro- 
 
 the oiling tected f rom bright j.^ j t j s quite as wdl tQ put ff 
 
 giving his bath and dressing him for four hours or 
 so, after the oiling. It will be found that he is very 
 easily cleaned after that length of time, because the 
 white substance has become quite softened. He may 
 then be dressed in a diaper, shirt, and flannel night- 
 gown and allowed to take his first feeding. 
 
AFTER-CARE OF MOTHER AND CHILD 
 
 Rest— Dressings— Breasts — Diet — The Baby's Bath — The Cord -dressing — 
 
 Order of Dressing— Care of Eyes, Nose, Mouth, and 
 
 Breast— Tub-baths— The Band— Feeding 
 
 REST 
 
 WE have spoken of the changes that have gone 
 on in the uterus during the nine months of 
 pregnancy. These have been not only changes in 
 size and weight, but also in functional activity, which 
 have involved the entire system. 
 
 With the birth of the child, the immediate cause 
 of this activity is removed, but Nature has now to re- Nature's 
 adjust the organs that have been working under ab- me^o?" 
 normal conditions, and especially to bring back the the or s ans 
 uterus to its previous size and position. She accom- 
 plishes the work usually in about six weeks, which in- 
 dicates that the tissues are in a state of tremendous 
 activity. This fact should impress upon our minds 
 the necessity of rest during this period, or the greater 
 part of it. It is marvelous enough that the system can 
 recover its usual poise after such a long-continued 
 strain, and even more wonderful to think of the rapid- 
 ity with which the uterus contracts and gets rid of the 
 extra tissue which it has taken nine months to acquire. 
 It seems only fair that a few weeks should be allowed 
 for the strengthening of ligaments and muscles, and ^fn 
 for the building" up of tissues more or. less depleted * hat read * 
 by the double burden they have carried. For these 
 reasons three weeks in bed are better than two, and 
 
 (245) 
 
246 
 
 MOTHERHOOD 
 
 Re-estab- 
 lishing 
 nervous 
 and physi- 
 cal tone 
 
 unless a woman is very strong three will probably leave 
 her in still better condition. 
 
 For three or four days after delivery, the mother 
 should be kept very quiet, lying most of the time on 
 her back, especially if the discharge is profuse. Vis- 
 itors should not be allowed to see her for at least a day 
 or two. Quiet and rest re-establish the nervous and 
 physical tone within a short time, and the rapid con- 
 valescence is as remarkable as Nature's other methods 
 of adjustment to changed conditions. 
 
 Bathing 
 parts with 
 a mild dis- 
 infectant 
 
 Cleanli- 
 ness and 
 comfort 
 
 DRESSINGS 
 
 The napkins should be removed every three or four 
 hours, for the first day. After that, every eight hours 
 will be often enough. 
 
 Each time they are changed, and after urination, 
 the' genitals should be bathed with a mild disinfectant. 
 This may be a bichloride solution made with one part 
 of the I -iooo preparation with four parts of water. 
 This bathing should consist chiefly of pouring the 
 water gently over the parts, while the patient is still 
 on the bed-pan, and then drying them before adjust- 
 ing the fresh pad. 
 
 This bathing will make for cleanliness and comfort, 
 will remove disagreeable odors, and hasten the healing 
 process. A separate piece of cloth should be put under 
 the body before the bed-pan is used, and with the fre- 
 quent changing of the pads, the bathing and the use 
 of squares laid over the draw-sheet, it will be found 
 possible to have a tidy bed, without too much extrava- 
 gance in the way of laundry. 
 
 BREASTS 
 
 Care should be taken to cover the breasts, because, 
 since at this time the glands begin to exercise* their 
 
MOTHER AND CHILD 247 
 
 function of secreting milk, they are more susceptible 
 to cold. An inflammatory condition may set up, and Protection 
 become very painful, and by keeping a light-weight breasts 
 bit of flannel over the breasts from the first, the dan- 
 ger is avoided. It is well to keep a clean cloth — linen 
 or cotton — over the nipples all the time, and to wash 
 them with boracic acid solution after each feeding. 
 
 The milk is manufactured by glands in the breasts, 
 and it must be remembered that the nipples lead into cieanii- 
 as well as out of these glands. If they are not kept breasts 
 clean and covered, or if particles of the milk are al- 
 lowed to remain on them and to decompose, the danger 
 of infection is very great. An abscess is caused by 
 infection, from some such reason, or because the milk 
 within the breast is allowed to accumulate and become 
 caked. 
 
 If lumps are noticed in the breasts, the attention 
 of the doctor should be called to them. Gentle mas- When 
 sage will generally soften them, but unskilled manipula- fo™m S 
 tion may be more harmful than beneficent. The mas- 
 sage should be given with the palm of the hand, being 
 a gentle circular motion from the base of the breast 
 toward the nipple. 
 
 If there is any tendency toward engorgement of the 
 breasts, the baby should be put to nurse with especial I en- 
 regularity, and in extreme cases the milk may have to 
 be drawn out with a pump. Pumping tends to in- 
 crease, rather than to restrict, the flow, however, so it 
 should be a last resort. Liquids may be largely elim- 
 inated from the diet, and if the child is a healthy one, 
 this difficulty will soon be overcome by his necessary 
 appetite. 
 
 There is rarelv anv excuse for the formation of an Proper 
 
 « .,,''.,. . rr^i care does 
 
 abscess in the breast, if proper care is given. The away with 
 bunches should be reported to the physician as soon as abscess 
 
248 
 
 MOTHERHOOD 
 
 Chapped 
 or cracked 
 breasts 
 
 Washing 
 the breast 
 after each 
 feeding 
 
 Other 
 treatment 
 
 Care in 
 treatment 
 
 they appear, and they generally yield to massage. If 
 they become inflamed, ice-bags are ordered, the bowels 
 are kept open by the use of laxatives, and the child is 
 taken from the breast. The chief danger lies in delay 
 in telling the doctor of the trouble, and in beginning 
 treatment. 
 
 If the breasts have had no treatment during con- 
 finement, and if the nipples are flattened at all so that 
 there is constant tension during nursing, they some- 
 times become chapped or cracked. This is intensely 
 painful, especially since the baby must still be put to 
 the breast so that the milk shall not accumulate. 
 
 The prevention of this condition, as well as one of 
 the cures, is cleanliness, which means that the nipple 
 should be washed after each feeding, and in case any 
 ointment or solution is applied, washing before feed- 
 ing is also necessary. 
 
 If the difficulty is slight, boracic acid ointment used 
 after each nursing will often be sufficient. 
 
 Painting the nipple with white of egg, applied in 
 several coats is a help, because it shuts out the air, 
 and gives the fissure a chance to heal. The same 
 treatment may be tried with compound tincture of 
 benzoin, but if the condition is obstinate, the doctor will 
 probably touch it with a solution of nitrate of silver, 
 twenty grains to the ounce, which greatly hastens the 
 healing process. Two treatments daily are sufficient, 
 and if left to an attendant, it should be done either with 
 a camel's-hair brush, or with a very small swab of 
 cotton twisted about a wooden toothpick. 
 
 The solution should not be allowed to flow over the 
 entire nipple, but only over the cracked surface. The 
 effect of its use is to cauterize the edges of the fissure, 
 and thus to make a fresher wound, which tends to heal 
 more easily. 
 
MOTHER AND CHILD 249 
 
 Unless the flow of milk is excessive, the breast may 
 be given entire rest for twenty-four hours, which will 
 often effect an entire cure. If this is not the result, 
 some provision must be made to draw off the milk from 
 the breast, because of the danger of abscess resulting 
 from an over-accumulation. 
 
 The use of a nipple-shield relieves the tension when 
 the babv nurses. This covers the nipple with a glass The , 
 
 rr , & nipple 
 
 bell, having a rubber mouthpiece very like that of a shield 
 nursing bottle. The disadvantage of its use is that 
 the baby may become accustomed to the longer rubber 
 nipple, and so may take the breast more reluctantly or 
 refuse it altogether at first. 
 
 DIET 
 
 The diet of the mother for the first two days should 
 be liquid. Milk is the best food, both because it is the 
 most nourishing, and because it helps to increase 
 the supply in the breasts. Tea and coffee tend to check Jittfltbor 
 the milk supply, so they should not be taken unless the 
 milk is secreted in excess. Cocoa, gruel, and soups 
 will vary the fare, which may be increased after forty- 
 eight hours to semi-solids, i. e., eggs, soft toast, cus- 
 tards, etc., and after the first movement of the bowels, 
 regular diet is allowable. 
 
 If the bowels have moved just before the baby's 
 birth, there need be no uneasiness if there is no evac- 
 uation for two or three days. Then the doctor will 
 order either a cathartic or an injection, and very often J^olv-eis 
 after solid foods and fruits are given the stools will be 
 regular and natural. The same care should be taken 
 after confinement as before, to regulate the bowels, 
 and to avoid the ills of persistent constipation. 
 
 The daily care of the mother should be what is 
 given an ordinary bed-patient. The daily bath, the 
 
250 MOTHERHOOD 
 
 Daily care changing of bed-linen, and the putting her room in 
 order should be attended to before the baby's bath 
 is given. It is much more essential for the mother 
 to start in her day with the cheer that attends clean- 
 liness, fresh air, and order than for the child to have 
 early attention. It is perfectly safe to give her a full 
 
 Rubs and bath, between blankets, on the fifth day, and before 
 
 baths 
 
 that alcohol rubs and sponging will freshen her each 
 
 day. 
 
 There may be interested neighbors or relatives 
 
 who will insist that her hair must not be combed for 
 
 a week after delivery, and that all bathing is danger- 
 Advice of ous. It is to be hoped that their counsel will not be 
 neig ors f |j owe( j j t j s q U if- e unnecessary to neglect the 
 
 patient in any particular, and if she is clean and 
 
 decently cared for her recovery will be hastened 
 
 rather than retarded. 
 
 THE BA3Y'S BATH 
 
 It is well to plan to give the bath at about the 
 same time if possible each day. This should always 
 be before rather than after feeding; and preferably 
 before, because the child can be put to the breast 
 immediately after the bath. 
 
 Before taking the baby from his bed everything 
 Every- needed for the bath should be collected and put in 
 essafy n fo C r P lace - The basket holds the needles and thread, the 
 the bath p Uls anc [ t ne bands, tightly rolled, and it may stand 
 hand on a table or chair near the bath-tub. 
 
 The powder and the cup containing a tepid boric 
 solution should be at hand, with the soap, face .cloth, 
 and towel. The bath-tub need not be full, as that 
 makes it very heavy to lift, and there is no advantage 
 in a quantity of water for a baby who is presumably 
 clean. 
 
MOTHER AND CHILD 251 
 
 The clean clothing may conveniently hang over 
 the back of the rocking-chair that one sits in, if it The cioth- 
 has a post or projection at one side. If not, #iey eafyreach 
 should be within easy reach on a towel-rack or chair, 
 and should be placed with the gown and petticoat 
 underneath, then the shirt and diaper, and the band 
 on top, in the order they will be needed. 
 
 It is well to have an extra blanket or flannel The 
 square kept especially for bathing, or one can use fla " n 1 ^ 1 
 a flannel apron, which is particularly convenient after 
 the baby begins taking tub baths. 
 
 For the first days he will have a simple sponging, 
 and we must remember in giving it that he is not a simple 
 
 11 1111 sponging in 
 
 used to the temperature of the cold world, but that the baby's 
 he has been kept at 98.8 F. for the nine months first days 
 preceding his birth, and we must protect him very 
 carefully from draughts. The temperature of the room 
 should be 75 ° and that of the water about ioo° F. 
 The latter can be fairly tested with the bared elbow. 
 
 In holding the baby the chair must be low, be- How to 
 cause the feet should be placed firmly on the ground, hold the 
 with the knees together, letting the baby's head and {^uSin^ 16 
 shoulders lie firmly on the lap. him 
 
 It does not matter if the child's legs are not sup- 
 ported, but he can be much more comfortably held 
 if the lap is firm and flat. If the knees separate he 
 will go into the hollow between them and can not be 
 as easily handled. 
 
 Placing him then in this position on the bath 
 blanket, remove the clothing, rolling him gently from Roil 
 side to side to unfasten the little garments. The Hf t ier 
 shock to a baby, and in fact to an adult as well, is dressing"* 
 much less if he is rolled than if he is lifted bodily. the bab y 
 
 . or patient 
 
 The dress and petticoat are unfastened and taken off 
 together, down over the feet. After the shirt is off 
 
252 
 
 MOTHERHOOD 
 
 Don't dab 
 at the 
 baby, but 
 wash 
 sensibly 
 
 Washing 
 the upper 
 parts of 
 his body 
 
 Washing 
 the trunk 
 and legs 
 
 one corner of the blanket should be thrown over him, 
 to protect him as much as possible while the band 
 and diaper are removed. A diaper should always 
 be laid underneath during the bath so that the bath 
 blanket or apron may not be soiled and wet. Then 
 he should be snugly wrapped and his face washed 
 with the clear water. 
 
 A baby should never be dabbled at as if he were 
 breakable china. Take the damp cloth firmly over 
 the hand, and wash his face as you would your own. 
 In drying any portion of his tx)dy the- skin should 
 be patted rather than rubbed with the towel, for it 
 is very delicate and a baby resents any approach to 
 rough usage. After the face is washed and dried 
 the water should be made soapy. Do not rub the 
 soap directly on the cloth, for in that way you Use 
 more on his skin than is at all necessary. 
 
 The head, neck, and ears should now be washed, 
 rinsed, and dried, and this must be carefully done, 
 because the thatch of down over the little head re- 
 tains the dampness longer than other parts of the 
 body. Next come the arms, one uncovered at a time, 
 keeping the chest and the rest of the body wrapped 
 in the blanket all the while. 
 
 Now with the left hand hold the edge of the 
 blanket up a bit away from his body, so that he is 
 entirely covered and protected, but so that there is 
 also a space between him and the covering. With 
 the cloth you can then wash the entire body without 
 letting the air strike directly .on it. Turning him 
 over directly on his stomach, a position which a baby 
 almost invariably enjoys, wash the back in the same 
 way. The legs can be exposed, as the arms were, 
 for they are generally being exercised so rapidly 
 that they will not feel the cooler temperature. 
 
MOTHER AND CHILD 263 
 
 Care must be taken to wash off all traces of 
 powder, and to cleanse carefully all the creases of 
 the body, just as was done with the oil in the first 
 bath. 
 
 THE CORD-DRESSING 
 
 If the doctor is paying daily visits, and there is 
 not a graduate nurse in charge, the bandage and D ° not 
 cord-dressing should not be disturbed unless the bandage 
 doctor's orders have been given concerning it. In , v " th out 
 that case the routine of the bath is the same except orders 
 that no bathing can be done under the band. 
 
 If the doctor is not coming regularly, and wishes 
 the cord dressed or the bandage changed, great care Most 
 must be taken. The dressing will not need to come t^eTtment 
 off unless it is moist. In that case it must be re- dre^lng^ 
 placed by a fresh piece of sterilized cotton or linen, 
 and no ointment or solution should be used on it. 
 
 If there is no person in authority to consult, and 
 the cord seems to be discharging, or if the odor from 
 it is very offensive, a little boracic acid powder will 
 probably dry it up and is the safest treatment that 
 can be given. 
 
 The question of powder is one on which persons 
 disagree, but we may strike a happy mean and use Moderate 
 it moderately. While the baby is lying on his stom- p^der 
 ach draw the puff across his neck and down his back, 
 following it with the hand, so that there is no ap- 
 parent trace of the powder left on the body. "When 
 the puff is used under his arms protect his face with 
 the hand, the back of it placed against his chin. 
 
 ORDER OF DRESSING 
 
 Now put on the shirt — we are assuming that the 
 band has been left on. Put your fingers up through 
 
254 
 
 MOTHERHOOD 
 
 To put on 
 the baby's 
 shirt 
 
 the sleeves, and pull the baby's hand through, first 
 slipping in the arm furthest from you, then turning 
 him over and drawing the shirt under him. 
 
 Never try to push a child's or an invalid's hand 
 through a long sleeve. Either put your hand through 
 to meet his or gather it up into small compass, with 
 the fingers through the opening. After trying both 
 ways it will be easy to understand the prohibition. 
 
 Place the diaper under the buttocks before using 
 the powder, which must not be put on in excess. It 
 
 The Flannel Petticoat and Dress 
 
 Putting 
 on the 
 diaper 
 
 only cakes in the groins and irritates more than it 
 soothes. After using the puff, rub the hand over the 
 thighs and buttocks to brush away any superfluous 
 powder. A very good way to put on a diaper is 
 to turn down the upper edge of the triangle — the 
 part that lies under the baby — about two inches, so 
 that it will be double at the baby's back. Bring the 
 ends around and grasp the edges between the thumb 
 and middle finger. Now twist the ends lightly, put 
 them between the legs, and bring up the point of the 
 
MOTHER AND CHILD 
 
 255 
 
 triangle to fasten. Turn the hand holding the diaper, 
 and put the pin in so that it comes out on the side 
 where the middle finger is, and not against the baby's 
 flesh. The diaper can be held as tightly as necessary, about the 
 and there is no danger of pricking the child. Care pm 
 must be taken, however, not to pin it too tight, since 
 
 Care 
 
 Slipping on the Flannel Petticoat and Dress 
 
 diapers which bind a baby closely are often respon- 
 sible for nausea. Xow turn him over and fold up 
 the doubled portion. A diaper well put on in this 
 way will never become loosened or drop off. 
 
 Slip the flannel petticoat inside the dress and put 
 them on together over the feet, not over the head. 
 
256 
 
 MOTHERHOOD 
 
 To put 
 on the 
 flannel 
 petticoat 
 and dress 
 
 In this way the baby needs to be moved less, and is 
 spared the irritation of having his face covered as 
 the clothes slip down. Put your right hand through 
 the dress from the bottom, and slip it up under the 
 baby's buttocks-. Therewith the left hand the skirts 
 may be drawn up into place, and the baby rolled 
 over on his stomach while the necks are fastened. 
 
 Washing 
 the baby's 
 mouth 
 
 Bathing 
 the baby's 
 eyes 
 
 Three 
 rules to 
 follow 
 
 CARE OF EYES, NOSE, MOUTH, BREAST 
 
 The boracic solution, half a teaspoon to a full 
 glass of water, is already prepared with small bits 
 of absorbent cotton or squares of soft cloth at hand. 
 
 Twist a bit of the wet cotton on the fingers and 
 wash carefully but very gently the inside of the 
 baby's mouth. It is necessary to do this at least 
 twice a day to remove particles of milk that might 
 decompose if allowed to remain there, and cause 
 disease. There has been some discussion of late 
 years over the desirability of washing a baby's mouth, 
 after each feeding, and many physicians now believe 
 that such frequent cleansing . often irritates the ten- 
 der lining of the mouth. 
 
 The eyes should be bathed every morning, or as 
 often as there is any sign of discharge. Taking a 
 bit of cotton between the fingers, allow the solution 
 to trickle over the lid, and unless there is marked 
 inflammation it may be gently drawn across the eye 
 from the nose toward the outer angle. Throw that 
 bit of cotton aside and repeat the same process with 
 a fresh piece. 
 
 Never dip the cloth that you have used back into 
 the solution. Never use the same piece of cotton 
 on both eyes. Never allow the solution to flow from 
 one eye to the other, as any inflammatory condition 
 is directly communicable. 
 
MOTHER AND CHILD 257 
 
 The nose often becomes stopped with mucus, Cleansing 
 which makes the respiration difficult, tends to bring and precau- 
 on mouth-breathing, which is always to be guarded VhaYtime 
 against, and sometimes interferes seriously with the 
 nursing. A small bit of the absorbent cotton, dipped 
 in a boric solution, and twisted dry can be inserted 
 up into each nostril, and will clear the nose without 
 any discomfort to the child. 
 
 If the mucus has hardened, vaseline or oil can be 
 applied in the same fashion, or on a cotton swab on 
 a toothpick. If the pick is used care must be taken 
 not to insert it too far, and not to press it against 
 the delicate membrane in the nose. 
 
 Sometimes the breasts of a new-born baby, of 
 either sex^ become distended and slightly inflamed, Treatment 
 and if pressed a thin fluid will exude from the nipples, baby's 
 Squeezing out this fluid must never be allozved, as breasts 
 it only increases the inflammation and may easily 
 produce abscesses. 
 
 The trouble usually will right itself within a very 
 few days, but if it is persistent a close bandage ap- 
 plied with perfectly even pressure will be of help. It 
 is better that a physician or nurse should at least Caution 
 superintend the bandaging, because uneven pressure ing 
 will do more harm than good. The inflammation is 
 not a condition that need cause any alarm unless 
 it is unwisely treated. 
 
 TUB BATHS 
 
 As soon as the cord comes off, the tub bath may 
 be given. The baby is undressed as for the sponge when the 
 bath, and is wrapped in the bath blanket. While ^nhis 
 he is thus covered his face and head are washed and tub bath 
 dried, and the water is made soapy. Now put the 
 left hand under his head, take the feet between the 
 
258 MOTHERHOOD 
 
 fingers of the right hand and let him down into the 
 water. There should not be enough in the tub to 
 cover the body, since the navel may not be entirely 
 healed and dry. 
 
 Supporting the head in the hand, bathe the body, 
 
 How the arms, and legs with the cloth. Avoid trickling the 
 
 shouidbe water over the body, but bathe the parts in order, 
 
 first ears, neck and chest, next the left arm, then the 
 
 Placing Baby in the Bath 
 
 right, changing the cloth from side to side by carry- 
 ing it down by the feet, rather than across the chest; 
 last wash the legs, thighs, and buttocks. 
 
 Now spread the towel across the knees over the 
 blanket or woolen apron and, taking the baby up by 
 the feet and head, lay him down and instantly wrap 
 him up in the two, patting him gently all over. In 
 this way he is kept quite warm, and is pretty thor- 
 oughly dried. After the patting he can be rolled 
 from side to side while the towel is taken out, and 
 
MOTHER AND CHILD 259 
 
 a little extra drying can be done under the arms and 
 in the groins. 
 
 THE BAND 
 
 The application of the band has not been de- 
 scribed, and practice is certainly more necessary than 
 written directions are. 
 
 The band should be rolled closely and held in the 
 right hand. Put the roll down on the right side of Putting on 
 
 & ° the band 
 
 the baby's abdomen and unroll the band away from 
 you, holding the left hand over the loose end till the 
 roll is slipped under the baby and brought up on the 
 right side. 
 
 Now hold the edges of the bandage between the 
 middle and the fourth fingers of each hand, and with 
 the thumb and index finger push the rolled end 
 around the body once more. After it is firmly over 
 the end it need be held no longer, and the remainder Fastening 
 of the strip is unrolled and fastened at the end with needle and 
 needle and thread. This method obviates the use thread 
 of safety-pins, which make a bulkier fastening, and 
 it is really very simple if the thread and needle are 
 always at hand. 
 
 The band should not be put on very tight, as the 
 little bones are compressible and may easily be forced The band 
 
 r 1 • • 1 r • / • ,.<• Should 
 
 out of shape, causing serious deformity later in life, not be 
 Besides this, the pressure from a tight band or diaper very tl§ * 
 may cause vomiting. 
 
 The flannel bandage is necessary only while a 
 dressing is kept over the cord, but the bowels need , The , 
 
 f r ' knitted 
 
 protection and the knitted band, like a little sleeveless band 
 shirt, may be substituted. In summer it may save 
 the baby from attacks of summer complaint, which 
 are commonly brought on by a cold, and in winter 
 the added warmth over a very sensitive part is 
 equally essential. 
 
260 MOTHERHOOD 
 
 As long as the navel discharges or is at all moist, 
 The little the little flat piece of sterilized cotton or muslin must 
 sterilized be laid over it before the band is put on. The ap- 
 cotton plication of boracic acid powder will tend to dry it. 
 
 FEEDING 
 
 After the baby's toilet is complete he should be 
 put at the breast, before he is allowed to fall asleep. 
 The feedings should be given with absolute regu- 
 larity from the first. A child does not particularly 
 J he ,. need food for the first twentv-four hours after birth, 
 
 feedings ' ' 
 
 the day but it is well to put it to the breast about six hours 
 
 after birth . ,_, , * . . .,, 
 
 after. The breasts do not begin to secrete milk in 
 any abundance until the third day, but they contain 
 a fluid which acts on the child as a laxative, clearing 
 the bowels of the tarry substance which fills them. 
 The act of nursing also tends to make the uterus 
 contract more firmly. 
 
 For the first day the baby may feed every four 
 
 Regular hours. After that feedings should be given every 
 
 feed?ng° r tw0 hours, beginning at half-past six, and the last 
 
 feeding being given at' half-past ten, leaving the 
 
 night for both mother and baby to sleep. 
 
 He should remain at the breast for twenty min- 
 
 Forming utes, and should be kept awake for that time, and 
 
 beneficial made to nurse. This is often a Herculean labor, but 
 
 andchiS if persisted in the habit will be formed and both 
 
 mother and child will feel the benefit of it. 
 
 The stomach of a baby, like that of a grown per- 
 Howto son should have its periods of rest and of work, and 
 
 impair the 
 
 baby's if he is kept at the breast and allowed to nurse for 
 
 aSgain a few moments till he falls asleep, then to wake and 
 
 nights" 1 nurse again for hours at a time, the chances for an 
 
 impaired digestion and consequent ill-temper, colic, 
 
 and wakeful nights are almost assured. 
 
MOTHER AND CHILD 261 
 
 A healthy baby should sleep twenty hours out 
 of the twenty-four, and if he is treated fairly his 
 crying will be only a means of communicating his 
 needs to the outside world, and will- cease when those 
 needs are attended to. 
 
 The training of a baby will be discussed later, but The more 
 
 ... , r 1 • 1 1 1 i ust an d 
 
 this point can not be too often emphasized, that the rational 
 more rational the methods, the more they appeal to |£g oTa"' 
 good sense and justice, the more likely they are to^y* 1 * 5 
 
 J j j more bene- 
 
 be properly hygienic and to make for the vigor and ficiai they 
 joy of healthy childhood. welfare 
 
VI 
 
 ABORTION AND PREMATURE BIRTH 
 
 Abortion— Premature Birth— Care of Premature Baby— Gavage and Lavage 
 —Suppressing Milk— Milk-leg— Inexorable Laws of Nature 
 
 THE discharge of the fetus during the first six 
 months of pregnancy is called abortion, or mis- 
 carriage; during the last three, it is known as prema- 
 of abortion ture labor. The term abortion is often misunderstood, 
 because its meaning has been commonly limited to the 
 inducing of labor by illegitimate means. In cases of 
 abortion, the life of the child can not be maintained — 
 it is not viable, in technical phraseology. 
 
 In premature labor, it is only excessive care and 
 
 determination on the part of those nursing him that the 
 
 fureSt baby is kept alive, though within a few months he may 
 
 gain enough to seem like a full-term child, and may 
 
 have a full and early development in every way. 
 
 ABORTION 
 
 There are many conditions that may be responsible 
 
 for abortion. If the uterus is diseased, or displaced 
 
 in any way, it is very difficult to carry a child for the 
 
 nine months. If the temperature of the mother is 
 
 illnesses of raised, and the fever continues for any length of time, 
 
 the mother, t j ie f e t U s generally dies within the uterus, and this 
 
 mechanical & J - 
 
 or emo- brings on abortion. Acute kidney disease or a depleted 
 violence condition of the blood may be the causes. Long- 
 continued and persistent nausea causes miscarriage, 
 and alcoholism or lack of vigor on the part of the 
 father may occasion it. Mechanical violence, such as 
 (262) 
 
ABORTION 263 
 
 blows, or sudden shock, or emotional violence, worry, 
 sudden grief, or fear, are often exciting causes. 
 
 If abortion occurs once, it is extremely liable to be a weakness 
 
 • e 1 1 liable to 
 
 repeated, and a habit is very easily formed, so that it repeat 
 becomes difficult for a woman who has had this ex- ltself 
 perience to bring forth a living chfld. 
 
 The majority of miscarriages occur during the 
 second or third month, so that in cases where it is an- 
 ticipated especial care must be taken at that time. It 
 is liable to take place at about the menstrual period, 
 and sometimes it may be avoided if the patient lies in 
 bed for a few days each month. 
 
 Abortion is really a more serious condition than 
 normal childbirth, not so much with regard to the Dangers 
 chances of life as to the effect on the general health ^Sto' 
 and on the condition of the uterus. It must be re- greater 
 garded as a disease, and Nature does not stand ready ordinary 
 to set at work upon immediate repairs and readjust- 
 ments as she does when a pregnancy runs its entire 
 course. As in any disease, she is the physician's chief 
 assistant, and supplements any efforts of his to bring" 
 the system back into healthy condition, and often with- 
 out his direction she overcomes the difficulty. But the 
 dangers of complication are far greater than in child- 
 birth. 
 
 The first indication that abortion is threatening is 
 generally the appearance of a bloody discharge, with The first 
 pain through the back and abdomen. This should be tbat Ca 
 the signal for the patient to go to bed, and she should threatening 
 remain there, lying on her back as quietly as possible. 
 The diet should be restricted to fluids, and nothing 
 hot should be given. A doctor should always be con- 
 sulted, since quieting drugs can be prescribed, which 
 may aid in checking the contraction of the uterus. 
 
 Sometimes, with care and absolute rest, a patient 
 
264 MOTHERHOOD 
 
 Care and can be carried through till the full term of pregnancy 
 rest is accomplished. It means, however, absolute obedi- 
 
 ence to laws prescribed by the' physician, and rest, even 
 beyond what necessity seems to demand. Even then 
 it is often impossible to control the flowing, and abor^ 
 tion occurs in spite of the utmost care. 
 
 If it takes place after the third month, there are 
 likely to be feelings of chilliness, loss of appetite, and 
 nervousness, which may precede by several days the 
 flowing and the pain. 
 
 All the discharges should be carefully observed, 
 Forms the because early in the course of pregnancy the ovum 
 abortion would look like hardly more than a blood-clot. It may 
 mayta e ^ discharged with its membranes entire, which is 
 more general during the first three months, or it may 
 take the course of a normal birth, the sac of waters 
 being ruptured first. In the first case, the hemorrhage 
 will be slight, and there will probably be little attendant 
 illness. The later abortion occurs the more it resem- 
 bles a full-term delivery, and the more difficulties arise 
 in its treatment. 
 
 Hemorrhage and blood-poisoning are the chief dan- 
 gers in abortion. 
 
 When the profuse flowing starts without warning, 
 The the doctor should be summoned at once. The patient 
 
 hemorrhage should lie flat on her back, without even a pillow under 
 her head. The hips may be raised on a cushion, pro- 
 tected by rubber sheeting, and the foot of the bed may 
 be elevated on a chair. She should never be given hot 
 drinks or alcoholic stimulants, but she may take plenty 
 . of cold water or milk. The room must be kept coo. 
 and the recumbent position must be absolutely main- 
 tained, and no exertion should, be allowed. Above all, 
 the feeling of alarm should be concealed as much as 
 possible from the patient. A very little blood makes a 
 
ABORTION 265 
 
 very large stain, and a surprising amount can be lost 
 without fatal consequences. 
 
 If these directions are carried out, and a doctor is 
 called at once, there is no need of excitement and ago- Quiet a 
 nized alarm. Quiet is a safeguard, and a reliable physi- 
 cian will know how to act promptly and effectively, so 
 that the danger will soon be over. 
 
 Blood-poisoning is. caused by the retention in the 
 uterus of the "membranes," as they are called, — that The 
 is, the placenta, and the sac in which the child is car- bfoTcT ° 
 ried. The uterus tends to contract after the expulsion P° lsomn € 
 of the fetus, and may close about these membranes, 
 or a portion of them, instead of expelling them entire, 
 as is general in normal childbirth. 
 
 As soon as the placenta becomes detached from the 
 uterine wall decomposition takes place, and the sys- The cause 
 tern soon feels the effect of the poison. It is for this poisoning 
 reason that a doctor should be given the charge of 
 such a case from the first. He will then make sure 
 that the uterus is quite empty, and will order treat- 
 ment to check the hemorrhage, and to prevent the 
 possibility of the poison's being carried through 
 the system. 
 
 The douche ordered in cases of confinement is a 
 sprav of water carried up into the vagina, and this The vaginal 
 
 • 11 r 1 -r r 1 . • louche 
 
 is generally necessary after abortion. If this spray is 
 sent into the uterus itself, the physician always gives 
 it, and he has special instruments for it, but often he 
 wishes the patient to have a simple vaginal douche each 
 day, and a member of the family may be responsible 
 for its administration. 
 
 A perfectly new fountain syringe, and a glass-point 
 having three outlet holes, should be used. The tern- To test 
 perature of the water should not be tested by putting ItureTf^" 
 the hand into the vessel containing it. A bath ther- the water 
 
 12 
 
 Vol. 3 
 
266 MOTHERHOOD 
 
 mometer can be used if the solution is a disinfectant, 
 
 and if plain boiled water is required, it is very possible 
 
 after a little experience to test the temperature quite 
 
 accurately, by pouring it over the arm. The douche- 
 
 steriiizing point should be boiled before using, and should be 
 
 douche placed in the syringe tube just before the douche is 
 
 pomi given, and should not be allowed to come in contact 
 
 with clothing, utensils, or any part of the body, before 
 
 it is inserted. 
 
 The hands of the attendant should be thoroughly 
 
 Thorough washed before giving the douche or the bed-pan, or be- 
 
 of hands fore changing the pads or bathing the breasts. All 
 
 this applies equally in cases of abortion and of normal 
 
 •confinement. 
 
 Douching should not be given without a physi- 
 Nodouch- cian's orders. In many cases, Nature would remedy 
 
 ing without .,.„.,. • <• 1 c i • • • 1 
 
 physician's difficulties if she were left alone, and it is certainly 
 possible that a continual use of the douche may tend 
 to weaken the muscles and ligaments and to debilitate 
 the tissues. It is better to be too conservative in this 
 matter than to run the risks of making improper and 
 too frequent use of the douche. After menstruation, 
 it is entirely superfluous, for the process is a normal 
 one, which calls for no artificial treatment beyond the 
 simple external bathing which ordinary habits of clean- 
 liness would suggest. 
 
 After a miscarriage, the same care should be given 
 Care and as is required after childbirth — as far as keeping the 
 fordelnH S patient in bed, and taking precautions regarding clean- 
 eflVof liness. But more than this, it must be remembered 
 
 Sa.ITlc 3.S 
 
 a , f * e r . , that the shock to the nervous system has been extreme, 
 
 childbirth , , , J t , . , . ' 
 
 and that there is liable to be mental depression, which 
 can be overcome only by great patience and by the 
 speedy return to physical well-being. Often, when the 
 birth of a child has been anticipated with great joy, 
 
PREMATURE BIRTH 267 
 
 the sorrow of loss is felt all the more keenly, because 
 the little life went out almost before it was given ; and 
 the fact that the consciousness of motherhood does not 
 follow, and crown the trial of pain and illness, is often 
 never expressed, perhaps because it is felt so intensely. 
 All this only goes to show how 'nursing in cases 
 of miscarriage should differ from that after normal Care and 
 
 . . sympathy 
 
 deliver} 7 . Here the mother's mind is so filled with in- with the 
 terests outside herself that her own ailments gain little mental S 
 attention, and nervous and mental disorders seldom state 
 need be reckoned with. After abortion, on the con- 
 trary, when the first danger is past, the mental state 
 overshadows and governs the physical, and the cour- 
 age and poise of the woman depend largely on the 
 patience, tact, cheefulness, and versatility of those 
 about her. 
 
 The period in bed will depend upon the condition 
 
 of the patient, both physical and nervous. Sometimes The P eriod 
 
 11-. 111 • in bed 
 
 when the depression is very marked and persistent, a 
 
 doctor may allow her to get out of bed, in the hope that 
 her interest will be roused. Ordinarily, however, it 
 depends, as in the normal case, upon the state of the 
 uterus — its position and the completeness of its con- 
 traction — and on the amount and character of the dis- 
 charge. 
 
 PREMATURE BIRTH 
 
 During the last two months of pregnancy, a child is 
 said to be viable ; that is, it is possible to keep it alive Care of 
 outside the uterus. At the seventh month, the child is seventh- 
 perfectly formed, the eyes are open, and the nails are ™^ h 
 present. The weight is between three and four pounds. 
 The chief difficulty here is the care of the child — to 
 keep it in an even temperature, to give it proper and 
 sufficient nourishment, in fact to reproduce artificially 
 
268 
 
 MOTHERHOOD 
 
 How the 
 
 incubator 
 
 works 
 
 Home 
 substitutes 
 for the 
 incubator 
 
 How to 
 
 make the 
 baby's 
 cotton 
 suit 
 
 some of the conditions of its life within the uterus, 
 which should have been prolonged. 
 
 In the hospital, of course, the incubator is used. 
 The heat supply is regulated so that it may always be 
 the same, and hot water is the medium through which 
 it is conducted, so that the lungs are given a proper 
 amount of moisture. The baby lies in a chamber in- 
 closed in glass so that he can be watched without being 
 removed, and the air is kept at the desired temperature 
 by artificial heat. 
 
 In the home, incubators are generally out of the 
 question, but there are various substitutes which can 
 provide approximate conditions. 
 
 There should be no attempt to dress the baby in 
 the regulation shirt, petticoat, and dress, beca.use rest 
 is one requisite to his welfare. A cotton suit can be 
 easily made of cheesecloth, padded with lambs' wool 
 or absorbent cotton. Cut out double thicknesses of 
 cheesecloth and cotton in the shape of a Greek cross, 
 
 o 
 
 one having four equal arms. Bring opposite arms 
 together, the cotton being laid between the cheese- 
 cloth, and the edges turned in, and sew over and over, 
 all around, except at the ends of the arms of the cross. 
 Now cut out a round hole in the centre of the fold, and 
 a slit down from this hole to the lower edge. Finish 
 
PREMATURE BIRTH 269 
 
 the raw edge, and you have a cosey little jacket, which 
 ma>- be sewed on and will keep the child much warmer 
 than the ordinary oarments. 
 
 \jy 
 
 Little bootees are made in the same way, using 
 stockings for patterns. These are pinned to the edge The other 
 of the jacket, or to the diaper. The little band and garments 
 diaper are the only other garments necessary. The 
 temperature should be kept as nearly uniform as pos- Necessary 
 sible, and as high as eighty-eight or ninety degrees. Mature" 
 Any device which makes this possible may be used. 
 
 A bed made in a clothes-basket and kept near a 
 fire, with a hot-water bag: on either side of the baby, P s< : of 
 
 ° J ' basket or 
 
 answers the purpose. Two tin tubs, put together after tin tubs 
 the fashion of a double-boiler, with hot water in the 
 lower one, is another arrangement which has proved 
 a successful substitute for an incubator. A lamp 
 placed underneath the tubs keeps the water hot, and 
 the pillow on which the baby lies in the inner tub pro- 
 tects him from the direct heat of the metal. 
 
 CARE OF THE PREMATURE BABY 
 
 A premature baby should be disturbed as little 
 as possible. Xo attempt should be made at bathing, Oiling 
 but each day he should be oiled with sweet-oil, being changing 
 kept carefully covered during the process, and a 
 fresh cotton jacket should be put on every second 
 day. The diaper should be changed as often as 
 necessary, and the child kept absolutely clean. 
 
 This can be done without taking him from the 
 
270 
 
 MOTHERHOOD 
 
 bed, and in fact he need be lifted very little. He will 
 Disturbing have to lie on the nurse's lap for his oil bath, but 
 as little as all the changing can be done without disturbing him, 
 possible an( j un i ess he. nurses his feeding can be given him in 
 
 his bed. 
 
 Some premature babies nurse with much strength, 
 
 but more often they must be fed. If the mother's 
 
 Feeder for Premature Baby 
 
 milk comes into the breasts it should be pumped out 
 and given the child either with a teaspoon or a 
 medicine dropper. 
 
 Forced 
 feeding a 
 simple 
 process 
 
 Method 
 to use 
 
 GAVAGE AND LAVAGE 
 
 Sometimes forced feeding through a stomach 
 tube must be resorted to. This is called gavage, and 
 should be done under the direction of a physician 
 until the method is understood. It is really a very 
 simple process, may be accomplished without dis- 
 turbing the child, and will take a very short time if 
 skilfully done. The apparatus consists of a small 
 soft rubber catheter attached to a glass funnel. 
 
 In giving the feedings the tongue is depressed 
 with the finger, and the tube, moistened with oil or 
 with water, is introduced quickly down the gullet 
 into the stomach. Two or three inches is far enough. 
 The funnel is then held up to allow the escape of 
 gases ; after which the milk is poured in and the tube 
 quickly withdrawn. If this is rapidly done, there 
 will be no vomiting. 
 
PREMATURE BIRTH 271 
 
 Lavage, or washing the stomach, is generally Method 
 necessary once a clay. It should be done with boiled ° 
 water. 
 
 The tube is introduced in the same way, and 
 about a tablespoon of water poured in. Before 
 it all disappears the funnel is lowered and the fluid 
 is drawn off. The process is repeated till the water 
 returns clear. If the finger is kept in the corner of 
 the mouth for a few seconds after the tube is drawn 
 out, vomiting is less liable to occur. 
 
 The tube and funnel should be washed carefully 
 in water containing a small quantity of baking soda. Absolute 
 The cleanliness of this apparatus is extremely im- arequSiS 
 portant, because the lining of the stomach is so deli- 
 cate that if any impurities were carried into it an in- 
 flammation would be likely to set in. The tube and 
 funnel should be occasionally boiled. 
 
 In caring for a premature baby one of the essen- 
 tials is the belief and determination that he shall be Determi- 
 kept alive. If warmth, nourishment, and rest can keep the 
 be kept up, the chances are good ; but it is impossible \^J e an 
 to give proper care if the ultimate death of the child essential 
 is believed to be a foregone conclusion. It is a diffi- 
 cult matter, and even with constant care, patience, 
 and watchfulness it may be many months before the 
 anxiety is removed, and the baby can be treated like 
 a normal child. 
 
 SUPPRESSING MILK 
 
 In cases where the child is dead at birth, or dies 
 soon after, there is likely to be trouble with the When . 
 
 J m t precautions 
 
 breasts unless precautions are immediately taken, should 
 The glands do not begin the secretion of milk until 
 the second or third day, so that if the baby is still- 
 born the treatment may begin at once. It is the 
 
272 
 
 MOTHERHOOD 
 
 Putting 
 on the 
 Murphy 
 bandage 
 
 same in any case, except that before the milk is in 
 the breasts they are less tender. 
 
 If the breasts are dusted with boracic acid pow- 
 der, non-absorbent cotton laid between them, and a 
 close bandage is put on so that even pressure is ap- 
 plied, there will be no danger of an accumulation 
 of caked milk and subsequent abscess. 
 
 The most satisfactory bandage is the "Murphy," 
 which is shaped to fit about the neck, and is cut out 
 under the arms. This should be pinned in front on 
 
 The Murphy Bandage 
 
 Its effec- 
 tiveness 
 and use 
 
 a straight fold from a point about half-way from 
 the neck to the lower edge. Above this it may be 
 turned in and made very close. 
 
 Below the middle pin on either side darts must 
 be taken in, and the bandage thus drawn as tight 
 as possible. The pieces over the shoulders are to be 
 pinned last. 
 
 , When the milk comes in, the bandage will, of 
 course, feel uncomfortably tight, but this can be en- 
 dured for forty-eight hours, when the pressure will 
 begin to subside and the difficulty will be over. The 
 bandage should be kept on for some time until all 
 danger of further secretion of milk is past. If this 
 method is used there is no need of external applica- 
 tions such as rubbing with ointments or painting 
 
PREMATURE BIRTH 273 
 
 with iodine. If the bandage cuts the flesh about the 
 arms non-absorbent cotton can be laid under the 
 edge of the arm's eye. 
 
 If suppression of the milk is necessary after it has 
 come into the glands, the same treatment is effective, When 
 but it is likely to be rather more painful, because of come into 
 the pressure applied directly on the already distended the glands 
 breasts. It is, however, certainly the simplest method, 
 although the various applications may be used with 
 success, and with no complications. 
 
 If the bowels are kept freely open with salts, and 
 fluid diet is restricted, the milk will come into the 
 breasts less freely. 
 
 MILK-LEG 
 
 Since abortion represents an abnormal condition, 
 we have included under it some of the diseases which 
 sometimes complicate the pregnant state. 
 
 Difficulties with the breasts may arise after a full- 
 term confinement, and the condition known as milk- 
 leg has no particular association with abortion, though 
 it has place in this chapter. This trouble received its 
 name because it was ignorantly supposed that it was 
 caused by an actual accumulation of milk in the leg. 
 
 It is a condition occasioned by a clot of blood which 
 is formed in one of the veins. The presence of the clot How 
 causes inflammation of the vein, which gives it one of isocca- 
 its various names — phlebitis. The local inflammation S10ne 
 has a still more remote cause, which is now generally 
 believed to be a mild infection from some micro- 
 organism. 
 
 It may follow unusual difficult labor, or sometimes 
 occurs after operation or after abortion, particularly 
 if the membranes have been retained within the uterus. 
 It generally begins within two or three weeks after 
 
274 MOTHERHOOD 
 
 labor. The pain is usually localized at first, either in 
 The symp- the hip or ankle, but soon extends. There is often 
 miik-ieg a chill, followed by fever, and the lochia, or discharges 
 from the uterus, begin to have an offensive odor. 
 
 In a very short time, the leg commences to swell, 
 and the power in it is almost entirely lost, while the 
 pain is extremely acute. It is generally not a danger- 
 ous condition, but it is a very stubborn one, for even 
 after apparent recovery there is a tendency to a re- 
 currence of the swelling for weeks or even months. 
 The leg should be given entire rest, should be el- 
 Treatment evated on pillows, and moist heat should be applied, 
 t/oubfe Compresses of flannel, wrung out of a solution of 
 witch-hazel and water in equal parts, applied as hot 
 as the patient can bear it, are very effective. 
 
 Gentle rubbing was formerly recommended to pro- 
 No rub- duce absorption of the clot, but that is a dangerous 
 friction process and should always be avoided. If the clot 
 is dislodged by the friction, it may pass along the 
 vein to a locality where it may do still more harm. 
 Local applications to promote its absorption may be 
 suggested by a physician, but anything like massage is 
 not advisable. The rest and the elevation of the leg 
 should be continued until the trouble is entirely cor- 
 rected, and a close bandage or elastic stocking is use- 
 ful when the patient begins to walk, to prevent the 
 swelling which is inclined to reappear. 
 
 INEXORABLE LAWS OF NATURE 
 
 Abortion produced by medicines, which bring about 
 
 The moral contractions of the uterus, or by instruments, ranks 
 
 cance of of course with malpractice when a physician is rer 
 
 abortion^ sponsible' for it. The moral significance of the act 
 
 seems to make little impression upon the number of 
 
 women who refuse to accept child-bearing; but they 
 
PREMATURE BIRTH 275 
 
 must realize in time Nature's inevitable retaliation for 
 violation of her laws in the weakening of physical 
 vigor and nervous force. There is always the ques- 
 tion which is the greater sin, to bring a child into the 
 world — to force upon him a life which must of ne- 
 cessity be starved and cramped — a possibility which 
 gives malpractice its opportunity — or to crush out 
 that life almost at its conception. Of course, the sin 
 goes further back than this, to the rights of parents to 
 take the responsibilities of child-bearing, unless they 
 are willing to make good — to give to their children the 
 chance to choose what they will do with their lives. 
 
 A child ought to be assured of the right to child- 
 hood, free, untrammeled, with sunshine, fresh air, and T , he ri £ ht 
 
 of every 
 
 loving care ; he ought to have the promise of food, child 
 
 shelter, and clothing, reasonable health and education 
 
 enough to fit him for the work of life. 
 
 But with Nature, this question of the greater sin 
 
 seems not to be considered. Her laws are disobeyed 
 
 when the life once begun is interrupted, and she metes 
 
 out her punishment inexorably. The penalty is abso- 
 t 1 x r i f e i ■ • A" abso- 
 
 lutely sure. If the functions of the generative organs luteiy sure 
 
 are interfered with, weakness, if not disease, results, pena ty 
 and a woman becomes nervously broken down, more 
 surely than if she had gone through the period of preg- 
 nancy and childbirth. 
 
VII 
 
 HABITS ARE METHODS OF TRAINING 
 
 Law of Habit— Unwise Training— The Day's Routine— The Baby's Laundry 
 —Details of Bath— Naps— The Outing 
 
 What the 
 baby 
 does not 
 "already 
 know" 
 
 Making 
 
 good 
 
 habits 
 
 W 
 
 LAW OF HABIT 
 
 E often hear mothers say that the baby of two 
 weeks "already knows" that he can force her 
 to indulge him, that he can make her walk the floor 
 with him, or nurse him whenever he cries. Perhaps 
 if she understood better just what that seeming keen- 
 ness of knowledge is, she would be more willing to en- 
 dure the little vexations of the moment for the sake 
 of the added comfort of the years. It is not dawning 
 intelligence that makes the baby cry till he is taken 
 up, and stop when he is soothed in the mother's arms, 
 or borne about over a comfortable shoulder. It is sim- 
 ply that law of our nature which has caused most of 
 our oft-repeated acts to grow mechanical, which makes 
 it possible to carry on the daily occupations, like dress- 
 ing ourselves, eating our meals, and going to our 
 work, without being obliged to concentrate our minds 
 upon them. 
 
 Habits are formed before there can be conscious 
 
 thought, and habits that help the child and the mother 
 
 are as easily established as those that make the baby 
 
 permanent a tyrant in the home. Each time an act is performed, 
 
 the chain of associations js made a little stronger, and 
 
 under the same conditions the same result is more likely 
 
 to be reached. It may take many trials to make per- 
 
 • manent some of the habits that one is working for, 
 
 (276) 
 
HABITS 277 
 
 especially if the baby is not perfectly normal in health, 
 but mothers as well as nurses have proved that it can 
 be done. 
 
 Mothers who have come under the influence of our 
 grandmothers' theories concerning the "bringing up" The old 
 of children, sometimes feel that the modern idea that i ng up 
 we should help Nature by supplying fresh air, sun-^new 
 shine, good food, and plenty of sleep, and after that- 
 let the child come up rather than be brought up, indi- 
 cates a heartless classing of the human young with the 
 "beasts of the field." To such a person the care of a 
 baby signifies the entire absorption of a mother's time 
 and strength, and often the depth of her devotion is 
 measured by the extent of his tyranny. 
 
 If she could only realize that it means a mutual 
 
 benefit to accustom the child to lone: hours of rest to Lon s p 
 i * • , * 1 1 1 , hours of 
 
 body in sleep, and to nerves and muscles through nor- sleep and 
 
 mal expression of his activities in natural exercise, exercise 
 she would have fewer qualms of conscience in en- 
 joying the added leisure it would give her. A baby 
 will find endless entertainment in the free movement 
 of his own limbs, if not hampered by clothing, as he 
 lies in his crib, unless he has been trained to cry for the 
 artificial exercise and the stimulation of constant 
 change of position. 
 
 For the first few months, sleep should make the 
 largest part of his day. This can only be accomplished 
 if he is kept comfortable as far as his other demands 
 are concerned. Food is the chiefest, and if this is 
 given when it is needed, it will take little time, and will ^eV* 
 be expected only at stated intervals. Warmth is an- intervals 
 other requisite, and can be realized if the temperature 
 of the room is well regulated, the crib is protected from 
 draughts, and the diapers are changed often enough to 
 keep the dampness from the other clothing. 
 
278 MOTHERHOOD 
 
 Great care should be taken to guard the baby from 
 Guard the shocks to the nervous system. Fear is not yet devel- 
 nervous oped, there is no reason in his sudden cry and start, 
 shocks ^ ut ^ jj tt j e fo £y j s a ij ve w }t n nerves, and every time 
 
 these are played upon uselessly they are so much more 
 easily affected and less likely to perform their greater 
 function. We see the results, not in added sensibility, 
 but in lack of control and poise, in little reserve force, 
 and often in an excessive emotionalism. 
 
 The aim of motherhood ought to be to bring forth at 
 
 least as good a representative of the species as either 
 
 of the parents, and after birth to give the care which 
 
 will bring about at least as perfect a development. The 
 
 ^""hnd amma ^ s of other species accomplish this, but the 
 
 develop human animal fails of it time out of number, and 
 
 Nature's too often has no sense of obligation in the matter. If 
 
 hnes obligation is admitted, it must also be conceded that 
 
 we could perhaps learn from the methods of animals 
 
 in caring for their young, that the best results are not 
 
 attained by surrounding a Child with artificialities, and 
 
 by keeping his senses abnormally alert, but by letting 
 
 his development progress along Nature's lines. 
 
 The number of babies who are allowed to go 
 through babyhood as little happy animals, with every 
 want gratified when they are clean and warm and fed, 
 is increasing every year, but there is still an appalling 
 amount of ignorance and well-intentioned cruelty in 
 their treatment. 
 
 UNWISE TRAINING 
 
 If we follow a baby brought up in the latter way 
 through his day, we can see why he is a troublesome 
 child, and can appreciate better, perhaps, the rational 
 method of caring for him. 
 
 In the morning, when his first day feeding is due, 
 
HABITS 279 
 
 he is asleep, and the mother, thankful for a little respite, The baby's 
 
 11 i , ..ii 11 1 • 1 • • morning 
 
 hushes the other children and lets him he quiet as in bad 
 long as he will. Stomachs only a few days old hold training 
 very little, and after a long fast this one begins to make 
 active remonstrance. Up comes the baby, wet and 
 starving, showing such signs of indigestion that the 
 mother at once gives him food in self-defence, and 
 pushes on bath and clean, dry clothes for an hour or 
 so longer. 
 
 The milk is taken so rapidly, and the stomach is 
 filled so full, that instead of going off to sleep, the How he 
 little one fusses and cries till life is a burden to. the 
 entire family. He is trotted and rocked, a rubber nip- 
 ple, a "pacifier," is put in his mouth, or an attempt is 
 made to nurse him again, till the process of digestion 
 has corrected some of the discomfort, when he falls 
 asleep. 
 
 When he wakes again, the dampness from his wet 
 diapers has penetrated through all his clothing, and His sleep 
 he is either steaming or cold, and must inevitably be 
 chilled when he is taken out of his nest for his next 
 feeding. His bath soothes him so that he sleeps for 
 some hours, and a repetition of the empty stomach and 
 the cramps from greedy feeding follow. 
 
 So the day passes with frequent periods of crying, 
 with irregular feedings, with much handling and with 
 discomfort on the part of both mother and baby. 
 The night brings little sleep, for the feedings have been 
 given at such long intervals that the night's rest is as 
 broken as the day. 
 
 The really pernicious thing about such a scheme 
 for the baby's life is that it is not confined to the early Pernicious 
 months. It can not help making its influence felt baftrain- 
 th rough the years. The stomach will not fulfil its ^ffer'iife 
 duty in after life if it is alternately starved and over- 
 
280 
 
 MOTHERHOOD 
 
 The key- 
 note of 
 a baby's 
 existence 
 
 The de- 
 forming 
 effect 
 of the 
 "pacifier" 
 
 How it 
 misshapes 
 the mouth 
 
 111 effect of 
 breathing 
 through 
 the mouth 
 
 loaded at first, and the nervous system will demand 
 variation, excitement, and indulgence if these things 
 are supplied in babyhood. That means that the ner- 
 vous force will be exhausted, and can not be depended 
 upon in time of need. 
 
 Serenity ought to be the keynote of a baby's ex- 
 istence. Through childhood, we are supposedly pre- 
 paring the body to meet the requirements of adult life, 
 and whatever handicaps the organism for future use- 
 fulness, whatever exhausts, rather than builds up, is 
 distinctly working against that end. 
 
 Few mothers understand the really harmful effect 
 of the "pacifier" or nipple, which a baby is allowed to 
 keep in his mouth between his feedings. The con- 
 stant use of such an apparatus is almost sure to de- 
 form the jaw, which means difficulties when the teeth 
 begin to come, and also a condition known as mouth- 
 breathing, which may be- responsible for many ills of 
 throat and lungs. If teeth are overcrowded, as they 
 must be when the jaw is misshapen, they are much 
 more liable to become decayed. 
 
 It is an easy matter to pick out from a group of 
 children those who have been allowed to suck empty 
 nursing bottles or the regular nipple. The upper-lip 
 is swollen and protruding, the under-lip recedes, and 
 unless the habit has been outgrown for some time, 
 the child generally drools when he has not the nipple 
 in his mouth. 
 
 When we breathe normally, through the nose, the 
 air is warmed and filtered before it reaches the lungs. 
 The impurities are largely sifted out in its progress 
 through the nasal passages, but when it is taken in 
 directly through the mouth, all the dirt and the germs 
 of disease have much freer access to the lungs, so that 
 the danger of infection is greatly increased. 
 
HABITS 281 
 
 This ought to have weight, even if the unsightly ap- 
 pearance of a child whose mouth has been so deformed 
 has no influence with the mother. 
 
 THE DAY'S ROUTINE 
 
 There can be a routine order in the care of the 
 child which becomes habitual and saves much labor. 
 
 lie should be taken up for his first feeding at 
 about half past six, and for six weeks food should be Hours for 
 
 . feedin° r 
 
 given every two hours, until half past ten in the even- a baby 
 ing. One feeding between this hour and morning is ^" e ^ S1X 
 enough. He should be allowed to nurse for twenty 
 minutes, but should be kept awake and busy during 
 that time. 
 
 Generally the mother can arrange a definite time 
 for the bath, and can give it at about the same hour Definite 
 each day. It should come between the feedings about ti^bath 
 an hour after he has nursed, and is given preferably 
 in the forenoon. 
 
 The baby should be waked during the daytime for 
 his feedings. There is a temptation to let him sleep, Wake 
 
 11 • • 1 r c r i tne baby 
 
 but he requires a certain number ot ounces ot tood for his 
 during the twenty-four hours, for the proper nour- ee ings 
 ishment of his body, and it is far better for him to 
 get this largely between six and ten, leaving the night 
 for unbroken rest. 
 
 The hours of his meals should be absolute. A 
 baby's cry generally means something, especially if . 
 he has been properly treated from birth, but it more 
 often means over than under feeding, and while put- 
 ting him to the breast may silence him, it does not cor- w^ter 1 "" 1 
 rect the trouble, but onlv makes it more liable to occur !. hree . or 
 
 J four times 
 
 again. He requires water as well as milk, and should a day 
 have a teaspoon of it three or four times a day. 
 
 The crying may be caused by thirst or by colic 
 
282 MOTHERHOOD 
 
 His crying pains from gas in the intestines. This latter diffi- 
 culty is especially frequent when the mother is taking 
 cathartics. The warm water may relieve this, or 
 turning the baby over on his stomach and rubbing 
 his back often sets the gas in motion and thus gets 
 rid of it.. Very often holding a baby in front of a 
 fire and warming his hands and feet will stop his 
 crying and will relieve pain. If colic seems to recur 
 
 for^cST* a * a k° u * the same time each day, a thorough toasting 
 and rolling the child in a heated blanket will some- 
 times act as an effective preventive. 
 
 Some babies cry when the diapers are wet, and 
 they should always be changed when the feedings are 
 given. If wet or soiled napkins are left on the deli- 
 cate skin becomes chafed and there is further cause 
 for uneasiness. If the precaution of frequent chang- 
 
 Treatment { n cr is observed there will probably be no trouble of 
 
 for irri- ° . ........... , 
 
 tation of this sort, though sometimes if there is diarrhoea there 
 is an unavoidable irritation of the skin. 
 
 Bathing with a solution of boracic acid tends to 
 heal the chafed surface, and if stearate or oxide of 
 zinc or bismuth subnitrate is used to powder the 
 buttocks after the bathing the condition is quickly 
 relieved. Talcum powder is all that is required 
 ordinarily, but the zinc has particular properties of 
 absorbing water which makes it of especial use when 
 the skin needs particular care. 
 
 Talcum powder is of equal service in the case of 
 similar an adult invalid, especially when there is difficulty in 
 retaining the urine or excessive perspiration, so that 
 the skin in the crease between the buttocks is in- 
 clined to be moist. It has no tendency to become 
 caked, but it should not be put on thickly, and should 
 always be washed off when the parts are dressed. 
 
 Having then looked after the diapers, having 
 
 treatment 
 for adults 
 
HABITS 283 
 
 made sure that the clothing is not creased uncom- Points to 
 fortably under him, and that there are no pins un- w hen a 
 clasped and pricking him, having given him water baby cnes 
 and changed his position in the crib, he may safely 
 be let alone and allowed to cry for a time without 
 fear of injury. 
 
 A mother soon learns to distinguish the character 
 of a crv, and can also tell bv the position the child Character 
 
 11 • 11 • T t> 1 1 ° f t,ie 
 
 assumes whether it is caused by pam. If he draws baby's cry 
 the knees up against the abdomen and holds them there position 
 it generally indicates colic, while in temper he usually 
 stiffens his arms and legs and makes his back rigid. 
 If a child is really delicate, not normal in health, it 
 may easily be impossible to follow the usual rules in 
 his training, but more babies are made abnormal by 
 unwise treatment than by inherited tendencies. 
 
 We will suppose that the bath is given in the 
 middle of the forenoon. The rest of the day is un- 
 varied till late afternoon. 
 
 The baby is undressed and put into his night- 
 clothes just before the half-past four feeding. If the ^"is^ 
 room can be made warm enough it is a very good undressed 
 plan to let a baby tumble about on a big bed, dressed 
 only in his diaper and shirt, for fifteen or twenty 
 minutes at this time. He will enjoy the freedom, 
 and after a few months he will begin to make efforts 
 toward co-ordinated motion. 
 
 He will especially enjoy lying on his stomach and 
 kicking very hard against a hand held at his feet. 
 Movements of this kind, the self-expression of his Baby's 
 activity, are helpful in the development of the child, gymnastics 
 while trotting, tossing, or walking the floor with 
 him are purely pleasurable excitements which retard 
 rather than increase his ability to depend on his own 
 resources. 
 
284 
 
 MOTHERHOOD 
 
 Let his 
 diversion 
 be along 
 natural 
 channels 
 
 We have 
 lost the 
 child's 
 point of 
 View 
 
 Excess of 
 toys unfits 
 a child 
 for the 
 work of 
 life 
 
 The day's 
 schedule 
 
 A baby does not need to be amused if his interests 
 are helped along natural channels instead of being 
 diverted into artificial ones. When he is old enough 
 to sit up in his crib or on the floor, a simple toy, or 
 often investigation of his own hands and feet, will 
 keep him busy and happy, and later the discovery of 
 the use of his muscles is a joy the sweets of which 
 we can not appreciate because we have lost it from 
 our memory of babyhood delights. 
 
 We make trouble for ourselves in our care of 
 children. We take from them simple pleasures in 
 the way of physical activities because we are "Olym- 
 pians" and have lost the child's point of view, and we 
 offer substitutes that seem desirable from our stand- 
 point, which require our co-operation and which do 
 not at all represent a child's original interests. 
 
 An over-abundance of toys and of devices for 
 the entertainment of the child means dissipation quite 
 as surely as over-indulgence in any other variety of 
 luxurious living, and the results educationally are 
 almost as pernicious as those of the latter sort are 
 physically. It is unfitting a child for the work of 
 life. 
 
 The day's schedule then would be as follows : At 
 half-past six the baby gets his first feeding of twenty 
 minutes, is changed and laid down again. At about 
 half-past nine the bath is given, and he is dressed 
 Clean and fresh for the third meal at half-past ten. 
 The afternoon routine is unvaried, nursing him and 
 keeping him dry being the rule, alternating with an 
 occasional drink of water and a change of position. 
 Between four and six comes the preparation for the 
 night, and the little frolic on the bed. 
 
 The body has not been disturbed by unnecessary 
 handling, the nerves have not been unduly stimu- 
 
HABITS 285 
 
 lated, the physical needs have been satisfied, and 
 neither mother nor child is nervously wearied by the Why the 
 end of the day. If the feedings have been regularly s i ee p well 
 given, the dark and extra quiet will tend to make the 
 baby sleep in longer intervals during the night, and 
 the mother can get her much needed-rest. 
 
 A baby needs fresh clothing each day, especially 
 the bands and shirts, which come next his bodv. ci ia , n . geso£ 
 
 ' clothing 
 
 Sometimes a slip and petticoat may be used a second 
 time if they are taken off at night and carefully aired. 
 
 THE BABY'S LAUNDRY 
 The shirts are very easily laundered, and it is ad- 
 visable to wash them out as they are used. If dia- Sim P ,if y- 
 
 J ing the 
 
 pers, shirts, and dresses accumulate it seems much laundry 
 more of a task to get them out of the way, but if they 
 are done each day as they are taken off it is a very 
 simple matter. 
 
 The device of putting small squares inside the 
 diaper to receive discharges from the bowels makes 
 more pieces to wash, but also makes the washing 
 easier. As soon as the diaper is taken off, the solid 
 matter on it should be rinsed off under running 
 water, and the cloth should be put to soak. Absorb- 
 ent cotton can be substituted for the small squares, 
 and can be burned; this is an additional expense, 
 though a small one. 
 
 Soiled diapers should never be put on a second 
 time, and it will take only a few moments to wash Wa s nin s 
 them out as they are used. The odor becomes very diapers 
 offensive if they are left, even when they are covered 
 with water, and they are more objectionable to handle. 
 
 DETAILS OF BATH AND NAPS 
 The daily bath may seem like a burden, and is 
 even regarded by some persons as unnecessary, but 
 
286 
 
 MOTHERHOOD 
 
 Comfort 
 and 
 
 health of 
 the skin 
 
 when the added comfort of the child is considered, 
 its value must be admitted. Added to. this, the same 
 reasons that are given for frequent bathing in the 
 case of a grown person obtain when applied to the 
 baby. It is a question of keeping the skin in healthy 
 condition, and this can- be done only by cleanliness. 
 
 Especial care should be taken to guard against 
 draughts. The room should be warm and of even 
 
 Bath Under the Blanket 
 
 temperature, and sunny as well, if that is a possi- 
 bility. There is little danger in the exposure of a 
 Guard . baby's body if the surrounding air is warm, though 
 dfaJTghts in for tn e first few days the bath should be given under 
 bathing t h e blanket, and for several weeks the baby should 
 not be long uncovered. It must be remembered that 
 his mode of living has been radically changed by his 
 
HABITS 287 
 
 birth, and the shock of the adjustment must be tem- 
 pered as far as may be. 
 
 When the first tub-bath is given the shock to the 
 nervous system caused by the plunge into water is How to 
 made much less if the child is put into the water with baby in 
 a clean diaper wrapped loosely about him. It can hls tub 
 easily be removed from the body and allowed to lie 
 in the bottom of the tub, where it will not interfere 
 in the least with the bath. 
 
 Attention to nose, eyes, and mouth should be sys- 
 tematically g^iven, even if there seems to be no Attention 
 
 J ° ' to nose, 
 
 especial apparent need. The boric solution strength- eyes, and 
 ens the eyes, and makes them less liable to inflam- mou 
 mation when the. child catches cold. Washing the 
 mouth is more rather than less important as the child 
 gets older, for the preservation of the teeth depends 
 on cleanliness. 
 
 If it is possible the baby should take his naps in 
 a quiet, darkened room. We can not be sure what Naps 
 impressions are being made on the sensitive nervous ^a"^^ 
 organization, nor how much consciousness of the darkened 
 
 room and 
 
 noise of talking and of the presence of numbers of alone 
 persons in the room exists, but we do know that 
 there must be more complete relaxation when these 
 conditions are not present, and that beyond this the 
 habit of going off quite alone at nap-time is a valu- 
 able one to establish. 
 
 At first life is a series of naps, with incidental 
 wakings for food, but later there will be, of course, 
 longer periods of wakefulness and fewer hours in 
 the daytime to be spent in the quiet of the nursery. 
 
 THE OUTING 
 
 A baby should have regular out-of-door exercise 
 after the first four or five weeks. In winter the 
 
288 
 
 MOTHERHOOD 
 
 Hours to 
 choose 
 
 Dress for 
 the outing 
 
 Substitute 
 for the 
 outing 
 
 Summer 
 outdoor 
 life 
 
 Summer 
 in the 
 city and 
 parks 
 
 outing should be made in the middle of the day, 
 either just before or just after noon. In the sum- 
 mer early morning and late afternoon are the safest 
 times. 
 
 In winter the baby should be thoroughly warm 
 before he is taken out, and should have plenty of 
 thick wraps. Especial care should be taken to have 
 his hands and feet warm, for it is by exposure of 
 the extremities that colds are contracted. 
 
 If the weather is too severe or stormy to risk 
 the out-of-door exercise, an indoor substitute may 
 be used. Dress the baby warmly, put him in his 
 carriage or on the bed, and open all the windows of 
 the room where he is sitting. Draughts must be 
 avoided, but plenty of air must be admitted, and the 
 danger of catching cold is no greater than it is out 
 of doors. 
 
 In the summer children should be kept in during 
 the middle of the day. In the morning the air is 
 fresh and will be good for them. In the country it 
 is often possible to keep the child out for the entire 
 day, but in the large cities the pavements and un- 
 shaded streets become so hot that it is not only 
 unpleasant but not safe to leave children out through 
 the heat of the day. 
 
 If a park or playground is accessible never keep 
 the children in the streets. Let them spend their 
 outing under the best possible conditions. The fresh 
 air, the lack of dust, the restfulness of green grass, 
 and the shade of trees are important factors which 
 make for health, and the mother will be repaid two- 
 fold for the little extra exertion of dressing and 
 taking the journey, long or short, both by added 
 serenity of temper and by comfort of body. Go 
 home before the sun is too hot, and give the baby his 
 
HABITS 289 
 
 bat'h, after which he ought to sleep through the mid- 
 day hours. 
 
 Do not make the mistake of keeping too many 
 clothes on him. If he is kept from draughts he may The baby's 
 dress very lightly in the hottest days. The abdomen in hot 
 should be protected by either the flannel or knitted tolV n 
 band, since the dread disease of the summer months 
 is cholera infantum. If the band is worn the regular 
 shirt may be discarded in the hottest weather. 
 Changes in temperature must be observed, however, 
 and the necessary addition in coverings must be 
 promptly made. The flannel nightgown gives place 
 to the cotton slip, and even the flannel skirt 1 may be 
 shed for a few hours in the day when the weather 
 is oppressive. 
 
 Late in the afternoon or early in the evening, if 
 it is possible to get another breath of clean air that 
 has blown through the trees or from the water, in- 
 stead of along dirty city streets, the night will be 
 more restful because of it. 
 
 The prejudice against night air has been pretty 
 thoroughly overcome as knowledge of the principles Ni s h t 
 
 r • 1 , • • 1 r i , r , , • , air is the 
 
 of right living and of the needs of our bodies has only air at 
 
 increased, but there are still many persons who are breathe 
 
 inclined to shield the baby from the fancied ills of 
 
 night dampness and to oppress him with the serious 
 
 danger of exhausted air. He must not be given 
 
 used-up air to breathe. Even more than those of 
 
 grown-up persons must his lungs be supplied with 
 
 oxygen to feed the blood. 
 
 It is always the direct draught that is dangerous. 
 
 The crib can be thoroughly protected and the baby How t0 
 
 can be kept warm even more easily than a grown baby from 
 
 person. It is a very good plan to have little straight raug ts 
 
 curtains of stout muslin made to fit around the head 
 i3 Vol. 3 
 
290 MOTHERHOOD 
 
 of the crib, and to tie on the bars with tapes. A 
 piece about eight inches in width may also be 
 stretched across the top at the head, shielding the 
 baby's eyes and more effectively protecting him 
 from draughts of air. 
 
 This is the simple life that best suits a baby's 
 The needs. The routine of it soon makes it the easiest 
 
 simple life - , , , , , . . . , . 
 
 the best f rom the mother s standpoint, and if it is persisted in 
 all the details become matters of habit, and their 
 accomplishment less and less of an effort. 
 
PART III 
 
 CARE OF CHILDREN 
 
INFANT FEEDING 
 
 Mother's Milk— Weaning— Cows' Milk— Modification of Milk— Prepared 
 Foods— Points to be Noted— Schedule for Feed- 
 ing—Household Measures 
 
 WE may divide the subject of feeding for chil- 
 dren into three parts, following the plan sug- 
 gested by Dr. Rotch. The first period would extend Three 
 over the first ten or twelve months ; the second, over periods of 
 the second or third years; and the third would in- "^^ 
 elude the remainder of childhood. 
 
 The first period is the most important and is the 
 only one where milk supplies the entire nutrition. 
 
 MOTHER'S MILK 
 
 To say that mother's milk is the ideal food for a 
 child states a self-evident fact. Every one knows The ideal 
 that it is the natural food, and that the child thrives the baby 
 on it, but sometimes it does not seem to be generally 
 understood that it provides to a degree really un- 
 attainable otherwise the properties that are needed 
 for his growth and development. 
 
 The most logical substitute for maternal feeding 
 would seem to be the wet nurse, and in our grand- The wet 
 mothers' days that was the first resort, though it nurse 
 was too often a questionable good on account of lack 
 of thought in the selection, the fact that a woman 
 had an abundance of milk being often her only recom- 
 mendation. 
 
 The existence of disease, or indeed the negative 
 
 (293) 
 
294 
 
 CARE OF CHILDREN 
 
 milk 
 
 condition of poor health, or an excessively emotional 
 Requisites temperament, however it may manifest itself, should 
 nurse debar a woman from taking up the duties of a wet 
 nurse. She should be in a thoroughly normal state, 
 her confinement should have been as nearly as pos- 
 sible on the same date as that of the mother en- 
 gaging her, the amount of her milk should be ascer- 
 tained, and if it can also be analyzed it will add an 
 element of surety to the result. She should be, if 
 possible, between the ages of twenty and thirty. 
 The advance of scientific interest in the modifica- 
 Substitutes tion of cow's milk for infant feeding and the numbers 
 mother's °^ P atent foods on the market have made the em- 
 ployment of wet nurses much less common than it 
 once was, and because it is true that children are 
 successfully nourished and become healthy and 
 strong on one or another of the prepared foods, we 
 are inclined to lose sight of the fact that Nature's 
 provision is the economical one, and that, other things 
 being equal, mother's milk supplies most satisfac- 
 torily the demands of the system. 
 
 There is generally a substance present in the 
 breasts at the birth of the child which acts in the 
 nature of a physic upon him, and which rids his 
 bowels of the black, tarry substance which fills them. 
 It should also be nourishment enough for him until 
 the regular supply of milk appears, which is usually 
 the second or third day. 
 
 It is well, however, to put him to the breast at 
 regular intervals so that he will learn to^ draw on 
 the nipple, and also because the act of suckling tends 
 to produce contractions of the uterus. After the 
 breast begins to secrete milk, the feedings should 
 be oftener and from alternate sides, so that the ful- 
 ness may be relieved. 
 
 At birth 
 
 Effect of 
 
 first 
 
 sucklings 
 
INFANT FEEDING 295 
 
 Sometimes, particularly if the breasts have had 
 no treatment before confinement, the nipples become 
 cracked and extremely painful. This condition may 
 be guarded against by the avoidance of pressure 
 over the breasts, and by particular cleanliness before 
 delivery. 
 
 The regular treatment of the breasts after the 
 child is born should be bathing with boracic acid Regular 
 solution after each feeding. The special treatment f the 
 for chapped or cracked nipples has been given on reasts 
 page 248. 
 
 The physical and the mental condition of the Effect on 
 mother has its effect on the milk, and hence on the m iik of 
 baby. Moodiness, worry, and despondency seem to ^dftion 
 affect the quality of the milk almost as much as lack 
 of physical tone. 
 
 'Medicine taken by the mother acts indirectly upon 
 the babv through the milk, and the food of the mother Medicine, 
 
 & ' w food, 
 
 has to be especially chosen with regard to the baby's alcoholic 
 diet. Alcoholic drinks are not advisable, but milk, 
 cocoa, and gruels help to increase the supply of milk 
 and should be taken in preference to tea or coffee. 
 
 Cereals, eggs, meats, and vegetables, whatever 
 would constitute the normal diet, is allowable for a neces- 
 the nursing woman, but she should be a little cau- sary care 
 tious about eating green vegetables or fruits, and 
 should also be very careful to keep her bowels regu- 
 lated. 
 
 If a woman keeps herself in good physical con- 
 dition she will have enough nourishment for her child, 
 and if the child is well nourished with a food that 
 meets his needs, he will be able to pass through the The 
 difficult periods of teething and the heat of his first milk 
 summer with much less danger. This is the reason po^er^f* 
 why the mother's milk is so far superior to any arti- resistance 
 
296 CARE OF CHILDREN 
 
 ficial preparation. It seems to supply a power of 
 resistance that is often lacking in other foods, and 
 which tides the child over the illness of his first year. 
 There are, to be sure, conditions enough which 
 When the warrant, even demand, that the baby shall not be 
 of the put to the breast. If illness has impaired the quality 
 milk S S °f the milk, or if the disease is such that it may be 
 impaired communicated in this way, a woman is entirely un- 
 fitted for nursing her child. If the mother has an 
 excitable temperament, is unhappy, or reluctant to 
 take up this duty, if she is extremely busy and does 
 not take regular rest and sleep, the milk will prob- 
 ably be so poor in quality that it will not be proper 
 nourishment. If, on the other hand, the nursing is 
 too much of a drain on the mother's health, it is 
 better to suppress the milk altogether. 
 
 Sometimes the conditions are such that they can 
 be corrected, and a strict observance of hygienic laws 
 on the part of the mother will sometimes restore the 
 milk to the normal standard. 
 
 WEANING 
 
 There is probably a tendency to nurse a child for 
 
 When a too long a period. He should be weaned at ten 
 
 b^weaned mon ths unless he is not well at this time, or it comes 
 
 in the heat of the summer. For the sake of both 
 
 mother and baby it is well to begin bottle feeding 
 
 before the child is weaned. 
 
 At four months one bottle a day may be given, 
 Beginnings a {- s } x months two bottles, from eight to ten months 
 
 of the ' & 
 
 feedings three bottles, and between ten months and one year 
 the baby should be weaned. The drain on the sys- 
 tem of the mother is very great; and to be relieved 
 even of one feeding during the twenty-four hours 
 means a little saving. 
 
INFANT FEEDING 297 
 
 In some cases it happens that there is an over- 
 supply of milk, when it may seem almost necessary in case of 
 to keep the child at the breast, but more often we supply of 
 find the milk growing less after the first few 7 months. millk 
 Even if the quantity of milk remains sufficient, analy- 
 sis of the quality would probably show that it was 
 far below normal, and the tissues of the child would 
 soon feel the lack. It must be remembered, besides, 
 that even normal mother's milk is not suited to his 
 needs after he has passed the age when Nature has 
 arranged for that supply to be withdrawn. 
 
 In cases where there is an overabundant supply 
 of milk at the time of weaning, it can be disposed 
 of and the breasts dried up without any danger of 
 caking. The breast-pump seems to stimulate the 
 glands, but it has been found that a laver of rubber Suppress- 
 
 . ' ing the 
 
 tissue laid over the breasts, and held in place with a milk with 
 light bandage, draws out the milk, and dries up the tissue 
 breasts without any difficulties. It should be mois- 
 tened frequently in w r ater, and kept scrupulously 
 clean. With this treatment the breasts remain soft, 
 there is no pain or discomfort, and the supply of 
 milk is gradually suppressed. 
 
 Another reason why the occasional bottle feed- a reason 
 ines are advisable is that in this way we accustom why . , 
 
 o J occasional 
 
 the baby gradually to an artificial food, and can settle Lottie 
 upon something which agrees with him before he is advisable 
 dependent upon it alone. 
 
 The actual weaning generally means a struggle, 
 but it will be a very short one if the baby has become in actual 
 somewhat accustomed to the bottle. After he has weaning 
 cried himself tired once or twice and has found that 
 he is not put to the breast, he becomes reconciled to 
 the new method and accepts the altered conditions. 
 A baby is a good deal of a philosopher, but he insists 
 
298 
 
 CARE OF CHILDREN 
 
 upon making sure that existing ills can not be cured 
 
 before he is willing to endure them. 
 
 One of the difficulties of bottle feeding is the 
 
 care of utensils. These include the receptacle for 
 
 the milk or food, the nursing bottles, and the nipples. 
 
 The safest bottle to use is the "Hygeia," which 
 
 Advantages has straight sides and a mouth about an inch and a 
 
 "Hygeia" half in diameter. It is as easily cleaned as a cup or 
 
 bottle" 8 §l ass > has no angles which are out of reach, and no 
 
 creases where milk can collect. The nipple, instead 
 
 'Hygeia" Nursing Bottle 
 
 of being a long mouthpiece, has more the shape of 
 the breast, as it is a curving cover of rubber with a 
 small elevation in the centre. In buying, care should 
 be taken to choose one having a small hole in the 
 nipple, for if the milk comes out too freely the 
 baby's stomach can not dispose of it easily, and it is 
 liable to form large curds which are often vomited. 
 The bottle should be rinsed at once after the 
 feeding, and the nipple carefully washed in cold 
 water, rinsed with hot, and put to soak in a solution 
 
INFANT FEEDING 299 
 
 of borax or baking soda — a pinch of either — in a cup 
 of water. Once a day the bottles and nipples should Especial 
 be boiled after washing in hot soap-suds, and they the nursing 
 should always be rinsed with hot water immediately bottles 
 before use. Improper care of the nursing bottles 
 or in the preparation of the food is responsible for 
 most of the cases of summer complaint among chil- 
 dren. 
 
 COWS' MILK 
 
 The first choice among foods is herd's milk. It 
 was formerly considered that the milk of one cow Herd's 
 should be chosen, but so many calamities followed mi 
 in the way of accident to that particular animal, the 
 drying up of her milk, or the appearance of disease, 
 that it is now believed safer to depend on the milk 
 from a good many cows. 
 
 It should be put up in bottles at the dairy and 
 delivered unopened. Grocerv milk should never be bottled at 
 
 r " the dairy- 
 
 USed for children, for no fluid accumulates and sup- 
 ports germs more readily, and it is constantly ex- 
 posed to impure, dirt-laden air. 
 
 In large cities milk may be purchased from 
 laboratories, where it is not only bottled under sani- Modified 
 tary conditions, but is afterward sterilized or Pas- 
 teurized. At such laboratories it is also possible to 
 have milk especially modified in accordance with any 
 formula that a physician may write out. 
 
 The essential, however, is that it is put up in 
 clean bottles at the dairy, and is not delivered from 
 a general can, which is opened and disturbed in- 
 numerable times during its journey. 
 
 MODIFICATION OF MILK 
 
 A few words must be said upon the scientific 
 modification of milk, because it is by far the most 
 
300 CARE OF CHILDREN 
 
 rational method of feeding children, though its ex- 
 pense and the fact that the large laboratories are 
 principally located in cities, put it at present quite 
 out of the reach of the majority. The problem that 
 Problem of is presented is to find a food that copies in every 
 food that possible detail the fluid that the baby at the breast 
 mother's normally receives. The analysis of average human 
 milk milk is taken as the basis of the changes that are 
 
 necessary, and the resulting food must be, besides, 
 fresh, sterile, of body temperature, and furnished in 
 amounts varying with the needs of the child. 
 
 The modification is carried on in laboratories 
 Modifica- provided with special apparatus, and is under the 
 accord wkh direction of scientists, who prepare the milk in 
 prescript S accordance with definite prescriptions sent them by 
 physicians. The physician can in this way use his 
 judgment about the formula which will best suit a 
 child's needs, and in illness can vary the food, know- 
 ing that it will be prepared with the same exactitude 
 that his medicines are in the hands of the druggist. 
 This is without question the ideal method of 
 other food preparation, but because it can not be attained 
 careful by numbers of mothers living in towns remote from 
 ee mg the laboratories or by equal numbers who are unable 
 to bear the expense, careful feeding need not be con- 
 sidered out of the question. 
 
 Sterilization can be accomplished by putting the 
 bottles of milk into water which is raised to the boil- 
 ing point and kept there for an hour. It is now con- 
 sidered that milk subjected to such a process loses 
 some of the qualities that the tissues of the child 
 Pasteuriza- require. For this reason Pasteurization is the method 
 fe°r?ed r to commonly employed. This is slightly more complex, 
 stenhza- b ecause it means that the milk shall remain at a tem- 
 perature not exceeding 167 F. for half an hour. It 
 
 tion 
 
INFANT FEEDING 301- 
 
 is well to prepare the milk as is desired, pour it into 
 bottles, and Pasteurize enough" for the twenty-four 
 hours' feedings. 
 
 Cows' milk varies enough from the mother's milk 
 so that a certain modification is necessary to suit the 
 baby's stomach. It is heavier, has more solids, less 
 sugar, more fat, and much more albumen, so dilu- 
 tion will not accomplish a proper modification. Home 
 modification has been made possible by the manufac- Home 
 ture of an apparatus which can be obtained for four tion 
 dollars at the Walker-Gordon laboratory in Boston, 
 Massachusetts, or Freeman's Pasteurizer, which may 
 be found at shops dealing in hospital supplies. 
 
 The chief essentials in the preparation of milk 
 are, first, that the cleanliness and health of the herd of Essent »ais 
 
 in modi- 
 
 cows shall be assured ; second, that the precautions fying the 
 in regard to the care of utensils shall be observed ; 
 and third, that the Pasteurization shall be conscien- 
 tiously carried out. These points can receive atten- 
 tion whether or not the modification follows a physi- 
 cian's formula, is carried on in the laboratory with 
 complicated apparatus or at home with the simplest 
 appliances. 
 
 Jars to set the milk in, generally those in which 
 it is delivered, bottles to hold it when readv to Pas- Articles 
 
 necessary 
 
 teunze, a thermometer, a graduate glass to measure in modi- 
 ounces, and cotton wadding, which makes the best y,ng 
 stoppers, are the necessary articles for an outfit. 
 
 A tin pail or dish can be fitted with a perforated 
 plate to hold the bottles upright, and this is quite 
 successful for Pasteurization. The water in this dish 
 should be at a level with the milk in the bottles. It 
 should be cool when they are put in, and should then 
 be brought to 167 F. 
 
 It is possible to test the water with the thermom- 
 
802 
 
 CARE OF CHILDREN 
 
 Keeping 
 the water 
 at the 
 
 eter till one learns where the dish must be put to 
 hold that degree of heat for the required time. Some- 
 times the heat of the back of the stove is necessary, 
 
 pXature"" an d sometimes if the pail is wrapped in a blanket and 
 removed from the fire entirely the temperature is 
 maintained. 
 
 After the process is completed the bottles should 
 
 After the ^ e se j- } n a coo i pj ace an d k e pt there till they are 
 
 process is ■ r ' r J 
 
 completed used. They should be the regular nursing bottles, 
 
 A Graduate Glass 
 
 and the milk should not be poured out to be warmed. 
 When it is ready for the child the rubber nipple is 
 substituted for the cotton stopper. If the entire 
 contents is not taken at a feeding the remainder must 
 be thrown out. 
 
 If no attempt is made to feed the baby by a strict 
 a formula analysis of liis needs and a doctor's prescription for 
 for modi- ^ modification of the cows' milk, what is known as 
 
 fying milk ' 
 
 Meig's mixture is a very gOod formula to follow. This 
 
INFANT FEEDING 303 
 
 consists of one part milk, two parts cream, two parts 
 lime-water, three parts sugar-water. The sugar- 
 water is made by adding two heaping teaspoons of 
 sugar of milk to a pint of water. 
 
 This formula supplies in a general way the differ- 
 ences we find between the mother's and cows' milk. 
 
 Another fact to be taken into consideration is the Mother's 
 way the milk is affected by the digestive fluids in Easily" 10 
 the stomach. The mother's milk, in the process of fhfr. sted 
 digestion, curdles in tiny flakes, while that of the cow cows ' milk 
 tends to form hard, solid curds. 
 
 This difficulty may be overcome in part if the 
 hole in the nipple is made very small, or if a bit of Sanitary 
 
 ., . . , . , and other 
 
 sponge or absorbent cotton is placed in the top so precauti 
 
 oris 
 
 that the baby will have to pull with some effort and digestion^ 
 will get the milk by the drop instead of in a steady J^ ™ 8 ' 
 stream. If this device is used great care must be 
 taken to keep the sponge clean. It must be thoroughly 
 washed each time, and often replaced. The absorb- 
 ent cotton is safer because it is thrown away each 
 time. 
 
 His feeding ought to last twenty minutes, and with 
 the ordinary nursing bottle he will generally take the Twenty 
 necessary amount in half the time, while the breasts the baby's 
 secrete enough between feedings so that it will require time 1 " 8 
 that amount of time for a baby to empty them. 
 
 PREPARED FOODS 
 
 There is no question about the superiority of cows' 
 milk over the various prepared foods. The difference 
 in price should not be considered, because it will be The 
 paid back many times over in the increased strength of foods'" 6 
 the child. The preparations made on so large a scale l *^ iormh 
 lack uniformity, and deviate somewhat from year to 
 year. The percentage of sugars and fats is estimated 
 
304 CARE OF CHILDREN 
 
 on the product as put on the market, but after dilution 
 for the infant's feeding, there is great danger that there 
 may not be the proper amount of nutriment for his 
 needs. 
 
 At all events, a scientific preparation of cows' 
 
 Scientific milk with regard to the age, digestion and develop- 
 
 tionof ment.of a child must of necessity be a superior food, 
 
 better food and the home modification as well furnishes a better 
 
 quality of nutriment. It is too often a question of the 
 
 ease of preparation which is responsible for the choice 
 
 of one of the patent foods as a substitute for mother's 
 
 . milk. 
 
 The number of these foods on the market is almost 
 beyond conception. It is very difficult to choose be- 
 tween them, and quite impossible to make any state- 
 ment that a baby will thrive on one and will not on 
 another. If it is impossible to get good herd's milk, 
 if the or if for some reason its use is not practicable, one 
 foods must of these preparations must be tried, and it is far better 
 be used tQ fegfa suc \ l experimenting while part of the nourish- 
 ment still comes from the mother. 
 
 Condensed milk is advocated by many authorities, 
 and in many cases it seems to be an ideal food. Its 
 its care preparation, with boiled water, is simple, and it is easy 
 to obtain and to preserve, which makes it especially 
 valuable in summer. If it is used, the can should never 
 be left exposed to the air, but should be kept in the 
 ice-box or a cool place, with a tightly fitting cover over 
 it. In the process of condensing one of the important 
 Loss in constituents of the milk is lost. This is concerned in the 
 which formation of bone tissue, and is one cause for rickets 
 bon k e e tissue m babies who are fed exclusively on it. For this rea- 
 son, the question arises as to whether it is well for the 
 baby to be kept altogether on this food. It also seems 
 sometimes as if a condensed milk baby had less re- 
 
 Condensed 
 
 milk and 
 
INFANT FEEDING 305 
 
 sistance and succumbed to illness more easily than one 
 fed upon cows' milk. 
 
 POINTS TO BE NOTED 
 
 If a baby has to be brought up on a bottle, and the 
 first food chosen does not seem to provide proper nour- 
 ishment, experiments will have to be tried, and this 
 must be done with no nervous agitation as to imme- 
 diate results. 
 
 The greatest care should always be taken with the 
 bottles, nipples, and utensils generally, which are used Sanitary 
 in preparing the food, and then the chances of trouble bottles, 
 during hot weather will be lessened by half. If thiSand PeS ' 
 is done the difficulties are being narrowed down to the utensils 
 combination that the child needs, and intelligent re- 
 gard to the indications of trouble will help in the choice. 
 If the baby vomits and the milk is curdled and sour, what sour 
 it probably means that the acid needs to be correct- ^°™ lting 
 ed, and an addition of lime-water is made to the food, indicate 
 or a teaspoon of it is given just before each feeding. 
 Sour vomiting may also indicate too much fat. 
 
 If he does not gain in weight, but seems well, the 
 percentage of sugar and fat may need to be increased. What other 
 If, on the other hand, with the lack of gain, the flesh may indi- 
 seems soft and flabby, if he is fretful, and if the move- cate 
 ments of the bowels show undigested curds of milk, 
 the tissue-building properties are not being taken into 
 the system properly, and the stomach is not able to 
 manage its share of the digestion. This means that 
 further dilution or a predigestion of the milk may be 
 necessary, though the latter should not be long-con- 
 tinued, since if the organs of digestion are not given 
 enough to do they do not develop properly. 
 
 The distinction between vomiting and regurgita- 
 tion should be remembered. When the stomach is 
 
306 
 
 CARE OF CHILDREN 
 
 Distinction filled too full, it literally runs over, which is quite a 
 vomiting different matter from the throwing out of food that 
 
 gi n tat[of Ur " has been actecl u P on b >' the digestive fluids. Milk 
 which is regurgitated is unchanged in odor and ap- 
 pearance, and is thrown up very shortly after a feed- 
 ing. 
 
 The temperature of the food makes a difference in 
 ufrToTthe t ^ ie ease °^ digestion. It should be about body heat, 
 baby's food between 98° and 99° F., and should be brought to 
 
 Never put 
 the nipple 
 of the 
 baby's 
 bottle in 
 your 
 mouth 
 
 Stomach of Infant Five Days Old (Natural Size) 
 
 that point by putting the bottle into hot water. It 
 is easily tested by allowing the milk to trickle over 
 the hand. 
 
 The nipple should never be put into the mouth of 
 the mother or nurse. It is, in the first place, taking an 
 unfair advantage of the helpless baby to subject him 
 to treatment that a grown-up person would resent; 
 and there is besides the more serious ill — the danger of 
 communicating the germs of disease. A baby is very 
 susceptible, and a mild disorder in the adult may be re- 
 produced as an acute condition in the child. The gums 
 and teeth are rarely in a state of absolute cleanliness, 
 
INFANT FEEDING 
 
 307 
 
 and it is impossible not to transfer micro-organisms 
 if the nipple is not thoroughly washed. 
 
 It is rather important that the size of a baby's 
 stomach should be taken into consideration when the 
 amount of the feeding is being decided upon. At 
 birth the capacity is from five-sixths 
 to one ounce ; at the end of the first 
 month it has increased to two and a 
 half ounces ; twenty weeks finds it 
 holding three ounces and six-tenths, 
 and at the end of the year it holds 
 eight ounces. 
 
 These dimensions should be kept 
 in mind in feeding a bottle baby, for 
 the tendency is always toward over- 
 feeding. It requires about an hour 
 to digest the milk, so the two-hour 
 interval gives the stomach sufficient 
 time for digestion and for rest be- 
 tween feedings. The subject of 
 feeding in disease will be taken up 
 in a later chapter. 
 
 A baby will generally lose in 
 weight for the first five days or a 
 week after birth. Then he should average a gain of a 
 quarter of a pound a week, for five or six months. The 
 more a child weighs at first, the more he loses as a 
 rule, a seven-pound baby often holding his own when 
 one of ten pounds will drop to seven. 
 
 Steady decrease in weight after the first week means 
 a lack in nourishment. For this reason the advice of 
 some authorities, that the amount of a baby's feedings 
 should be what he can and will take, may be accepted 
 with limitations. If he is overfed, the surplus will 
 flow back — regurgitate, to be sure; but first it will 
 
 Sizes of 
 the baby's 
 stomach 
 
 Tendency 
 to over- 
 feeding 
 
 Glass Cylinder Showing 
 
 the Capacity of the 
 
 Stomach 
 
 What the 
 baby's gain 
 in weight 
 should be 
 
 What de- 
 crease in 
 weight 
 means 
 
308 
 
 CARE OF CHILDREN 
 
 distend the stomach and cause uncomfortable feelings, 
 which will be strenuously resented. This is not de- 
 sirable, and it seems better to plan a 
 
 Schedule 
 for the 
 first week 
 
 Between 
 the first 
 and sixth 
 week 
 
 From 
 six weeks 
 to ten 
 months 
 
 SCHEDULE FOR FEEDING 
 
 A definite schedule allows us to approximate the 
 amounts given as the changes are made from week to 
 week. 
 
 In general, then, for the first week, a baby should 
 be fed every two hours, an ounce — two tablespoons at 
 a feeding. There should be ten of these feedings 
 given during the twenty-four hours, and the whole 
 amount taken in that time should be ten ounces. 
 
 Between the first and sixth weeks the intervals may 
 be lengthened to two and one-half hours, and the 
 amount is then gradually increased to two ounces. 
 This brings up the total to from twelve to sixteen 
 ounces, and there need be only nine feedings in the 
 twenty-four hours. 
 
 From six weeks to ten months, the baby will need 
 nourishment every three hours, but the amounts of the 
 feedings increase, and the number decreases, till from 
 four ounces we have come to eight, and we are giving 
 only five instead of seven in the twenty-four hours. 
 This means that the night is entirely unbroken, from 
 six to six, or whatever hour may be chosen for the 
 morning meal. To sum up, then, we may represent it 
 all by the following schedule : 
 
 Age 
 
 Intervals 
 
 2 hours 
 
 2% " 
 
 3 " 
 3 " 
 3 " 
 3 " 
 
 No. IN 
 24 hour; 
 10 
 
 9 to 8 
 7 to 6 
 6 
 6 
 5 
 
 Amount at 
 each feed 
 
 Amount in 
 24 hours 
 
 i week 
 
 i to 6 weeks 
 
 6 to 12 " 
 
 5 months 
 
 6 " 
 io " 
 
 1 ounce 
 
 i}£ to 2 ounces 
 
 3 to 4 
 
 5 
 6 
 8 
 
 10 ounces 
 12 to 16 " 
 21 to 24 " 
 
 30 
 36 
 40 
 
. INFANT FEEDING 309 
 
 It must be understood that this is not absolute. 
 Some authorities advocate giving the baby two ounces Variations 
 for his first feeding, and some vary the total amounts guide 
 or the intervals in such a way that the results are 
 slightly different, but this is reliable for a guide, and 
 that is all one needs. Observation will teach one what 
 the deficiencies are. 
 
 Proper treatment of a child requires above all cool 
 judgment, rational thought, and the intention of fair Proper 
 play. Emergencies that arise are often alarming only of a child 
 because they are not met with the good sense of a J2J-SS? 
 steadv brain, and if the reason that is required in all thought 
 
 * and j usl 
 
 other problems of life were used with regard to the 
 puzzles in feeding, in hygiene, and in physical and 
 moral training which come up during the life of a 
 child, we should have men and women in the coming 
 generations who would be more evenly developed 
 physically and nervously and who would have a saner 
 outlook upon life in general. 
 
 MEASURES FOR THE HOUSEHOLD 
 
 i teaspoon about a dram 
 
 i tablespoon about half an ounce 
 
 i wineglass about two ounces 
 
 i teacup about four ounces 
 
 i coffee-cup or i drinking glass . . about eight ounces 
 
 rational 
 t 
 tice 
 
II 
 
 DIETARIES 
 
 Digestion— Needs of the Child— Diet Lists from Eleven Months to Three 
 Years and a Half— Sweets for Children— Family Breakfast- 
 Family Dinner— Supper— The Child at Table 
 
 The ali- 
 mentary 
 canal 
 
 T 
 
 DIGESTION 
 
 HE digestive apparatus consists of a long tube 
 of varying shape and size, which passes through 
 the body, the entrance being the mouth and the exit 
 the rectum. There is no direct communication be- 
 tween this tube and the rest of the body, though there 
 are intimate relations through the blood-stream which 
 gathers its nourishment from the food after it has been 
 chemically treated in this natural laboratory. 
 
 In the feeding of both children and., adults, better 
 results can be attained if there is a little recognition of 
 the processes that are going on in the digestive tract. 
 
 The digestion of foods means the reducing of them 
 
 by the action of the digestive fluids into such a con- 
 
 foodmeans dition that the nutrient substances they contain may 
 
 be taken up by the blood-stream, and thus distributed 
 
 to the various tissues of the body. 
 
 Digestion begins in the mouth, and is assisted by 
 
 Digestion a chemical substance contained in the saliva, and by the 
 
 the mouth mechanical act of grinding, by the teeth and turning 
 
 over and over by the tongue and cheeks. In this way 
 
 the food is reduced to a pulp and thoroughly exposed 
 
 to the action of this digestive fluid. The chemical 
 
 action of the saliva is upon the starches, which that 
 
 fluid converts into sugar and puts into soluble form. 
 
 (310) 
 
 What di 
 
DIETARIES 311 
 
 Such substances as bread, cereals, and potatoes then 
 need to be thoroughly masticated in order that their 
 digestion may be begun. 
 
 In the stomach, which is the next portion of the What part 
 tube, the gullet being simply the passage into it, the f 00 d the 
 starches undergo no change, but it is such foods as ^"^ 
 milk, lean meat, and white of egg which are treated u P° n 
 by the gastric fluid. 
 
 The fats and the starches which have escaped 
 
 the action of the saliva, together with whatever the What 
 
 1 1,,- i work the 
 
 stomach has not acted upon, are thoroughly digested intestinal 
 
 in the intestines, where also most of the absorption 3^°° 
 
 takes place. The residue — the waste matter which P hshes 
 
 is of no service to the system — passes along and is 
 
 thrown out in the daily evacuation from the bowels. 
 
 NEEDS OF THE CHILD 
 
 As long as the digestion of a little child is normal 
 it is unwise to give it any amount of starches to dis- 
 pose of. They will pass on to the intestines entirely 
 unchanged, and it is better to put more of the work 
 upon the stomach. 
 
 Milk contains all the constituents needed by the Do not 
 tissues, and does not require any digestion in the fhiM solid 
 mouth. When this is understood it is readily seen f ood until 
 how absolutely unwise it is to give a child solid food teeth to 
 until he has a sufficient number of teeth to masticate STfooV 
 properly. 
 
 Bread and potato can be made soft enough for a 
 baby to swallow long before he has teeth, but to 
 give them before he can chew means that they 
 hardly come into contact with the saliva at all. There 
 may be some action, because the chemical which 
 saliva contains is very powerful, but Nature's pro- 
 visions are generally to be trusted, and when the 
 
312 CARE OF CHILDREN 
 
 system needs the varied dietary, the teeth, the 
 mechanical aids to digestion, will be ready. 
 
 In illness it sometimes becomes necessary for the 
 
 When ill- stomach to be temporarily relieved of its work, and 
 
 change then we are glad to know what to eliminate from the 
 
 of diet diet in order to throw the task of digestion upon 
 
 the intestines alone. 
 
 As long as a child is nursing, up to the tenth 
 month at least, there is no need of variation in diet, 
 provided the health remains good. If he is a breast- 
 fed baby he has already begun to have at least part 
 of his feedings from outside sources, so that his food 
 is not all of exactly the same quality. 
 
 After the tenth month he can be given broths or 
 
 Proper beef-juice occasionally, and by the time he is a year 
 
 a ro IT °^ ^ e can ^ ave °l u ^ e a ^ ew changes from the regular 
 
 food for milk diet. Between the eleventh and twelfth months 
 
 after he he should be weaned from the bottle by being given 
 
 months old 'it only for the first and last meals. He should on no 
 
 account be nursed from the breast after he is a year 
 
 old. The mother's milk is no longer suitable food, 
 
 and will not supply him with the constituents needed 
 
 by the blood for the building up of the tissues. The 
 
 bones should be growing firmer, so that the weight 
 
 of the body can be borne, and the necessary material 
 
 for this work can be better supplied by other foods. 
 
 The quality of the blood also becomes impoverished 
 
 if the mother's milk is the only food. There may 
 
 be exceptional cases where the milk remains rich and 
 
 abundant enough, but as a rule the mother's system 
 
 is depleted by the long strain, and the milk is poorer 
 
 in quantity and quality. 
 
 Changes in a child's diet should be made very 
 slowly, and he should be watched carefully after 
 each change, to see if it agrees with him. One addi- 
 
DIETARIES 313 
 
 tion only should be made at a time. If the mother Changes in 
 has decided to introduce broth into his bill of fare, should be 
 she should substitute a portion of that for one of ° n t ; n ** 
 the milk feedings and let that suffice for the first day, 
 unless the occasion is one of illness, when it is neces- 
 sary to eliminate the milk. 
 
 She can then observe the effect of the change 
 on the child, and regulate the next feedings accord- The 1 mo , t J" 
 
 & & er should 
 
 inglv. It must be remembered, too, in giving broths, watch 
 
 effects 
 
 that unless bread, rice, barley, or spaghetti is added 
 to them, they are stimulants rather than foods. The 
 fat is skimmed off and the tissue-building properties 
 are in the meat which is rejected. As a stimulant 
 broth has an important place in quickening the appe- 
 tite and in aiding digestion. 
 
 DIET LIST FROM ELEVEN MONTHS TO 
 THREE YEARS AND A HALF 
 
 A diet list for children between the ages of one 
 and three and a half years may be put in a condensed 
 form as a suggestion to mothers who may have a 
 little doubt as to the proper foods and their methods 
 of preparation. 
 
 From Eleven to Twelve Months. Five Meals 
 a Day 
 
 first meal, 7 a. m. 
 
 Cream one tablespoon 
 
 Milk fifteen tablespoons 
 
 Milk sugar one teaspoon 
 
 Salt .a. pinch 
 
 Water (boiled) four tablespoons 
 
 SECOND MEAL, 10. 30 A. M. 
 
 * A breakfast cup of warm milk. , r . 
 
 14 l Vol 3 
 
314 CARE OF CHILDREN 
 
 THIRD MEAL, 2 P. M. 
 
 The yolk of an egg lightly boiled, with stale bread 
 crumbs. 
 
 FOURTH MEAL, 6 P. M. 
 
 The same as second meal. 
 
 FIFTH MEAL, IO P. M. 
 
 The same as first meal. 
 
 On alternate days the third meal may consist of 
 nate a da r *s ^ rom ^ our to s ^ x ounces of mutton, chicken, or beef 
 . broth, containing a small quantity of stale bread 
 crumbs. A small piece of unsweetened zwieback or 
 dry toast may be used instead of the stale bread. 
 Toward the end of the period indicated above the 
 strained juice of an orange or a tablespoon of prune 
 jelly may be given. 
 
 PRUNE JELLY 
 
 Soak the prunes overnight in cold water; the 
 next morning add enough fresh cold water to cover 
 the prunes; then stew slowly for an hour or two, 
 until they are very soft, adding water from time to 
 time to keep the prunes covered. When they are 
 done rub them through a fine sieve, add a tablespoon 
 of molasses to a pint of prune pulp, and stew again 
 for about half an hour. If the child is troubled with 
 constipation this jelly and the fruit- juice are valu- 
 able additions to the diet. 
 
 EGGS FOR THE CHILD 
 
 The eggs should either be boiled very lightly, or 
 else so thoroughly cooked that both yolk and white 
 will crumble when the shell is broken. If soft-boiled 
 they should not be kept in more than three minutes 
 if the water is continuously boiling, and about seven 
 if they are cooked at the back of the stove in water 
 
DIETARIES 315 
 
 that has reached the boiling point just before the 
 eggs were added. If the second method — that of 
 thorough cooking — is used, they should be thoroughly 
 cooked in water at the boiling point for an hour. 
 Eggs cooked in this way are especially digestible, 
 and will be found to be quite dry and mealy. The 
 yolk of an egg is more easily digested than the white. 
 
 From Twelve to Eighteen Months. Five Meals 
 a Day 
 
 first meal, 7 a. m. 
 A slice of stale bread, broken and soaked in a 
 breakfast cup of new milk. Or two tablespoons of 
 well-cooked and strained porridge, oatmeal or 
 cracked wheat, with two tablespoons of cream and a 
 little salt, no sugar; a breakfast cup of new milk. 
 
 SECOND MEAL, IO A. M. 
 
 A teacup of milk, with a soda biscuit, or a thin 
 slice of lightly buttered bread. 
 
 THIRD MEAL, 2 P. M. 
 
 A teacup of beef, mutton, or chicken broth, with 
 a slice of bread. One good tablespoon of rice and 
 milk pudding. 
 
 FOURTH MEAL, 6 P. M. 
 
 The same as first meal. 
 
 FIFTH MEAL, IO P. M. 
 
 A breakfast cup of milk, with or without the addi- 
 tion of a cereal. 
 
 To alternate with this: 
 
 FIRST MEAL, J A. M. 
 
 The yolk of an egg lightly boiled, with bread 
 crumbs and salt. A teacup of milk. 
 
316 CARE OF CHILDREN 
 
 SECOND MEAL, IO A. M. 
 
 A teacup of milk with a soda cracker, or a thin 
 slice of buttered bread. 
 
 THIRD MEAL, 2 P. M. 
 
 A mashed baked potato, moistened with four 
 tablespoons of meat broth; two full tablespoons of 
 junket with cream. 
 
 FOURTH MEAL, 6 P. M. 
 
 A breakfast cup of milk with a slice of dried toast 
 or zwieback broken up and soaked in it. 
 
 FIFTH MEAL, IO P. M. 
 
 A teacup of milk. 
 
 The fifth meal is often unnecessary, and the child 
 should never be disturbed for it. Very often he will 
 wake early, at five or six in the morning, and can 
 then be given a cup of warm broth, instead of taking 
 the io p. m. feeding. 
 
 OAT JELLY 
 
 Four ounces of coarse oatmeal are allowed to 
 soak in a quart of cold water for twelve hours. The 
 mixture is then boiled down so that it will make a 
 pint, and is strained through a fine cloth while it is 
 hot. When it cools a jelly is formed, which is to 
 be kept on ice till needed. A little salt improves the 
 jelly if it is to be eaten cold. 
 
 From Eighteen Months to Two Years and a 
 Half. Four Meals a Day 
 
 first meal, j a. m. 
 A breakfast cup of new milk; the yolk of a 
 lightly boiled egg, with a little butter and salt; two 
 thin slices of bread and butter. 
 
DIETARIES 317 
 
 SECOND MEAL, 1 1 A. M. 
 
 A teacup of milk and a soda biscuit. 
 
 THIRD MEAL, 2 P. M. 
 
 A breakfast cup of beef, mutton, or chicken broth; 
 a thin slice of stale bread ; a saucer of rice and milk 
 pudding. 
 
 FOURTH MEAL, 6.3O P. M. 
 
 A breakfast cup of milk with bread and butter. 
 To alternate with this : 
 
 FIRST MEAL, 7 A. M. 
 
 Four tablespoons of well-cooked porridge, oat- 
 meal or cracked wheat, with two tablespoons of 
 cream and a little salt (no sugar) ; a teacup of milk. 
 
 SECOND MEAL, II A. M. 
 
 A teacup of milk and a soda cracker. 
 
 THIRD MEAL, 2 P. M. 
 
 One tablespoon of underdone mutton pounded to 
 a paste ; bread and butter or mashed potato moistened 
 with good plain dish gravy; a saucer of junket. 
 
 FOURTH MEAL, 6.3O P. M. 
 
 A breakfast cup of milk; a slice of soft milk 
 toast or a slice or two of bread and butter. 
 
 The receipt for junket has been given on page 214. 
 
 RICE PUDDING 
 The rice pudding is made as follows : Five cups 
 of milk, two tablespoons of rice, half a teaspoon of 
 salt, one-third of a cup of sugar. \Yash the rice, 
 mix the ingredients and pour into a buttered 
 pudding dish. Bake from two to three hours in a 
 very slow oven, stirring three times during the first 
 hour of baking to prevent the rice from settling. 
 
318 CARE OF CHILDREN 
 
 -9 
 
 From Two Years and a Half to Three Years 
 and a Half. Four Meals a Day 
 
 first meal, 7.3o a. m. 
 One or two drinking glasses of milk; a saucer 
 of thoroughly cooked porridge, wheatena, cream of 
 wheat or oatmeal, and one or two slices of bread, 
 one day old., with butter. 
 
 SECOND MEAL, IF HUNGRY, II A. M. 
 
 A glass of milk or a teacup of meat broth with a 
 biscuit. 
 
 THIRD MEAL, 2 P. M. 
 
 A slice of rare roast beef or mutton, or a bit of 
 roast chicken or turkey minced as fine as possible; 
 a baked potato thoroughly mashed with a fork, and 
 moistened with gravy ; a slice or two of bread and 
 butter; a saucer of junket or rice pudding. 
 
 FOURTH MEAL, 7 P. M. 
 
 A glass of milk; one or two slices of bread and 
 butter or of well-moistened milk toast. The fourth 
 meal may consist of porridge, bread and butter, and 
 milk, if the child likes the cereal well enough to 
 take it at two meals. If there is special need of 
 laxatives a little baked apple or stewed prunes may 
 be added to this meal. 
 
 SWEETS FOR CHILDREN 
 
 During the first years of childhood, the diet should 
 
 Keeping be very similar to the foods in the above lists. A child 
 
 tastes will become accustomed to simple food if he is always 
 
 simple o-i ven it, and he will even accept as a matter of course 
 
 a difference between his fare and that of his parents 
 
 if that difference is constantly made, and he is never 
 
 allowed to "taste" of dishes that appeal to him because 
 
DIETARIES 319 
 
 they are unusual. It is extremely unwise to give a 
 young child cake or candy or any rich sweets. The 
 system needs sugar, it is true, but it can be supplied 
 quite easily in the regular diet. 
 
 Simple sweets do not necessarily have a bad effect 
 on the digestion, but they create a perverted taste, and Sweets 
 interfere with the healthy appetite for the food which taste and 
 is most healthful and nutritious. If a child does not unTeaHhy 
 know the taste of cake or candy, he will feel no de- a PP etite 
 privation, and when he is old enough to choose for 
 himself, he will be far less likely to have an unnatural 
 desire for them. 
 
 FAMILY BREAKFAST 
 
 It is very easy to make the breakfast of the family 
 one which is equally suitable for the children. Fruit, children 
 either raw or stewed, a well-cooked cereal, toast, and, if ^""mii 
 desired, some other very light dish, eggs, or minced breakfast 
 meat, or fish, make a meal that may be shared by all. 
 The adults may add their coffee to this, but there is 
 no excuse for giving it to children. Milk and water 
 are the best drinks for children, and they will usually 
 take them, unless their taste has been perverted. 
 Cocoa can be occasionally given, when there is no hot 
 dish included in the meal, or if the child can not drink 
 milk. 
 
 Tea and coffee are distinctly bad for children, and 
 yet there are mothers who give them to their babies. Never gh-e 
 in the nursing bottle, for no reason but the effects, coffees 
 most deplorable, which the tender body clearly shows. children 
 The stimulant acts upon a child as it does on an 
 adult, giving him a sense of satisfaction and of well- 
 being that ought to be derived from the nourishment, 
 and from physical vigor. After the child gets older, 
 he craves the tea or coffee, and if he gets it, he de- 
 mands far less in the way of solid food. 
 
320 
 
 CARE OF CHILDREN 
 
 A woman can feed her children on tea and bread 
 Evil effects when poverty is pinching, simply because the tea sup- 
 plies artificially and temporarily what heartier diet 
 would give permanently, and takes away the healthy 
 appetite of the growing children. It lays no founda- 
 tion for resistance in time of need, and debilitates the 
 nervous system most surely, by depriving it of the nour- 
 ishment it demands, and by exciting it continually with 
 a stimulant that ought to be quite uncalled for. There 
 is a brand of cocoa on the market which, claims to have 
 special nutritive value. It is called "Plasmon Cocoa," 
 and contains besides the cocoa the nutrient constitu- 
 ents of milk, condensed and in the form of powder. 
 "Phillips' Digestible Cocoa" is considered very light, 
 and particularly suitable for children or invalids. Di- 
 rections will be found on the boxes. 
 
 Cocoa as 
 a drink 
 
 The din- 
 ner in 
 which 
 children 
 
 FAMILY DINNER 
 
 The midday meal should be the hearty one for 
 children, so that if the family takes its dinner at night 
 it is a better plan for supper to be served in the nursery 
 at an earlier hour. 
 
 The dinner may begin with a clear soup. The 
 meat or fish should be roasted or boiled, and cut into 
 fine pieces. The potatoes are most digestible baked or 
 may d share m ashed, and there need be only one other vegetable. 
 Hominy, plain macaroni, spinach, peas, stewed celery, 
 cauliflower, new string beans, and green corn, if it is 
 grated from the ear, are vegetables that children 
 can digest. 
 
 Fried food should be avoided, and no condiment 
 but salt need be used. The dessert should be a light 
 pudding, like rice, custards, tapioca, or gelatine. 
 
 The seasons should be considered in the choice of 
 foods. Oatmeal, cornmeal, fats of any sort, food con- 
 
DIETARIES 321 
 
 training much butter in its preparation, or bacon, are Consider 
 heating and not suitable for warm weather. The wheat i n choos- 
 cereals, fruits, vegetables, fish and salads are less heat- ing food 
 ing, and are more satisfactory for the hottest weather. 
 
 SUPPER 
 
 The supper should be a very simple meal, such as 
 has been described. Milk or cocoa may be given, and Asim P le 
 
 J & supper 
 
 toast or bread with porridge, or some stewed fruit will 
 furnish sufficient nourishment. If the breakfast is 
 taken early, and the dinner late, especially if the child 
 is very active, it may be wise to give a luncheon in the . 
 middle of the forenoon. This may consist of a glass 
 of milk, and some sort of biscuit. Animal crackers 
 are a delight to most children, and graham biscuit, or 
 butter thins may be alternated. 
 
 THE CHILD AT TABLE 
 
 Children should always take at least two meals a 
 day with their parents or an adult attendant, so that children 
 they may be taught to eat slowly and masticate thor- taught tcf 
 ougrhly. A child can learn to handle his knife, fork, eat J s,owl > r 
 
 & J ' ' and to 
 
 and spoon properlv if a little trouble is taken with him. masticate 
 
 T . ., . i'ii r iii-ri thoroughly 
 
 It is a mistake to give a child a spoon for all his food, 
 for it accustoms him to it, and he is awkward when 
 he begins to use a fork. A child should be expected 
 to take his food daintily, and will soon learn to keep Muscular 
 his place at the table tidy if he is ordinarily devel- and^dain- 
 oped in muscular control, and has not been allowed to tiness 
 feed himself before his hands have grown strong and 
 steady enough. 
 
 In planning meals for the child or the adult, the ap- 
 petite as a factor in digestion must be recognized and 
 considered. If food is not pleasing, it will not be taken 
 in the first place, and secondly, if it is taken with no 
 
322 CARE OF CHILDREN 
 
 pleasure attendant, it is almost never as completely di- 
 gested. 
 
 Before dietaries had become so varied, the appetite 
 a guide was a reliable guide in the choice of food, and what 
 dietaries man craved was what he needed. We realize that with 
 were so j^e i ncrease i n kinds of foods, and in the manner of 
 
 varied 
 
 their preparation, that keenness of instinct is lost, but 
 . there must still be a sense of "relish" if we are to get 
 the full amount of nourishment from our daily meals. 
 Variety, attractive preparation, and attractive serv- 
 Aids to ing are important aids, and though they are less es- 
 sential with children having the normal appetites of 
 abounding health, they will be found worthy of consid- 
 eration. 
 Memtai ^ 1S °^ educational value for children to sit down 
 
 effect of to a well-set, tidy, attractive table, and the orderly 
 
 an orderly . . . 
 
 meal meals, at regular times, affect his habits of mind as 
 
 well as his habits of digestion. 
 
Ill 
 
 SCHOOL-CHILDREN — THEIR FOOD AND 
 EXERCISE 
 
 Breakfasts — Luncheons— Physical Activities and Mental Development- 
 Health and Education 
 
 THE diet list given on the foregoing pages is quite 
 suitable for children of any age, and even the 
 adult members of a family would find that with occa- 
 sional modification its suggestions furnish food that is 
 nourishing enough to satisfy the daily demands, and 
 sufficient in variety to stimulate appetite, unless elabo- 
 rately made dishes or rich and unusual foods have 
 spoiled them for simple, wholesome fare. 
 
 BREAKFASTS 
 
 Breakfast is usually the meal that seems the most 
 difficult with school-children. In the home where 
 there are several children, and where the task of The pull 
 dressing them and getting them all off to school {^inning 
 comes on the mother, nine o'clock seems rather of the da * 
 early, and the breakfast is likely to be a very hurried 
 meal. Either on account of the feeling of haste, or 
 because the functions of the body are still dormant, 
 the appetite is often capricious, and any nourishment 
 is taken with difficulty. 
 
 If children are accustomed to the simple meal, so 
 that it seems sufficient, the appetite will be much more Va iues of 
 likely to be tempted bv it than bv the array of hearty the simple 
 
 e i 1 11" -i 1" - « - « breakfast 
 
 food that used to be considered an essential for the 
 American breakfast. When there is no servant, the 
 
 (323) 
 
324 
 
 CARE OF CHILDREN 
 
 Breakfast 
 should 
 not be 
 hastily 
 taken 
 
 economical side of the question would recommend it, 
 for the saving of labor is always worth consideration. 
 The fruit, cooked or uncooked, needs no preparation in 
 the morning; cereal, toast, and coffee take very little 
 time, and the eggs for those who wish them can 
 be boiled or dropped with very little hurry or work. 
 Breakfast should not be hastily eaten, because the 
 abundance of starchy food needs thorough mastica- 
 tion. It is well to vary the cereal several times dur- 
 ing the week, and to give, in general, wheat prep- 
 arations rather than pats. All the varieties need longer 
 cooking than is recommended in the ordinary direc- 
 tions. Consult the article on the cooking of cereals in 
 the Every Day Cook Book. Hominy and cracked 
 wheat must be put on the night before, for they are ex- 
 tremely indigestible unless very thoroughly cooked. 
 
 LUNCHEONS 
 
 The luncheon problem is a serious one in many 
 households, because of the burden of preparing some- 
 thing every day, and still more on account of the lim- 
 schoois ited choice of suitable food. When the school hours 
 are so arranged that a luncheon is a necessity, there 
 ought to be some arrangement for serving the whole 
 or a part in the school building. This is provided for 
 in many schools, and would be in many more if the 
 parents brought it to the notice of the boards and in- 
 sisted upon its accomplishment. 
 
 Hot soup, or hot or cold milk, adds to the nourish- 
 ment and to the pleasure, and if the luncheon takes 
 the place of the noonday meal, is quite a necessity. 
 The simplest arrangement would be tanks of cocoa, 
 or bouillon, and of hot milk and water. 
 
 Beef tea, made with tablets or capsules, and malted 
 milk could then be prepared as they are desired, and 
 
 Luncheon 
 
 Arranging 
 for soup, 
 milk, etc. 
 
FOOD AND EXERCISE 325 
 
 with sandwiches from home a child could make a com- 
 fortable, suitable meal. The fact of having a definite 
 place where pupils can sit together and eat comfort- 
 ably, the sociability, and lack of haste promote diges- 
 tion. 
 
 Unless the entire luncheon is prepared at school, 
 the home basket must be furnished daintily if its con- 
 tents are to be appreciated. Children who have nor- Putting 
 
 ., . • . . up school 
 
 mally hearty appetites, and who are not sensitive to luncheons 
 appearances, may think more of the quantity given than 
 of the exquisiteness of its preparation. But, however 
 that may be, it is better for the child, from the educa- 
 tional standpoint, to find his sandwiches cut thin and 
 small, and carefully wrapped in parafine paper or in 
 a napkin, with whatever may be added daintily packed 
 in a suitable box, than to take an equally nourishing 
 lunch carelessly put up in a brown paper parcel. This 
 subject of luncheons for school-children is also treated 
 in the Every Day Cook Book. Sandwiches always 
 suggest themselves as the staple of any lunch of the Sand- 
 picnic order, and their variety is legion. A simple ^ their 
 cake, a piece of gingerbread, or some fancy biscuit, E an°JJJ ents 
 fruit or a little sweet chocolate, or bit of pure candy 
 added as an occasional surprise, is quite adequate if 
 supplemented at the school by milk or a hot soup, or 
 if the luncheon does not take the place of the meal, 
 but merely bridges a space between breakfast and a 
 late dinner. 
 
 To these general suggestions are appended some 
 directions for making the less common varieties of 
 sandwiches, which may serve to change an otherwise 
 monotonous fare, and will add the element of surprise, 
 which is such a stimulus to appetite. 
 
 White, graham, or brown bread, or fresh small 
 rolls may be used for sandwiches. 
 
326 CARE OF CHILDREN 
 
 Bread should be a day old and fine in grain, and the 
 Bread in sandwiches cut to better advantage if the loaf is nearly 
 oAhe 3 mg square. If the crusts are to be trimmed off, it is bet- 
 
 sandwich ter tQ cut them from the loaf ^ Then there is nQ waste 
 
 of butter, and the crusts can be dried and used for 
 crumbs. The first slice may be spread on the loaf, 
 but the second must be cut first in order to make them 
 fit. Generally, both slices must be buttered, but only 
 one need be spread with the filling. They may be cut 
 into squares or triangles, or with a biscuit or cake cut- 
 ter into other shapes. 
 Butter The butter should be slightly warmed, so that it 
 
 for the to ./ > 
 
 sandwich can be evenly spread, and the bread will not be torn. 
 
 Slices of meat, unless it is very tender, are awk- 
 ward for sandwich filling. It should at least be cut 
 in small pieces, and is better chopped finely, and mixed 
 
 meats""* with a little stock, cream, or dressing to make it moist. 
 
 sandwich Fish can ^ e pounded to a paste, or potted meats can 
 be used, though they are usually too highly seasoned 
 to be advisable. A little seasoning, like salad dress- 
 ing or lemon- juice, improves the insipid meats or 
 fish. 
 
 EGG SANDWICHES 
 
 I. Cut hard-boiled eggs into slices; sprinkle with 
 salt, and spread with butter, which has been mixed 
 with finely chopped watercress. 
 
 II. Add to the above a layer of lettuce leaves - and 
 salad dressing, omitting the cress. 
 
 III. Chop the eggs fine or mash them with a fork, 
 seasoning them and mixing them with salad dressing. 
 
 LETTUCE SANDWICHES 
 
 Crisp lettuce leaves may be sprinkled with salt, and 
 laid between the buttered slices of bread, or the bread 
 may be first spread with salad dressing. 
 
FOOD AND EXERCISE 327 
 
 CHICKEN SANDWICHES 
 Celery added to chicken and chopped very fine 
 makes delicious sandwiches. 
 
 CHEESE SANDWICHES 
 Cottage or ordinary dairy cheese is spread on the 
 well-buttered bread, a little salt is sprinkled over it, 
 and with the dairy cheese a bit of French mustard is 
 an addition. 
 
 NUT SANDWICHES 
 
 Spread thin slices of Boston brown bread with 
 chopped nuts, adding a little salt. 
 
 SWEET SANDWICHES 
 Jam, jelly, marmalade, or any preserved fruit, 
 makes sandwiches that are very popular with children. 
 
 PHYSICAL ACTIVITIES AND MENTAL 
 DEVELOPMENT 
 
 During the first twenty-five years of a person's 
 life the influences which enter it have a vital impor- 
 tance. Character is being made, habits are being 
 formed, knowledge is being stored, which not only The far- 
 determines what the life of that person shall be, but effect of 
 which decides what sort of inheritance he shall pass training 
 on to the next generation. One can never be sure 
 whether the child whose equipment in life one has 
 undertaken will in turn take upon himself the like re- 
 sponsibility of bringing children into the world and fit- 
 ting them for its duties, but he ought to be given, for 
 his own sake, the chance for the fullest possible de- 
 velopment, that he may get from life the deepest pos- 
 sibility for lasting joy. 
 
 Until the age of fifteen, there is usually little as- 
 sumption of responsibility, and little consciousness of 
 
328 CARE OF CHILDREN 
 
 The child's the purpose underlying school work. This is as it 
 scious should be, and the child's training should follow along 
 gaming these lines, letting him gain knowledge without realiz- 
 ing that it is part of a scheme of education, and form- 
 ing his powers so that he can see and will and choose 
 to know when the time for decisions comes. 
 
 Our time is one of upheaval along educational lines. 
 The old theories have been tried and found lacking. 
 We get the record from the elementary school that chil- 
 dren's growth is largely arrested during the school 
 ■aside" 8 year, and that those who are not placed in school until 
 the old after they are seven or eight vears old are stronger 
 
 theories J & & 
 
 than school-children of the same age. School, which 
 ought to be reckoned among the pleasures of child- 
 hood, so often stands in their estimation as one of its 
 tragedies. 
 
 One great truth has been conceded : that children 
 need more appeals to their sense-perceptions and 
 
 Fewer de- fewer demands for abstract thought. The general re- 
 mands for . 
 abstract suit of this concession in some of the public schools 
 
 1 oug * has been that a mass of extra work has been thrown 
 upon the teachers, and that the children have been con- 
 fronted with a bewildering assortment of accessories 
 in the way of colored objects, pictures, and so forth, 
 without being relieved of the strain of the former 
 work. 
 
 The results have been hardly more satisfactory, for 
 
 very obvious reasons. The child loves to learn. From 
 
 the moment that the baby's -fingers begin investigations 
 
 Child's de- with his own toes, he is eager, demanding, insistent for 
 
 IhoZTbe knowledge. What does the child need most in these 
 
 along bod- years that are given to us to mold? How does he 
 
 ily activity ' ° _ 
 
 gain his knowledge of the things that are vital to him r 
 He needs to be given the chance for the normal bodily 
 development, and for the most untrammeled activity, 
 
FOOD AND EXERCISE 329 
 
 because not only the physical but also the mental poise 
 depends upon it. 
 
 A child's method of mastering a new and difficult 
 
 , 1 • -i 1 , . . , , The child's 
 
 problem is never to sit down and approach it with ab- method of 
 stract theories. His is the plan of the true scientist. mas ery 
 He conducts personal investigations, he makes un- 
 ceasing inquiry, and he lives the thing he wishes to 
 know till it is a part of him. This is the key of the 
 situation. The mental processes of the child express 
 themselves in action, and since the mental and 
 physical activities are naturally associated how can 
 the dissociation of them in school work good re- 
 sults ? 
 
 "Physical culture" — that is, the set drills and calis- 
 thenic exercises, which are a part of the day's routine 
 in many classrooms, have their place. They relieve physical 
 the tense muscles, and if well directed are of value in defective 5 
 correcting defects in position, in carriage or in the de- 
 velopment of muscles, which might seriously affect the 
 health. Regarded from the standpoint of education, 
 they have no special meaning. They are given of 
 necessity under the exact direction of the instructor, 
 whose ideas thev express. The effort at concentra- XT . .. 
 
 1 , No mdi- 
 
 tion, and the necessity of prompt, unreasoning obedi- viduaiity is 
 ence to commands, are conditions which are created by 
 the plan of the exercises, by the limitations of space, 
 and the numbers working at one time. 
 
 Work in a gymnasium, where the element of sport 
 comes in, and the exercises, increasing in difficulty, in- 
 cite the child to individual effort and interest, has both 
 the educational and the hygienic side, and is an essen- 
 tial factor in development. 
 
 Physical education should not be limited to an hour 
 or two twice a week. Since it is through physical ac- 
 tivities that all other development is gained, the aim 
 
330 CARE OF CHILDREN 
 
 should be to associate all the work of the early school 
 years with such physical activity. 
 
 If one estimates the value of the first years of 
 ah the school life by the amount of abstract facts stored up, 
 early ° f or ^y the quantity of symbols mechanically learned, it 
 school m ay be that the conventional methods of teaching 
 should be would seem to achieve most. If, on the other hand, 
 w7th C1 physi- one balances the results with the mental and physical 
 ties 30 * 1 ™ con trol, with the ability to use the mind and to co- 
 ordinate the muscles, and with the increased bodily 
 vigor, which are accomplished facts when the modern 
 educator is allowed to carry out his ideals, we must 
 admit that childhood is a more joyous time, that youth 
 will be one of stronger, more purposeful endeavor, 
 and that adult life will stand for larger achievement. 
 A person's interest is really the secret of his ac- 
 The nat- quirements. The interests of the child are manifold 
 est and if the mind is allowed to unfold naturally and is led, 
 oTthe aClty not forced, into the new channels. At eight, he will 
 child m teach himself to read with tireless industry, because 
 
 acquiring J 7 
 
 knowledge f the world of wonders which the magic symbols un- 
 lock to him, while at five he toils along the dead level 
 road of commonplace to glean such valuable truths as 
 "The cat has a rat," or "I see the cat," and literature 
 has no attraction for him. 
 
 The introduction of handwork, if it is given its 
 proper place in the dav's work, offers a solution 
 
 Intro- « . - , , . \ ,. , < 
 
 ducing which has proved its value bv thorough expenmen- 
 
 knowledge . _, . , 1 , 
 
 by hand- tation. The weaving and sewing do not become 
 isolated subjects, but associate themselves naturally 
 with history and geography; the abstractions of 
 number and form become vividly concrete when 
 applied to carpentry, and the cooking processes lead 
 to simple chemistry, by the direct path of cause and 
 effect. 
 
FOOD AND EXERCISE 331 
 
 In this way the conventional subjects are not 
 thrown aside. They are woven into the general 
 scheme so that dry facts do not confront the child, 
 but interest colors them and makes them living. 
 
 The object of the industrial education is not to industrial 
 
 1 1 ttt , • • t education 
 
 teach trades. \\ e are not making artisans, but men is not 
 and women, and as we lay the foundations of educa- Jr a des°- 
 tion we ask from the child physical expression, be- 
 cause that is his absorbing interest, and through it 
 his mental interest is awakened. 
 
 HEALTH AND EDUCATION 
 
 The health of the children is the note we are 
 sounding, and normal life and growth generally g T °J™ t ^ 
 mean healthy life. Most of our schools work along mear >s 
 lines distinctly opposed to this. They place the child life 
 under abnormal conditions, in confining him in the 
 classroom, out of the air and sunshine which are 
 his by right, by seating him at a desk which often 
 cramps or strains his muscles, and by restricting his 
 motions to set exercises allowed only at stated inter- 
 vals, with no regard to his inclination, and suggested 
 by a mechanical power quite outside his conscious- 
 ness. With this utter lack of spontaneity they de- demands 
 mand irrational results, and in their disregard of 
 hygienic principles they defeat their own ends, for 
 the most rapid mental progress is made when bodily 
 health is assured. 
 
 The health of the child ought to be benefited in 
 consequence of his attendance at school. If we find 
 that this is not true, our criticism of school methods 
 is justifiable. 
 
 Some of the diseases which school-children are Diseases 
 found suffering from are affections of the eyes, bad condi- 
 spinal curvature, nervousness, rickets, chorea, catarrh. school*' 
 
What 
 statistics 
 
 332 CARE OF CHILDREN 
 
 headache, tuberculosis, indigestion, and constipation. 
 All of these are aggravated at least by unhygienic 
 conditions which are existent in the common schools. 
 Nearsightedness and other such abnormalities are 
 very prevalent among school-children, and statistics 
 show that nearsightedness progresses with the grades 
 till in the highest classes more than one-half the 
 pupils have defective vision. 
 
 The city schools show a higher percentage than 
 those in the small towns, and among the pupils in 
 show buildings of recent model construction in regard to 
 lighting the proportion is smaller. This is the most 
 eloquent argument against the crowded, ill-lighted 
 schoolroom, and yet in the face of such proved facts 
 we find classrooms in large cities which have to de- 
 pend largely upon artificial light. 
 School Unhygienic school furniture is chiefly respon- 
 
 furniture sible for spinal curvature, which is appallingly com- 
 
 responsible *■**•*■, <-> • • 
 
 for spinal mon among school-children. Sometimes it is not 
 curvature no ti ceaD l e) but often it increases till it is a very 
 apparent deformity. Between seven and fourteen 
 the largest percentage of this disease is found, prob- 
 ably because before that a child is not confined so 
 closely at school. 
 
 It is entirely unnatural for children to remain 
 
 for any length of time in the sitting position. The 
 
 bones are not yet firm, and the muscles are weak. 
 
 School hours are unfortunately long, and the bones 
 
 of the spinal column yield in time to the force of 
 
 gravity, even if a strained position at the desk has 
 
 not played its part in causing a curvature. 
 
 Bones of The ossification of the bones is not complete 
 
 children until the age of twenty-five, and until thirteen or 
 
 ou'm 101 " fourteen it; is possible to make definite changes in 
 
 ossified their position by judicious or injudicious treatment. 
 
FOOD AND EXERCISE 333 
 
 Nervousness is marked in school-children, and 
 manifests itself in various forms, but is increased 
 by the pressure which is applied in school work, by Results of 
 the worry over examinations, and often by the nerv- impure a ir 
 ous tension of the instructors, who must feel the 
 stress in their turn. Rickets, tuberculosis, catarrh, 
 and headache may not necessarily be brought about 
 by impure air, but it certainly tends to increase any 
 of those troubles, and the sitting posture, particu- 
 larly if the back is not held erect, has its effect 
 if there is any predisposition to rickets or tuber- 
 culosis. 
 
 Two essentials in any lung trouble are that the 
 lungs should have air rich in oxygen and that they ^f^g 3153 
 should expand fully. When the shoulders droop or trou bies 
 the body is held in a cramped position at an ill-made 
 desk, the lungs are compressed and the air cells can 
 not do their work. 
 
 The special causes of chorea have been discussed. 
 The fatigue of muscles forced to the strained effort Fati f ue 
 
 # p in chorea 
 
 of maintaining one position, or of concentrated at- 
 tention to circumscribed movements, as in writing, 
 probably has much to do with increasing the severity 
 of the attack, especially as the nature of the trouble 
 is often not recognized and more pressure rather 
 than less is applied. 
 
 The time for meals is shortened, eating is too 
 often a hurried, perfunctory task, and indigestion 
 results. The sedentary life increases the difficulty, suits of a 
 and adds the grave one of constipation. The rush of s "hoo! 
 getting off to school in the morning, the restraint llfe 
 during working hours, also have their effect, for 
 habits of regularity are difficult to form under these 
 conditions, and if the bowels are neglected results 
 are disastrous. The old English philosopher, John 
 
334 CARE OF CHILDREN 
 
 Locke, in touching this point in his famous work on 
 education, advises a regular hour at which a child 
 should invariably "solicit nature" — this hour being 
 kept to with inflexible regularity. 
 
 "There is reason to suspect," says Locke, "that 
 Locke's children being: usually intent on their plav and verv 
 
 famous r i • 
 
 remedy heedless of anything else, often let pass those motions 
 tiveness °f Nature when she calls them but gently ; and so 
 they, neglecting the seasonable offers, do by degrees 
 bring themselves into an habitual costiveness." The 
 remedy suggested is the holding the child daily 
 to an hour for action, and thus establishing the 
 regularity in which Nature rejoices in all her 
 works. 
 
 We do not mean that these evils are inevitable 
 in the school life of a child, but it is true that a 
 general survey and examination of the health of 
 Schools pupils shows that a surprising proportion has chronic 
 signs of ew disease of more or less serious nature, that head- 
 advance acnes are universal, that, in short, Civilization has no 
 advance to show as regards the physical condition 
 of her children. The Spartans gave their youth first 
 and foremost the gift of vigorous bodies, trained by 
 endurance to perfect control, to a thorough enjoy- 
 ment of life through spontaneous self-activities and 
 expression. When our system of education accom- 
 plishes that for the physical, it will be time to point 
 with pride to the gain in mental development of the 
 children under its guardianship. 
 
 The nervous breakdown in college dates back to 
 pressure in the elementary school, systematic pres- 
 sure, persistently applied. If all schools were like 
 the worst, the evils would be such crying ones 
 that parents would demand a change, and it would 
 come. 
 
FOOD AND EXERCISE 335 
 
 The number of schools of the better sort is in- 
 creasing, and as the experimentation succeeds the 
 popular prejudice against learning made joyous will 
 disappear, and the normal training of children will sor t f 
 not be limited to the few, but will be the natural ?^° e ^ sin 
 heritage of all. 
 
IV 
 
 POINTS ON HYGIENE 
 
 Toughening "—Baths— The Teeth— Footwear— Dress 
 
 Cold baths 
 and cold 
 rooms may 
 tend to 
 make chil- 
 dren less 
 resistant 
 to disease 
 
 "TOUGHENING" 
 
 THE process of "toughening children" is a very 
 mistaken one, failing utterly of its purpose in 
 nearly all cases. Generalization in the treatment of 
 children is not rational, and cold baths and exposure 
 to all kinds of weather indoors and out are not uni- 
 versally helpful. 
 
 The cold bathing, unless a child has vigorous, 
 abounding health and a nervous system that enjoys 
 the shock, tends to debilitate rather than to stimulate, 
 and with increased nervousness come loss of appe- 
 tite and sleeplessness. 
 
 Exposure in cold sleeping-rooms, instead of 
 making a very little baby less liable to throat and 
 chest affections, often leaves him more susceptible to 
 colds, catarrh, and sore throat, and this susceptibility 
 increases the severity of many of the infectious dis- 
 eases of childhood. 
 
 In exceedingly inclement weather very little -chil- 
 dren should not be taken out. The air in their 
 sleeping-rooms must be fresh, and they must be so 
 ventilated that it is changing constantly, but widely 
 opened windows and atmosphere perceptibly chilled 
 are conditions which are likely to make children less 
 resistant rather than more so. 
 
 The extreme is quite as much to be condemned. 
 (336) 
 
POINTS ON HYGIENE 337 
 
 To keep a human being protected like a hothouse 
 flower indoors, to wrap the throat and indeed the Weaken- 
 whole body in fur, and to make impossible free exer- too much 
 cise out in the air is to make sure a weakening of protectl0n 
 vitality which leads to practically the same results, 
 along perhaps more direct paths. The individual 
 must be considered, and the process of hardening 
 must be gradually established, with little attempt at 
 radicalism till after the child is capable of indepen- 
 dent motion. 
 
 BATHS 
 
 Bathing in disease, and its relation to the func- 
 tions of the skin, have been described. Its impor- The daily 
 tance in health is no less to be considered. The daily 
 bath ought to be as much a part of the day's routine 
 as the care of the hair, and children will so regard 
 it if it is given them as regularly after they are 
 grown as when they are babies. 
 
 In summer a child who has been vigorously play- 
 ing all day needs a warm cleansing bath at night, The bath 
 because the perspiration has been secreted so plenti- s i e e ^, re 
 fully and the oil-glands have also poured out their 
 fluid in abundance. This has been mixed with the 
 dust, which collects upon the surface of the body, 
 sometimes in a perceptible amount, but always enough 
 to need removal with warm water and soap. 
 
 A bath should not be given immediately after a 
 meal, but if children have their suppers at five or 
 half-past, there is time for the little frolic which 
 always seems to have its place before bedtime, and 
 the bath will quiet the nerves and relax the muscles 
 for restful sleep. 
 
 In the winter the bath is useful to stimulate the 
 circulation, to increase the heat of the body, and to jointer 
 render the child, if possible, less susceptible to cold. 
 i5 Vol. 3 
 
338 CARE OF CHILDREN 
 
 For this reason the cool or tepid plunge in the morn- 
 ing is of especial value. If he is of normal health, 
 and is gradually accustomed to the cool water, he 
 will learn to like the shock and will especially enjoy 
 the glow and tingling warmth of the reaction. A 
 cold bath must be given with care, for unless a child 
 is very vigorous the shock will be too great, and no 
 good will result. 
 
 Children enjoy the feeling of the air on their 
 bodies, and if the household is one which will admit 
 bath of it, they should be given the chance each day for a 
 
 brisk run about through the rooms of comparatively 
 even temperature, without the restraint of clothes. 
 As long as children are unconscious of their bodies 
 there is no reason why they should not have that 
 freedom, and it is made impossible by remarks which 
 they feel though they do not understand. 
 
 Children's scalps collect dust and their hair re- 
 and q thor- quires shampooing much more often than that of 
 pooing ham " adults. If the hair is short it is very easily kept 
 clean, but it must not be neglected, because an accu- 
 mulation of dirt may lead to disease, and if a little 
 borax or alcohol is added to the last rinsing water 
 the hair dries quickly and there will be no danger of 
 catching cold. 
 
 THE TEETH 
 
 Teething usually begins at six months. It may 
 if teething be delayed until the second year, with no other sign of 
 consider* 1 arrested development, and the order in which the teeth 
 the , chil 4' s come may vary in every way without any indication of 
 digestion illness, and with no bad effects upon the system. 
 
 Parents, however, should be sure that the food 
 contains the proper elements for the nourishment of 
 the child, and that it is being properly digested. The 
 food is often responsible for disorders that are at- 
 
POINTS ON HYGIENE 339 
 
 tributed to teething. If the teeth are delayed in their 
 appearance, or if the gum is unusually hard and 
 fibrous, so that they have unusual difficulty in pierc- 
 ing it, there will be nervous irritation and there may 
 be functional disorders, but if the food is suitable 
 the symptoms are not the same as those produced by 
 intestinal trouble. 
 
 The diarrhoea that is sometimes caused by diffi- 
 cult dentition can be distinguished from that brought _ 
 
 ° ° Symptoms 
 
 about by intestinal irritation. In difficult dentition in difficult 
 there will be great fretfulness and acute pain, with 
 spasmodic movements of the muscles of the face, the 
 gums will be swollen and red, and the appetite will 
 be variable. The child troubled with indigestion wishes 
 to bite and chew anything put into the mouth. One 
 suffering with pain from swollen gums will not bring 
 them together upon anything. If the teeth are re- 
 sponsible for the condition, lancing the gums will 
 give immediate relief. 
 
 The teeth appear in groups, making a division 
 in time which allows a rest between their appear- 
 ances. Changes in food, weaning, or any such break f tefth UpS 
 in regularity may best be arranged for one of these 
 periods of rest. 
 
 A table which may be accepted as representing 
 the usual order is as follows : 
 
 I. 6 — 8 months 2 middle lower incisors 
 
 II. S — io months 4 upper incisors 
 
 ttt to r. rv,™ Tr1 c j 4 lateral lower incisors 
 
 III. 12-14 months J J first molars 
 
 IV. 18 — 20 months 4 canines 
 
 V. 28—32 months 4 second molars 
 
 The first set of teeth numbers twenty. The four 
 middle teeth in both jaws are called incisors, the next f U ?he r 
 four on either side the incisors, both upper and lower, first set 
 are canines. The remaining eight are molars. 
 
340 CARE OF CHILDREN 
 
 The importance of care of the temporary teeth 
 
 is not appreciated, and they are too often allowed to 
 
 become decayed, and thus of no use to the child. The 
 
 what evil evils of this are twofold. The presence of a decayed 
 
 tooth aye tooth in the mouth means that the micro-organisms 
 
 may do w hich cause the decay are spreading their poison to 
 
 other teeth, through the roots to the permanent tooth 
 
 which is to take its place, and leaving an effect upon 
 
 the general digestive tract. In the second place a 
 
 tooth which contains a cavity is incapacitated from 
 
 its share in mastication. 
 
 A child will adjust himself to conditions if a 
 How bad remedy for them is not forthcoming, so that often 
 teeth affect ne w jh ce ase complaints of an aching- tooth because 
 
 a child s r ° 
 
 mastication he has adopted the plan of giving it no work to do. 
 If there are decayed teeth on both sides of the mouth 
 this frequently means that food is swallowed prac- 
 tically without mastication. Habit is strong in all 
 the acts of our daily life, and such a one established 
 would inevitably lead to imperfect digestion. 
 
 The teeth are intended for use, and the mastica- 
 tion of solid food keeps them in a healthy condition, 
 and is one of the best helps toward cleaning them. 
 
 The pain of decayed teeth also affects the nerves 
 in a way that is exceedingly bad for a child's devel- 
 opment. 
 
 If the temporary teeth are decayed and neglected 
 the permanent ones which follow are almost sure "to 
 
 Care 
 
 of the be imperfect. When a tooth is lost the gum shrinks 
 first set an( j t ^ e S p ace tnat t ^ e secon( i tooth is to occupy 
 
 changes in shape. It is then very likely to be out of 
 place, and will very probably crowd the other teeth. 
 The greater probability is that the decay of the first 
 tooth is communicated to the second, and to its neigh- 
 bors as well. 
 
POINTS ON HYGIENE 341 
 
 Children should have early instruction in the 
 care of the teeth. While they are very young they The sort of 
 can be taught to rinse the mouth thoroughly, and use and 
 the use of the toothbrush will interest them, in the usTit° 
 beginning at least, because of its novelty and as being 
 a sign manual of increasing ability. Such a brush 
 as that called the prophylactic is the most sanitary 
 and effective. Its bristles are of unequal lengths, and 
 a tuft of longer ones at one end penetrates well be- 
 hind and between the teeth. The curved shape of the 
 handle makes it fit the jaw better than the straight 
 brush. 
 
 The toothbrush should be used over the surface 
 of the teeth with a downward motion on the upper J^ u e s iJ 00th " 
 teeth and an upward motion on the lower teeth, which 
 causes the bristles to pass between them. The food 
 arid the motion of the lips, tongue, and cheeks over 
 the surface of the teeth prevents the accumulation 
 of organic substances and the development of micro- 
 organisms, and it is between the teeth that decay 
 begins. Dental floss may be used additionally to P ental 
 
 J J floss versus 
 
 make sure that no food has lodged there, and is much wooden 
 better than wooden toothpicks, which are very liable 
 to splinter and leave behind more harm than they 
 remove. 
 
 A tooth-powder is useful, though not absolutely 
 essential, if the cleansing process is regularly and 
 carefully carried on. A very good formula for powder 
 powder to be made in the household is as follows : 
 One part white castile soap, two parts precipitated 
 chalk, with powdered orrisroot to flavor it. Shave 
 the soap in thin flakes, and dry it for a day or two 
 before using. Proportions and flavoring can be 
 varied. 
 
 Children can be accustomed to visits to the 
 
342 
 
 CARE OF CHILDREN 
 
 The teeth 
 should be 
 regularly 
 examined 
 by a good 
 dentist 
 
 The per- 
 manent 
 teeth 
 
 When a 
 
 tooth 
 
 aches 
 
 Care of 
 the teeth 
 
 dentist's so that there need not be that frantic terror 
 at the thought that often keeps a parent from giving 
 them the proper care in that regard. Too often 
 stories of agonies suffered are retailed to their ears. 
 This should never be allowed, and the regular visits 
 for examination will remove many of the alarms. 
 
 The permanent teeth number thirty-two. At 
 about six years of age four of these teeth, the molars, 
 appear just behind the temporary molars. Four more 
 come about six years later, still further back on the 
 jaw, and the eight bicuspids take the place of the 
 eight temporary molars. This early appearance of 
 the first permanent teeth should be understood, for 
 often it is considered that they are first teeth, and 
 they are allowed to decay. 
 
 When the pain in a tooth is caused by the pres- 
 ence of a foreign body on a live pulp, removal of 
 the cause relieves the pain, but when there seems to 
 be no especial reason for it the treatment is different. 
 The cavity should be carefully washed out with tepid 
 water or with water and peroxide of hydrogen in 
 equal parts, dried, with absorbent cotton, and a tiny 
 bit of the cotton, soaked in equal parts of carbolic 
 acid and oil of cloves, placed in the cavity. A five 
 per cent solution of carbolic should be used, and care 
 must be taken not to get it on the surrounding gum, 
 since it will be liable to burn any tissue it touches. 
 Compound tincture of benzoin applied in the same 
 way may also relieve. 
 
 The necessity of immediate care of diseased teeth 
 can not be too strongly emphasized. If the teeth are 
 properly brushed as they are coming in, the loss of 
 teeth in adult life is very unusual. "Gum-boils," ab- 
 scesses, and decay of teeth, aside from the pain, 
 which must be nervously debilitating, are constantly 
 
POINTS ON HYGIENE 343 
 
 introducing poisons into the system, which negative 
 any measures taken toward hygiene of the digestive 
 organs, and imperfect digestion is incompatible with 
 normal development. 
 
 FOOTWEAR 
 
 Troubles with the feet, either from corns, from 
 tenderness in the soles, or from difficulty in getting Careful 
 ig shoes, are common enough among 
 
 attention 
 
 comfortablv fitting shoes, are common enough among to the 
 
 adults, so that the need of careful attention to the feet ^f 
 feet in childhood must be recognized. We have spoken children 
 of the cartilaginous state of the bones in infancy. 
 That condition and the fact that the foot and ankle 
 are composed of a number of very small bones make 
 it possible to compress the feet in childhood and 
 cause them to grow misshapen or even deformed, 
 without severe pain. 
 
 The fad of bare feet and legs had for its inspira- 
 tion the reasonable revolt from the unhygienic treat- 
 ment that childhood had received in this regard, but 
 it was extreme, and may be modified on more rational 
 lines. The freedom is admirable, but the exposure 
 is not always wise. Warmth of the extremities is 
 what we emphasize as necessary to protect a baby 
 from colds, and the intestinal disorders which so 
 often follow. 
 
 The first shoes should be soft kid moccasins, made 
 of ooze or undressed kid, with no stiffness in the ^ g first 
 sole, and fastened with a soft lacing up the front. 
 These are sold by any firm dealing in children's 
 furnishings, but are much more cheaply made at 
 home. To make them is very pretty work, and the 
 pattern can be enlarged as the foot grows, so that 
 there need be no danger of pinching the feet. 
 
 A child can often wear these from the time he 
 
344 CARE OF CHILDREN 
 
 begins to walk until he is three years old, a stouter 
 kid being chosen as he becomes more vigorous. They 
 ensure an absolutely natural position of the foot, 
 quite as truly as no shoe at all, and they offer ample 
 Need of a protection from cold and dampness on the one hand, 
 
 moccasin , r , ,. , , , . , 
 
 protection and irom the dirt and sharp objects that experience 
 to the feet nas p rovec [ are a source f danger to children allowed 
 to go with legs and feet uncovered. The baby who 
 is only creeping, or whose walks are confined to his 
 nursery, does not run the second risk, but older chil- 
 dren do, and cuts from sharp stones or pieces of glass, 
 or the more dangerous wounds from rusty nails have 
 been sources of such serious illness that the protec- 
 tion of feet and legs ought to be appreciated. 
 
 Almost every child when he begins to stand or 
 The nat- walk will hold the feet either at a direct right angle, 
 urai posi- f rom a ii ne drawn down the front of the leer, or 
 
 tion of & ' 
 
 the feet slightly turned in. The prints of his feet show a 
 series of almost parallel lines. It is only when he 
 has grown considerably older that he adopts the 
 "toeing-out" position, which he acquires either from 
 imitation or by definite instruction. The natural 
 position should not be interfered with. He may ac- 
 
 Values 
 
 of the quire habits, like standing with the weight resting 
 posi ion on one j e g on \y } or w jth one foot turned over, which 
 certainly requires correction, but the straight posi- 
 tion of the foot is now believed to give better bal- 
 ance to the body, a firmer contact with the ground, 
 and less strain on the muscles and bones composing 
 foot and ankle. 
 
 The small bones are put together in such a way 
 
 that they form the arch which gives the foot its 
 
 ing 6 of f the grace. An habitually false position continually kept 
 
 the h foot U P weakens the muscles and ligaments which hold 
 
 the bones in place, and the arch breaks down, causing 
 
POINTS ON HYGIENE 345 
 
 the foot to rest evenly on the ground, depriving the 
 carriage of its elasticity and occasioning intense 
 pain during the gradual sinking of the arch, and 
 afterward when the weight of the body is borne for 
 any length of time. 
 
 This is a condition known as flatfoot, and must 
 be corrected by metal plates worn in the shoes, to 
 support the broken arch in its original position. With 
 children the condition is very unusual, and if they 
 were encouraged to maintain the normal position 
 of the feet rather than being instructed and sometimes • 
 forced to walk in the more conventional way, there 
 would be fewer adults with weakness of this kind. 
 
 When the time comes for the child to put on 
 stouter shoes, especial care should be taken to get shoe should 
 those that follow as closely as possible the outlines the outline 
 of his foot. If he has enjoyed the freedom of moc- of the foot 
 casins for two or three years he. will rebel at any 
 approach at undue compression, and this early edu- 
 cation, especially if his somewhat radical views on 
 the subject of footwear are respected by the parents 
 who provide and choose his clothing, will probably 
 make him always regard comfort before fashion, and 
 will save him from many of the adult infirmities. 
 
 Stout soles, flexible leather, and spring heels are 
 three other essentials, and when the heel is changed Essentials 
 
 of a shoe 
 
 it should be by the addition of a very few lifts at 
 a time, should never be high, and should be as a sup- 
 port at the extreme back of the sole, not sloping in 
 toward the middle of the foot. 
 
 DRESS 
 
 We have emphasized the need of simplicity in the 
 clothing of the baby, and of giving him entire free- Need of 
 dom of movement so that he will not feel the restric- simp iaty 
 
346 CARE OF CHILDREN 
 
 tions of tight bands and heavy skirts. These needs 
 increase rather than otherwise with the growing 
 child. 
 
 There is a temptation to regard a child, particu- 
 larly a girl, in the light of a doll, and to try the effect 
 of frills and ribbons upon her, losing sight of the 
 question of her right in the matter. 
 
 Whatever the sex, . the child should be dressed 
 a child with regard to his activities, not to his capacity for 
 dressed decoration. When a baby begins to crawl about 
 
 regard on tne ^ oor or m ms "P en >" ne can ^ e made more 
 to his comfortable and his clothing- will be protected if he 
 
 activities ... ° 
 
 is put into "creepers." These are very full, baggy 
 "Creepers" trousers, gathered around the legs, and extending 
 to the armpits. 
 
 Pinafores may be made for the same purpose, 
 with a draw-string in the hem at the bottom. These 
 serve as a protection to the skirts, which are safely 
 tucked up inside, but the question is whether the 
 little dresses themselves might not be made of col- 
 ored stuff after the trousers pattern, thus avoiding 
 the extra bulk and clumsiness. 
 
 During a baby's waking hours he is always hap- 
 piest when he is carrying on investigations in the 
 dirt or about the floor, which even in a model house 
 can not be free from dust. If he is dressed properly 
 Proper he can be allowed much more freedom both summer 
 allows and winter, and though he may not be such a source 
 na e turai by °^ gratification to the aesthetic sense, his sturdiness, 
 activities healthy color, and growing strength will soon con- 
 vince any one that the beauty of health is greater 
 than the combination of dainty, spotless skirts and 
 fluffy hats, with the delicacy of skin which is due 
 to shelter from breezes and sunshine. When laundry 
 is no consideration the colors of wash suits may, of 
 
POINTS ON HYGIENE 347 
 
 course, be lighter, and white may be worn and is 
 rather more satisfactory than the delicate shades, 
 which soil almost as quickly, and fade in washing. 
 
 We make the mistake often of burdening a child Do not 
 
 . , iii-ii r burden the 
 
 with too much clothing when the same amount of child with 
 warmth could be gained with less weight and clum- clot es 
 siness. 
 
 A perfectly comfortable and suitable set of gar- 
 ments for children to wear may consist of a com- A su j ta bie 
 bination suit, or shirt and drawers, of cotton jersey dress 
 in summer and of woolen or part woolen in winter, 
 a pair of full bloomers or knickerbockers coming 
 just to the knee, and made on a cotton waist, and a 
 Russian blouse of the same material as the knicker- 
 bockers. In winter the combination suit should be 
 high in the neck, long sleeved, and should reach to 
 the ankles. In spring one of medium weight is 
 needed and if the summers are cool or if the child 
 is delicate they may be suitable for the entire season. 
 Otherwise a third set, light in weight, low-necked, 
 short-sleeved, and knee length, will be necessary. 
 
 The knickerbockers and dress are made of cot- 
 ton or linen in summer, and of wool in winter, and 
 the long coat, made of warm stuff, and interlined 
 for the coldest weather, supplies the needed protec- 
 tion. 
 
 This dress, with modifications, is equally suitable 
 for boys or girls. There are no extra garments, the The suit 
 task of dressing and undressing is made very simple, boys and 
 and no style of costume is more becoming to the gir s 
 grace of a childish figure than the long simple lines 
 of the Russian blouse. It lends itself very effectively 
 to artistic ornamentation, though frills, bows of rib- 
 bon, and lace are eliminated by its severity. 
 
 For a girl the skirt of the blouse reaches below 
 
348 CARE OF CHILDREN 
 
 Variation the knickerbockers, concealing them entirely. A 
 boy's is shorter, coming down about halfway between 
 the knees and the waist. 
 
 The difference between their dress usually makes 
 
 Allowing necessary a difference in pursuits, for which there 
 
 activity * s no indication so far as good sense and reason are 
 
 and health concerned. A girl enjoys freedom of limb, activity 
 
 of exercise, and life in the open as well as any other 
 
 healthy little animal, and too often she is forced to 
 
 follow her natural instincts only at the expense of 
 
 her clothes, and a reputation for gentleness, which 
 
 she may not in her heart desire, but which is held 
 
 up before her as a model for her sex. 
 
 The association of children should be natural and 
 
 free, and sexual differences should be emphasized 
 
 Do not as little as possible, either by their dress or their 
 
 sScna1 Slze manners. In this way unnatural precocity will be 
 
 differences SU pp r essed, and consciousness of sexual questions, 
 
 and curiosity concerning them will be delayed till 
 
 development makes explanation necessary. 
 
V 
 
 DISORDERS OF CHILDREN 
 
 Symptoms of Illness— Colic— Jaundice— Inflammation of the Eyes— Thrush— 
 Diarrhoea, Constipation, Convulsions— Teething— Milk Crust— Eruptive 
 Disorders— Hives— Prickly Heat— Ringworm— Croup— Rickets— St. Vitus's 
 Dance 
 
 T 
 
 SYMPTOMS OF ILLNESS 
 
 HE observation of symptoms in children's dis- 
 eases requires much more skill than in the ail- 
 ments of adults. Even when a child is old enough to 
 make complaints, he often does not locate or describe 
 pain at all accurately, and in infancy we must depend 
 almost altogether on objective or involuntary signs of 
 distress. 
 
 We have spoken of the character of the cry. When 
 the pain is in the abdomen, the cry will be long and Signs of 
 loud, and tears will be shed. The muscles of the ab- in the 
 domen will be relieved of strain by the position of the abdomen 
 legs, which will be drawn up close to the body. As 
 the pain subsides, the loud cry will change to deep sob- 
 bing. 
 
 When the chest is involved, the cry is sharp and 
 short, and the breathing will be rapid and labored, in the 
 
 If a child rolls his head from side to side, there is head,' ear 
 suspicion of brain trouble. The cry in this case may 
 be a sharp scream, or a low moaning. If he has ear- 
 ache, he generally rubs the affected side with his hand, 
 and sleeps with it turned down on the pillow. 
 
 Restlessness during sleep, the position he takes 
 when at rest, the character of the stool, the breathing, 
 
 (349) 
 
350 CARE OF CHILDREN 
 
 the temperature, and the pulse should be noted and 
 reported. 
 
 The pulse can be most accurately taken when the 
 
 The pulse child is asleep. In health it should be between ninety 
 
 and one hundred, but it varies so very easily, and is 
 
 influenced by such trivial causes, that more dependence 
 
 is put on the temperature as a guide in sickness. 
 
 If a child shows any symptoms of illness we look 
 Observing at the tongue, we take the temperature, and ascertain 
 symptoms the condition of the bowels. The tongue should be 
 clear and moist, the temperature should be in the near 
 neighborhood of 98. 6° F., and the bowels should be 
 moving easily once or twice a day — the movements 
 should show no undigested food, should be pasty in ap- 
 pearance, and yellow or light brown in color. If we 
 find these three points satisfactory, we may feel as- 
 sured that the disturbance is not a serious one. 
 
 If the child seems to be in pain, and has a rise of 
 Examining temperature, it is always wise to examine the throat. 
 Many of the children's diseases begin with throat 
 trouble, and little children rarely make any complaint 
 that would lead one to suspect where the difficulty 
 lies. 
 
 When a child first shows any signs of illness it is 
 Value of always wise to put him in a warm bath. He should 
 bath remain in it for about five minutes. That will tend to 
 
 bring out the rash if it is one of the eruptive diseases, 
 to reduce temperature, and to soothe the child so- that 
 he can sleep. The room should be warm and the bath 
 should be given with as little disturbance as possible in 
 the preparation. 
 
 It is always safe to give some mild laxative, and 
 oif ia°xa^ e olive oil is as simple a remedy as can be tried. The 
 tlve dose is from twenty drops to a teaspoon of it. 
 
 If there are other children in the family, it is safer 
 
DISORDERS OF CHILDREN 351 
 
 to keep the baby by himself until one is sure that the 
 disease is not contagious. 
 
 If the baby is being fed on the bottle, the food may 
 be diluted a little — one-half the strength if the stomach Food and 
 is disordered. If the temperature is high, he should be 
 given plenty of pure boiled water to drink. 
 
 Xo medication beyond the laxative should be given 
 without the doctor's orders. Many of the various dis- 
 orders that afflict babies can be treated without a doc- 
 tor, but mothers must understand what symptoms are 
 alarming, and which are typical of the more serious 
 diseases. 
 
 COLIC 
 
 One of the earlier of baby ills is colic. If it is 
 persistent, it can often be traced to the food or to a Remedies 
 disordered condition in the mother, when the baby is 
 nursing. Cold hands and feet are sometimes responsi- 
 ble for it, and heat, applied to the body outside, and by 
 warm water, or a little peppermint internally is the best 
 remedy. Colic is caused by an accumulation of gas in 
 the intestines, so the logical course is to set it free, and 
 to cause it to pass downward, and out if possible. 
 
 Paregoric or soothing syrup of any kind is partic- Do not 
 ularly harmful, since it simply dulls the consciousness soothing 
 of pain by the action of the opiate, which is contained p^"^^ 
 in almost any such preparation. 
 
 JAUNDICE 
 
 The jaundice of the new-born is rarely at all alarm- 
 ing. It occurs during the first and second weeks of in- 
 fant life. The skin and the whites of the eyes look very 
 yellow, and the urine is highly colored. It is some- 
 times caused or increased by a tight bandage, and 
 after that is loosened, the symptoms may entirely dis- 
 
352 CARE OF CHILDREN 
 
 Remedies appear. If it persists, especially if it seems to affect 
 
 jaundice the general health, a physician will prescribe medicine 
 
 to stimulate the secretion of bile and to clear out the 
 
 intestines. The bowels should always be kept freely 
 
 opened, and often the use of olive oil will be sufficient. 
 
 INFLAMMATION OF THE EYES 
 
 The routine care of the eyes has been described. 
 
 The discharge from the vagina of the mother at 
 
 the time of birth may infect the baby's eyes, so that 
 
 the inflammation appears shortly after birth. For this 
 
 The reason, the greatest care should be taken to bathe the 
 
 at birth of eyes with boric solution before they are opened at all. 
 
 solution They may be infected at a later time by carelessness in 
 
 handling or by coming in contact with a towel or 
 
 handkerchief that has been used by a person suffering 
 
 from some disease. The treatment in any case is the 
 
 same. 
 
 In the beginning, a redness of the eyelid, with a 
 slight swelling, is remarked. There is also a discharge 
 inflamma- which tends to prevent the eyes from opening. All 
 tion of the these symptoms rapidly become worse, till the eye is 
 and y it s eyeS completely closed, the lining becoming so swollen that 
 danger jj- turns completely out over the lid, if the latter is 
 drawn down. 
 
 It is an extremely dangerous condition, if allowed 
 to persist, for the discharge is very poisonous, and the 
 cornea, or covering of the eyeball, may become ulcer- 
 ated and destroyed, when, of course, the disease would 
 penetrate to the inner chambers of the eye, and the 
 sight would be destroyed. 
 
 A physician should be consulted, unless the redness 
 yields at once to treatment. If the trouble appears 
 in a new-born baby, the doctor should be at once ad- 
 vised of it. 
 
DISORDERS OF CHILDREN 353 
 
 Thorough irrigation of the eye is necessary. This irrigat- 
 should be done with a boric solution, and may have to 
 be repeated every fifteen minutes. It must be done 
 often enough to keep the eye entirely free from dis- 
 charge. The lids are to be separated, and the solu- 
 tion, warmed to body heat, allowed to flow plentifully 
 over the ball of the eye. 
 
 The same precautions which are to be given in 
 the ordinary care of the eyes are to be observed here. Precau- 
 The solution must flow toward the outer angle of the 
 eye, so that there is no chance of carrying the infec- 
 tion from one eye to the other. Cloths or compresses 
 must be burned. 
 
 Basins should be boiled or burned out with alcohol Disinfec- 
 after use, and great care must be taken in washing 
 the hands at once after giving the treatment. 
 
 The baby should never occupy the same bed with 
 other children, and he ought to be completely isolated. 
 The doctor will probably order compresses wrung out 
 of ice-water, and applied constantly over the eyes. 
 
 Danger lies in the neglect of such a condition as 
 this. It is estimated that no less than one-fourth of the Danger 
 cases of blindness in adults is traceable to this disease, neglect 
 It is most common among persons who live in unsani- ^nesT 
 tary surroundings and who are careless about cleanli- 
 ness, and the commonest laws of hygiene. 
 
 THRUSH 
 
 Thrush or sprue is a disease of the digestive tract. 
 
 It is caused by improper food, or by neglect of the 
 mouth, which should be washed frequently during the How 
 day. The particles of milk which remain in the mouth D r 0U ght S 
 after feeding decompose and cause tiny ulcers to form. about 
 These spread into patches, and in severe cases extend 
 all over the mouth, and even into the stomach. The 
 
354 
 
 CARE OF CHILDREN 
 
 The 
 remedy 
 
 throat and mouth may become so tender that swallow- 
 ing is almost impossible, or the irritation may cause a 
 diarrhoea, which is very exhausting. 
 
 A wash of borax, or one made of a teaspoon of 
 baking soda in a cup of water, is usually the remedy 
 given. The mouth should be washed out very gently, 
 as there is danger of irritating the delicate lining mem- 
 brane. It is perhaps better to apply the solution with 
 a soft camel's-hair brush. 
 
 Prevention is much simpler than cure, and the ut- 
 Prevention most care should be taken in the preparation of food, 
 and in the care of utensils, in order to guard against 
 such possibility of disease. 
 
 There are normally in a baby's mouth tiny white 
 spots, which are called "pearls." These do not indicate 
 disease, and should not be rubbed with any force in 
 cleaning the mouth. After a little observation, it will 
 not be difficult to distinguish the difference. 
 
 Thrush is more likely to occur in a child whose re- 
 sistance is weakened by some exhausting disease. 
 There is no need of its appearance in a healthy child, 
 if he receives proper care. 
 
 "Pearls" 
 
 What 
 
 diarrhoea 
 
 indicates 
 
 The first 
 treatment 
 
 DIARRHCEA 
 
 Diarrhoea is caused by some irritating substance 
 which is present in the intestines. 
 
 With the bottle-fed baby, who is most subject to 
 the trouble, it means too often neglect in the care of 
 bottles or nipples, or carelessness in the choice of the 
 milk. With older children it is generally due to the 
 eating of unripe or decayed fruit, or to an excess of 
 green or tainted vegetables. 
 
 Our first task is to get rid of the irritating poison, 
 and there are certain things that the mother can do 
 promptly before a physician comes. A teaspoon of 
 
DISORDERS OF CHILDREN 355 
 
 castor oil will purge the bowels, and the digestive ap- 
 paratus may be relieved of some of its work by stop- 
 ping all the milk for twenty-four hours at least. " 
 
 Barley water, wheat gruel, or mutton broth and 
 barlev water, in equal parts, may be substituted. The Substitutes 
 frequent loose movements are taking a great deal ot 
 water from the system, so this should be supplied as 
 far as possible, by giving as much water as he will 
 drink. It should be boiled and cooled. 
 
 There is often vomiting with the diarrhoea, when 
 it may be impossible for the stomach to dispose of any Egg-water 
 food at all. In that case, egg or albumen water, as 
 it is called, will furnish a little nourishment, and can 
 generally be retained. This can not be relied upon 
 for any length of time, but is better than an absolute 
 fast, till the trouble is under control. The egg-water 
 is given in small amounts, sometimes a teaspoon at 
 a time, and at intervals of half an hour, or from two 
 to three ounces every two hours. 
 
 If the trouble seems to be chiefly in the stomach, 
 it may not be necessary to eliminate the milk entirely Peptoniz- 
 from the diet. It may instead be predigested by pep- p n r |5ge S t- 
 tonizing. As has been stated in a previous chapter, ing foods 
 the peptonizing must not be continued, as it leaves too 
 little work for the stomach to do. Cereo is a prepara- 
 tion which predigests starchy foods, as the peptoniz- 
 ing powder does milk, and this can be added to gruel, 
 leaving out the sugar in this case, and making it double 
 the strength. Cereo comes in bottles, with directions 
 for its use, and can be obtained in any drug-store. 
 
 The movements of the bowels are not only watery 
 and frequent, but they are generally of a bright green Symptoms 
 color, and contain small curds, showing that the milk require 
 is not being taken into the system, but is passing ^nh^miik 
 through the canal undigested, and is acting only as an 
 
356 
 
 CARE OF CHILDREN 
 
 Summer 
 complaint 
 and 
 dysentery 
 
 irritant. This condition is an indication for stopping 
 all the milk for twenty-four hours at least, to relieve 
 the digestive apparatus of some of its work. 
 
 The diarrhoea may indicate a simple temporary 
 derangement of the bowels, or it may accompany the 
 dreaded summer complaint, when the stomach as well 
 is involved, or it may take the form of dysentery, when 
 blood and mucus appear in the stool. The two latter 
 diseases are very dangerous, because if long continued 
 the system becomes so weakened that the strength is 
 spent and the child does not rally, even if the first cause 
 can be removed. If the cathartic does not accomplish 
 the desired result, the doctor will probably order rectal 
 irrigation with a salt solution. He will give the mother 
 directions and assistance for the first time at least, and 
 usually it should not be done without his orders. 
 
 There are times, however, when a woman must act 
 upon her own responsibility in such matters, and if 
 she understands the use of the syringe and realizes the 
 need of care, there is little danger of harm. The ap- 
 paratus for flushing a baby's bowels is a fountain 
 syringe, a soft rubber catheter, one that will fit over 
 the smallest enema point, and a basin to receive the 
 water as it flows out. 
 
 The solution is boiled water, which has been cooled 
 Giving to about -100° F., to which is added one teaspoon of 
 In 6 enema table-salt to each pint. Put the baby on a table, with 
 a thick pad and a rubber under him. His clothes 
 should be turned up, so that there is no danger of' their 
 getting wet, and he is drawn down so that the buttocks 
 rest on the edge of the table. A basin is placed just 
 underneath, close enough to receive the water^ and 
 the syringe is hung about three feet above. 
 
 The directions for enemata and rectal irrigation in 
 Part II are to be followed here, but with a baby the in- 
 
 Using the 
 
 syringe 
 
DISORDERS OF CHILDREN 357 
 
 sertion of the oiled catheter must be clone with extreme Especial 
 gentleness, because of the danger of puncturing the precau- 
 delicate intestine, It should never be forcibly pushed t,on 
 up, but if it is done slowly, waiting till the bowel re- 
 lapses from time to time, it can gradually be intro- 
 duced nearly its entire length. 
 
 The water is first turned on when the catheter is 
 inserted about two inches into the rectum, in order 
 to clear out the gas, and the accumulation in the 
 lower bowel. After the water comes away clear, 
 which it will generally do while the second pint 
 is being given, the enema point is detached from the 
 catheter, and the abdomen is gently kneaded with the 
 hand to get rid of the remaining fluid. 
 
 This irrigation may be ordered twice a day, and is 
 valuable, not only because it cleanses the intestine of Effect 
 the irritating poison which it contains, but because it treatment 
 supplies a fluid to replace what is lost by the watery 
 evacuations, and because the salt stimulates the tissues, 
 and reinforces the blood supply. It should not be con- 
 tinued more than a few days v/ithout a doctor's advice, 
 because in cases of extreme prostration the exertion 
 may outweigh the results for good. 
 
 The baby's bath should be continued through any 
 illness, unless forbidden by the physician. It should, Added 
 however, be given under a blanket, and the child should daifybath 
 be moved as little as possible. When the diarrhoea 
 is accompanied by extreme emaciation, it is sometimes 
 considered that rubbing the child with oil supplements 
 the feedings. 
 
 Olive oil may be used, and it should be rubbed in 
 thoroughly, particularly over the abdomen. It was The oil 
 once believed that the skin possessed to a considerable at 
 degree the property of absorption, and medication was 
 often given in that way. The importance of this func- 
 
358 CARE OF CHILDREN 
 
 tion was probably exaggerated, but the good effects of 
 rubbing are unquestioned, and the oil will do no harm, 
 especially if the daily bath frees the pores from any 
 accumulation which might clog them. 
 
 The band or woolen covering ought never to be 
 Protecting left off. If it has been taken off, it should immediately 
 abdomen ^ e P ut on > an d as tne ^ eet are inclined to be cold, it 
 and feet [ s we \\ to use little socks or stockings, at least until the 
 circulation is re-established and the disordered con- 
 dition is corrected. Entire change of air and sur- 
 roundings often does more for the baby than any 
 amount of treatment or medicine, and if he can be 
 taken away at once to where he will be able to breathe 
 purer air, the trouble may be almost immediately re- 
 lieved. The treatment of whatever sort should be 
 given at once. The danger here lies, as it does in any 
 disease which progresses rapidly, in delayed treat- 
 ment. 
 
 CONSTIPATION 
 
 Constipation is too often the result of carelessness 
 on the part of the person who has charge of the child. 
 Care the From his birth, the condition of the bowels should be 
 Xmid" given attention, and any disorder should be at once re- 
 exerdse lieved. If the mother is nursing the baby, she can reg- 
 ulate his bowels by attention to her own. She should 
 take daily walks, drink plenty of water, and eat fruits 
 and coarse bread, and, if necessary, use medicines to 
 remedy the constipated condition, which will act upon 
 the baby through the milk. 
 
 Gentle rubbing of the baby's abdomen from the 
 right groin up, across and down the left side, with a 
 circular motion of the fingers, often stimulates the 
 action of the intestines. This should be done two or 
 three times each day, but not immediately after a meal. 
 
DISORDERS OF CHILDREN 359 
 
 If a child is held over a small chamber, and the ab- Teaching 
 domen is gently massaged, twice each day shortly after regularity 
 he has had his bottle, he can be taught habits of reg- 
 ularity at an early age. 
 
 A little stimulation to the rectum may be all that 
 is needed. A small cone of castile soap may be cut, 
 and inserted for a moment into the rectum, or a very 
 tiny bit may be pushed up and allowed to stay till it 
 comes away with the defecation. Gluten suppositories 
 may be used, but glycerine is usually too irritating. 
 If the trouble lies in the sluggishness of action in the 
 lower bowel, these remedies will be all that is neces- . 
 sary. If the child is losing in weight, it may be that 
 he is not getting enough food, and if he is nursing, 
 one or two bottles of modified milk may be substituted 
 for the breast feedings. A little cream or beef- juice 
 given him before nursing may help him. 
 
 With a bottle-fed baby, the amount of cream may 
 be increased, oatmeal gruel may be added to the food, Modifka- 
 and the lime water should be omitted. He should have b6ttie-° r * 
 plenty of boiled water to drink, and if this treatment fed baby 
 does not prove effective, olive oil may be safely given. 
 
 Castor oil leaves a baby more constipated than be- Neither 
 
 J r castor oil 
 
 fore, so should not be used. Drugs should not be given nor drugs 
 without a doctor's orders. remedy 
 
 CONVULSIONS 
 
 Convulsions may occur in connection with some 
 disease, such as croup, diarrhoea, some of the infec- Causes of 
 
 r . convulsions 
 
 tious fevers, or as a serious brain trouble, but they 
 are also caused by a disordered stomach, difficulties 
 in teething, and extreme nervousness. 
 
 The treatment in any case is the same, and meas- 
 ures for immediate relief can generally be taken before 
 it is possible to summon a physician. The head should 
 
860 
 
 CARE OF CHILDREN 
 
 Giving 
 the warm 
 bath 
 
 be kept cool with compresses of cold water, or with 
 bits of ice in an ice-bag or piece of oiled silk. The 
 Treatment extremities should be heated, and for this purpose the 
 doctor ' child should be given a mustard foot-bath — not hotter 
 than 95 F. Two tablespoons of mustard to a gallon 
 of water are used, and the feet and legs should be kept 
 covered with the water till they are quite red. After 
 the bath, he should be wrapped closely in a blanket, 
 which will induce perspiration. 
 
 If the child is small, and conveniences are at hand, 
 the entire body can be immersed in the bath. If a bath- 
 thermometer is not available, the bared elbow may be 
 used to test the temperature of the water, using it no 
 hotter than can be comfortably borne if no mustard 
 is added, remembering that the mustard increases the 
 stimulating action of the bath, .so that it is given at a 
 lower temperature. 
 
 If the convulsions continue, an enema should be 
 given, for pressure in the bowels is very liable to 
 cause them. If the bath has relieved the condition, 
 a dose of castor oil will answer the purpose as well 
 as the injection. 
 
 TEETHING 
 
 Teething can not be reckoned among diseases, 
 
 Teething and is spoken of here very briefly, simply because it 
 
 susceptible makes a child more susceptible to other ills, and 
 
 ii°is° ther special care should be taken to keep all the conditions 
 
 of his life as normal and hygienic as possible. 
 
 He should spend as much time as he can in the 
 open air, and the feet and legs should be protected 
 with stockings and soft kid moccasins if short 
 dresses are worn, and the care in the preparation of 
 the food should be increased. The appetite may be 
 variable, and the feedings should not be forced. 
 
DISORDERS OF CHILDREN 361 
 
 The first teeth usually appear at about the sixth When the 
 month. At about the fifth month there begins to be appear 
 an increased flow of saliva, and the baby will need 
 bibs, generally lined with some sort of waterproof 
 cloth, to protect his dresses. 
 
 Care must be taken that he does not form the 
 habit of thumb-sucking' at this time. A little baby Restrain- 
 
 . ' ing from 
 
 can be restrained by drawing his dress sleeve down thumb- 
 over his hand and sewing it over and over across su 
 the end. A small bag tied over the hand has the 
 same effect. 
 
 If there is fever and restlessness, frequent sponge 
 baths in alcohol and water will be found very quiet- 
 ing. Sometimes the gums become so red and swollen 
 that lancing is necessary and gives great relief. 
 
 MILK CRUST 
 
 This is most frequently seen on the head, and is 
 often caused by lack of cleanliness over the fontanelles cause of 
 or open spaces between the bones of the scalp. It crust 
 is caused by the inaction of the tiny glands which 
 manufacture oil, but it is allied to eczema, and should 
 receive similar treatment. 
 
 The hair should be cut as close as possible, and 
 the crusts softened with oil or a simple ointment, like Treatment 
 that made from boracic acid. It may be necessary 
 to leave the ointment on overnight, after which the 
 head is washed with warm water and castile soap. 
 
 The scalp should be washed daily with warm olive 
 oil, and fresh ointment, spread on a linen cloth, should 
 be applied. 
 
 The scalp is sometimes neglected on account of 
 fear of injuring the delicate brain beneath the open- 
 ing;. There is very little danger of this with the 
 moderate energy required to keep it clean. 
 
362 CARE OF CHILDREN 
 
 ERUPTIVE DISORDERS 
 
 Eczema is another disease of the skin which at- 
 tacks children more generally than adults. It may 
 appear with the formation of crusts over the affected 
 part, or the surface may seem reddened and moist 
 In any case there is intense itching, and as scratch- 
 Treatment ing may retard recovery very materially, the first 
 of eczema requisite in its . treatment is' to protect the parts from 
 the child's hands. The physician will advise the. 
 ointment or powder which should be applied, and 
 the use of water should be avoided for the process 
 of cleansing, oil being used instead. Rest and quiet, 
 with the thorough application of the remedy, gener- 
 ally give good results 
 
 On very little babies there sometimes appears a 
 
 Cause is red rash like tiny pustules, which is found especially 
 
 digestive on the face and neck, and about the buttocks. It is 
 
 disorders g enera iiy due to a slight digestive disorder, and needs 
 
 no treatment beyond powdering for comfort. 
 
 Indigestion in children is often accompanied by 
 a rash, and it may occasion alarm because of its 
 resemblance to measles. Keeping the child warm and 
 quiet, giving a warm bath and a laxative is always 
 safe treatment, and a day or two will decide if the 
 trouble is at all serious. 
 
 HIVES 
 Hives or nettlerash is another form of eruption, 
 Treatment which is very uncomfortable though not at all dan- 
 gerous. The itching is extreme, though one charac- 
 teristic of the disease is that the blotches are not 
 raised and apparent all the time. Bathing with 
 water containing bicarbonate of soda (baking soda) 
 soothes the irritation. 
 
DISORDERS OF CHILDREN 363 
 
 PRICKLY HEAT 
 
 Prickly heat is common in the summer, especially 
 if a baby is kept too warm and has not frequent 
 sponge baths. 
 
 When the rash is troublesome the baths may be 
 of tepid water, with a little vinegar or baking soda Remedy 
 added. It may be wise to put on a short slip of h eat PnCk V 
 cotton or linen next the skin, because the woolen 
 shirt may be too irritating at this time. 
 
 RINGWORM 
 
 Ringworm is a disease caused by the action of a 
 parasite, and is seen sometimes on the scalp and 
 sometimes on other parts of the body. When it 
 attacks the scalp it causes the hairs in the affected 
 part to break off from lack of nutrition. 
 
 It can be conveyed from one person to another, 
 and for this reason painting with iodine or with Ringworm 
 
 .,«.-.- i i . i * s conveyed 
 
 collodion is often the treatment, as this serves the from one 
 double purpose of protecting other children from Jnother° 
 infection and of keeping the diseased area from dust 
 and other irritation. 
 
 Ointment of salicylic acid or carbolized vaseline 
 is effective and any curative measures must include Treatment 
 thorough soap and water cleansings. The name sug- 
 gests the circular form of the appearance. 
 
 CROUP 
 
 Many of the diseases which used to be looked 
 for as a matter of course during a child's life are 
 much less common now that more reason is used in 
 the feeding, clothing, and general care. 
 
 The ordinary spasmodic croup may result from 
 exposure or a sudden change from heat to cold, caused symptoms 
 by wearing an unnecessary amount of clothing, or of croup 
 
364 CARE OF CHILDREN 
 
 from an overloaded stomach. The attacks are gen- 
 erally sudden. The child wakes in the night with 
 hoarse breathing and the rasping cough which is so 
 characteristic of the disease that once heard it is 
 always recognized. 
 
 Flannels wrung out of hot water and placed about 
 Treatment the throat give relief, and the heat and moisture may 
 be kept in by a piece of oiled silk. A mustard bath 
 or a foot-bath is often given. Vomiting and a free 
 evacuation from the bowels generally give great 
 relief. The physician will probably give syrup or 
 wine of ipecac, followed by drinks of warm water 
 till vomiting results. 
 
 The attack is often repeated for several succes- 
 sive nights unless precautions are taken. These pre- 
 cautions are light diet, quiet and rest, and free move- 
 ment of the bowels. 
 
 Membranous croup is altogether a more serious 
 
 Membra- affair, and is classed by many physicians with diph- 
 
 oup theria. The especial danger lies in the growth of the 
 
 membrane in the throat. The character of the cough 
 
 will indicate to the mother whether the throat is 
 
 clear. 
 
 In all cases of croup the air should be kept moist, 
 Safeguards and this also gives great relief in bronchial colds. An 
 of a croup es apparatus called a vaporizer can be bought at a drug 
 store, but it is rather expensive, and the same effect 
 can be obtained with a teakettle and a few feet of 
 rubber tubing with a bore large enough to go over 
 the spout of the kettle. 
 
 Very often it is sufficient to keep the air about the 
 
 Arrange- patient's bed in a moist state, but sometimes direct 
 
 secure inhalations, medicated or not, are given, and in the 
 
 Sanations case °^ cr °up the doctor may order a tent to be 
 
 arranged over the crib so that the moisture may be 
 
DISORDERS OF CHILDREN 365 
 
 confined. A screen or a clothes-horse may be placed 
 about the head of the crib, and sheets may be hung 
 over it in such a way as to keep in the steam very 
 successfully. Special methods of inhalation have 
 already been described. 
 
 RICKETS 
 
 If a child has improper food, or unhygienic sur- 
 roundings, if he is fed exclusively on condensed milk How the 
 
 i i • i-i i disease is 
 
 or is kept too long at the breast, he is likely to induced 
 develop a disease called rachitis, which, while not 
 being of a serious nature in itself, impoverishes the 
 system so that it is very susceptible to tuberculosis, 
 and, in fact, to any disease. 
 
 If the cause of the trouble is recognized and re- 
 moved, and the child's food and exercise are regu- 
 lated with regard to the highest ideals of health, 
 entire cure of the disease is possible. 
 
 The head of a child with rachitis is generally 
 larger than normal, and it is inclined to perspire very symptoms 
 freely so that the pillow may be quite wet. The disease 
 blood is of poor quality, so that the child is very 
 white and the flesh is soft "and flabby. All the tissues 
 are lacking in tone, but it is the bones which show 
 most plainly the results of the trouble. At birth the 
 bone substance is largely cartilaginous, but the hard- 
 ening or ossifying process is rapidly carried on till 
 it is possible for a child to support the weight of the 
 body on the legs, the bony plates of the skull no 
 longer have openings between them, and the entire 
 framework of the body is more rigid and unyielding. 
 
 When a child has rickets this hardening of the How 
 bones is not complete, and there is consequent danger results 11 * 7 
 of deformity as an effort is made to sit up or to 
 walk. The muscles of the back are insufficiently de- 
 
366 CARE OF CHILDREN 
 
 veloped to keep the spine straight, so that a curva- 
 ture is very noticeable; the weight of the body on the 
 bones of the pelvis forces them out of place, and if 
 an effort is made to walk the legs are almost surely 
 bowed or knock-kneed. 
 
 The pelvic deformity may cause no discomfort 
 till later in life, but if the baby is a girl there may, 
 be serious or even fatal consequences from it at the 
 period of child-bearing. Other symptoms which in- 
 dicate this disease are a protruding abdomen, en- 
 larged joints^ constipation, and restlessness. 
 
 The child needs an increase of fat in the food, 
 
 Food for and may occasionally be given a strip of boiled bacon 
 
 w ith to suck. The bacon should be thoroughly cooked, 
 
 nckets k ut not cr - S p enough so that he can break off bits in 
 
 his mouth. 
 
 The food should be varied, and of course his age 
 will decide how much deviation is possible, but the 
 existence of the trouble indicates that more nourish- 
 ment is required. Beef -juice, broths, and fruit- juices 
 are advisable, but starchy and sweet food should be 
 limited. Daily baths and thorough rubbing must be 
 given, and plenty of fresh air and sunshine are always 
 prescribed. 
 
 CHOREA, OR ST. VITUS'S DANCE 
 
 How "Chorea is a disease characterized by irregular 
 
 fancfc'is 18 S spasmodic contractions of different muscles or sets 
 brought on f milS cles, especially of the upper and lower ex- 
 tremities." It attacks children chiefly, usually at 
 about the period when the second teeth are coming 
 through, It is a nervous disorder, v and may be 
 brought on by fright or by the excitement of com- 
 petition in school. It often seems to accompany rheu- 
 
DISORDERS OF CHILDREN 367 
 
 matic and heart disorders, though many times the 
 attack seems quite independent of other diseases. 
 
 The twitching of the muscles may be slight, but 
 in severe cases it becomes so constant and violent Symptoms 
 that the child can not walk or speak, take nourish- 
 ment, or even lie quietly in bed. During sleep there 
 is usually rest. 
 
 A child showing any signs of chorea should be 
 taken at once from school. Absolute rest in bed is Treatment, 
 the most effective treatment for the first week till im- and Vest 
 provement begins. After that the exercise should 
 be moderate, there should be no mental excitement, 
 and the diet should be nourishing and easily digest- 
 ible. Milk and eggs should be given in plenty, and 
 koumiss is advised if the child has a liking for it. 
 
 Above all the night should be restful, and a phy- 
 sician will probably prescribe a sedative if there is a How 
 tendency to sleeplessness. The society of other children 
 children is not advisable, because if they are inclined ma y . . 
 
 . . . . . acquire the 
 
 to be nervous at all they have an inclination to imi- disease 
 tate the awkward motions of the patient, and may 
 even contract the disease. On the other hand she is 
 less able to control her movements when she is em- 
 barrassed by observation. 
 
 There should be no thought of putting her back 
 into school until recovery is complete, and all mental The 
 strain should be avoided for a year or more, in order need" 1 
 to guard against the possibility of a second attack. lon s rest 
 It should be remembered that a healthy body is the 
 first requirement in the child's equipment for life, 
 and the early years of school count very little when 
 weighed against a loss of physical or nervous vigor. 
 
VI 
 
 CONTAGIOUS DISEASES 
 
 Mumps— Whooping - Cough— Measles— Chicken - Pox— Scarlet Fever— Neces- 
 sary Precautions in Contagious Diseases— Scarlet Fever is 
 Infectious— Diphtheria 
 
 IT should not be taken for granted that a child 
 must go through the entire list of contagious 
 diseases. The susceptibility to most of the diseases 
 decreases with the years, and as a general rule we 
 may say that the mortality is less among older chil- 
 dren than among babies. 
 
 The diseases of children are regarded too much 
 a child m a fatalistic way, as if they were a foreordained 
 though' g ° m > with little attem P t at mitigation. On the other 
 the con- hand, there is no need of borrowing trouble and of 
 
 tagious .. . ii- 1 
 
 diseases avoiding contagion by unreasonable caution and over- 
 suppose carefulness. The mother who takes her children 
 to°cMd- out °^ a neighborhood when a case of measles is re- 
 hood ported there, is quite as likely to find it in the house 
 with her at the end of her journey. 
 
 MUMPS 
 
 This is a disease affecting the salivary glands, es- 
 pecially the one lying back of the ear. 
 
 There is difficulty in swallowing and acute pain, 
 Symptoms especially when taking food. The trouble begins 
 with chill, headache, and a general . feeling of dis- 
 comfort. 
 
 The period of incubation, that is, the time be- 
 tween exposure and the first symptoms of disease, is 
 (368) 
 
CONTAGIOUS DISEASES 369 
 
 from eight days to two weeks, and the pain and 
 swelling begin to subside after four or five days. 
 
 Cloths wrung out of hot water help to relieve the Relieving 
 pain somewhat, and there is little treatment besides f mumps 
 this. As is usual in any disease, the bowels must be 
 kept open, the diet should be light, and the child 
 should be kept quiet in a well-ventilated room of 
 even temperature. This disease is both infectious and 
 
 WHOOPING-COUGH < 
 
 Whooping-cough is an infectious disease, and be- 
 gins very much like a catarrhal cold. The charac- 
 teristic "whoop" may not be heard for ten days. 
 
 The attacks of coughing are spasmodic, and the 
 feeling of strangulation is very distressing. The fits 
 of coughing often end in vomiting, though otherwise 
 the stomach seems unaffected. 
 
 The child should be instructed to close his eyes Special 
 while he is coughing, because of the strain which to the 
 sometimes causes them to become crossed. sufferer 
 
 He should be kept out of doors as much as pos- 
 sible, if it is warm weather, and if the fever which 
 often is present in the beginning has subsided. If Fresh air 
 the autumn comes on before the cough has stopped, tre atment 
 it may run on and prove troublesome during the cold 
 weather. For this reason a change of air during the 
 later stages may be advisable, since it often shortens 
 the attack. 
 
 MEASLES 
 
 Measles is an extremely contagious disease, and 
 spreads so rapidly that it is liable to become epi- 
 demic. The period of incubation is from eight to ten 
 days. 
 
 The first symptoms are those of an ordinary cold 
 
370 
 
 CARE OF CHILDREN 
 
 Symptoms 
 of measles 
 
 The rash 
 of the 
 measles- 
 
 Length 
 of the 
 patient's 
 seclusion 
 
 Special 
 care of 
 the eyes 
 and mouth 
 
 The 
 warm bath 
 
 in the head. There is marked influenza, the discharge 
 from eyes and nose is watery and profuse, and is 
 accompanied by a cough. This is the period when 
 there is most danger of contagion. There is gener- 
 ally some rise of temperature and headache. 
 
 A physician can detect the rash in the throat and 
 the roof of the mouth before it appears on the skin, 
 where it generally can be seen on the fourth day, 
 first on the forehead, then upon the neck and chest, 
 rapidly spreading all over the body. It is a dull red- 
 dish color, and feels distinctly rough under the fingers. 
 The tiny spots soon run together, leaving crescent- 
 shaped patches of clear skin between. 
 
 The rash remains in evidence for two or three 
 days usually, and with its disappearance the other 
 symptoms gradually subside. Desquamation, or peel- 
 ing of the skin in fine scales like bran, follows, and 
 the child should be kept away from other children 
 for two weeks after this has entirely ceased. 
 
 As a rule measles is not a difficult disease to care 
 for. The child should remain in bed, carefully pro- 
 tected from draughts, but not too warm; the room 
 should be well ventilated and kept at a temperature 
 between 68° and jo° F. The diet should be light, 
 and the bowels should be kept open. 
 
 The eyes are generally inflamed, and they are ex- 
 tremely sensitive to light. 
 
 The room should be darkened, and the eyes should 
 be bathed two or three times a day with a boric solu- 
 tion. Lack of care in this detail sometimes leads to 
 a permanent weakness. The mouth also needs fre- 
 quent rinsing. 
 
 During the peeling a warm bath, under a blanket, 
 should be given each morning, after which the whole 
 body should be rubbed with vaseline. This prevents 
 
CONTAGIOUS DISEASES 371 
 
 the scales of skin from flying about, and also allays 
 the itching. 
 
 The complications in measles are what make it 
 a disease to be feared. With babies and very small tions in 
 children there is a liability to pneumonia which makes 
 watchful care necessary, and which calls for a physi- 
 cian's supervision over the condition of the lungs. 
 
 The child should be completely isolated, and if 
 possible the person caring for him should have noth- 
 ing to do with the rest of the family. This is not ^ h e e ssening 
 practicable in homes where the mother must be nurse dan ? er . of 
 
 r contagion! 
 
 and housekeeper as well, but she can lessen the 
 danger of contagion by proper care. 
 
 Cotton dresses should be worn whenever one is 
 caring for the sick, and if the mother keeps a large 
 cap and a garment like a long-sleeved, high-necked 
 pinafore just outside the chamber, and always wears 
 it when waiting on the child, the risk of unneces- 
 sarily communicating the disease is reduced. She 
 should be careful to wash her hands before touching 
 anything outside the sick-room and should never use 
 for the child a towel or handkerchief which is to 
 serve any other purpose. 
 
 The discharges from the nose and eyes are the 
 most direct means of communicating the disease, and 
 since the complications may be so serious we should 
 be very conscientious in our efforts to keep other 
 children from exposure. 
 
 The clothing and bed-linen used about the child 
 should be soaked in a solution of carbolic, one ounce i ng the 
 of the acid to two gallons of water. They should j^^Tes 
 then be boiled for half an hour before they are 
 handled by the laundress. 
 
 Before the child leaves the room he should be 
 given a full bath in a 1-5000 bichloride solution. 
 
372 
 
 CARE OF CHILDREN 
 
 Disinfect- 
 ing the 
 room 
 
 Contagion 
 of chicken- 
 pox 
 
 The rash 
 or pox 
 
 Relieving 
 the 
 
 The 
 
 patient's 
 isolation 
 
 Then he may be wrapped in a clean blanket and 
 taken into another room, where fresh clothing may 
 be put on. 
 
 The room must be fumigated before it is used, 
 and in most towns this is put into the hands of the 
 Board of Health. In the country, where there is 
 no such provision, it will be done under the doctor's 
 supervision. 
 
 CHICKEN-POX 
 
 Chicken-pox is a mild contagious disease, which 
 attacks children of all ages. It may be communi- 
 cated by a third person or by direct contact, and may 
 appear at any time between ten days and three weeks 
 after exposure. The liability of contracting, it is 
 much less as time goes by. It is an intensely uncom- 
 fortable disease, on account of the itching, and be- 
 cause scratching must be prohibited. 
 
 A slight fever may introduce it, but the rash is 
 often the first indication. This appears first as reddish 
 pimples, which come out in successive crops all over 
 the body, being thickest on the back. The spots soon 
 become blisters, which dry, leaving crusts. These 
 may drop off in the course of five days, and they may 
 remain for over two weeks. 
 
 If the eruption has been deep or if the crust has 
 been removed before it is loosened there may be 
 slight scarring, but this is not usual. If the body is 
 rubbed with vaseline the irritation will be relieved, and 
 the scratching must be prevented because of the 
 danger of poisoning if the finger-nails come in con- 
 tact with the open sore. 
 
 A child should be kept in bed as long as the fever 
 lasts, and in fact while the eruption is appearing he 
 will probably be most comfortable undressed. He 
 
CONTAGIOUS DISEASES 373 
 
 should not be allowed to play with other children 
 till the skin is quite clear. 
 
 Fumigation, while not so essential as in more 
 serious diseases, is an advisable course when there 
 is any chance of exposure to other children. 
 
 SCARLET FEVER 
 
 Scarlet fever is one of the most serious of the 
 contagious diseases, more by reason of its complica- 
 tions and the illnesses that sometimes follow it than 
 by its direct results. Children under one year old are 
 less susceptible to it, and it is supposed that grown 
 persons rarely contract it. 
 
 One attack generally renders a person immune. 
 It is communicated by direct exposure, by contact scarlet 
 with a third person, with articles that have been used i s commu- 
 about the sick-room, by being in a room which has mcated 
 not been fumigated. 
 
 The first symptoms generally make their appear- 
 ance about a week after exposure, though the time 
 may vary from three to twelve days. Increase in symptom! 
 temperature is very rapid, making us suspect that it ? f scarlet 
 is more than an ordinary cold, even if the acute sore 
 throat did not alarm us. Nausea and vomiting are 
 generally early symptoms, and with little children 
 there may be convulsions. White spots appear on 
 the tonsils, and the appearance of the tongue is very 
 characteristic — a white coating dotted with bright red 
 spots, giving it the name of ''strawberry tongue." 
 
 The rash, which generally comes out on the sec- 
 ond day, is bright red, finer than measles and so 
 close together that the whole body looks scarlet. It The rash 
 is seen first on the neck and chest, and rapidly ex- 
 tends over the whole body. Ordinarily the rash re- 
 mains out for about five days, but the desquamation 
 
374 
 
 CARE OF CHILDREN 
 
 Special 
 care in 
 the desqua- 
 mation 
 
 Baths and 
 ventilation 
 
 Watchful- 
 ness 
 against 
 colds and 
 resulting 
 kidney 
 disorder 
 
 Earache 
 with 
 scarlet 
 fever 
 
 often takes two and sometimes three weeks. The 
 skin is shed in much larger scales than in measles, 
 and this period of the disease is considered the most 
 contagious. Care must be taken to keep these scales 
 from being scattered about the room, and the rub- 
 bing with oil Or vaseline is of use on this account. 
 
 Washing the mouth, spraying the throat, and 
 giving frequent sponge-baths if the temperature is j 
 high help to make a child less restless, and relieve 
 the suffering. If the fever is high, ice-bags or cool 
 compresses on the head often quiet the restlessness. 
 
 Particular care should be given to ventilation, and 
 to keeping the room at an even temperature, and the 
 food should be liquid, and diluted if the child is still 
 on the bottle. 
 
 The skin with its glands assists in the work the 
 kidneys carry on, of ridding the system of waste 
 matter. During desquamation there is especial danger 
 of catching cold, which interferes with this function. 
 It then happens that an extra burden is laid on the 
 kidneys, and they are very liable to become diseased. 
 This is one of the complications to be guarded against 
 in scarlet fever, and it is well for the mother to save 
 specimens of the child's urine for the doctor's exam- 
 ination. 
 
 This trouble may appear after the child is ap- 
 parently well, so the watchfulness must not be re- 
 laxed, and the doctor must be consulted if the urine 
 at any time seems unnatural in color or quantity. If 
 the limbs or eyelids seem unduly swollen or puffy it 
 should be at once reported. 
 
 Earache sometimes still further complicates the 
 disease, as it may leave a child permanently deaf 
 unless it is attended to at once. It is due to the fact 
 that the inflammation of the throat has extended up 
 
CONTAGIOUS DISEASES 375 
 
 into the ear, and the physician will puncture the ear- 
 drum, which gives relief and often saves the hearing. 
 When the inflammation subsides the small hole in 
 the drum will soon heal over. 
 
 PRECAUTIONS IN CONTAGIOUS DISEASES 
 
 All the precautions necessary in other contagious 
 diseases are to be observed here, and with doubled 
 care, since the fever itself and its complications are 
 more serious, and the dangers of spreading the con- 
 tagion are increased. 
 
 The attendant should never go from the sick child Care . 
 into rooms where there are children, in the same the at- ( 
 clothes* that she has worn when caring for him. The dress 
 cap and long gown should always protect her hair 
 and dress. 
 
 The dishes and utensils used for him should be The sick 
 kept by themselves, and boiled before they are again meTsiis 
 used by the family. Above all, the scales of skin should 
 not be scattered about. Rugs or bed-clothing should 
 never be shaken out of the window, and everything The rugs 
 used about the child should be soaked in carbolic and clothes 
 boiled before being washed. A doctor or nurse going 
 about from house to house finds strange inconsisten- 
 cies in the care of contagion. 
 
 They do not wonder at the spread of disease when 
 they find a seltzer-water bottle at the bedside of a child instances 
 who is in the worst stage of desquamation. He uses it ° n f g sp d r j e S ease 
 himself whenever he wishes, and it is returned to the through 
 
 ...... . careless- 
 
 shop, bearing with it a chance for direct infection, ness and 
 
 The milk bottle is used in the same way, and then taken thought 
 
 down to be washed with the household dishes. 
 
 The mother goes into the sick-room/- takes a corner 
 
 of her apron to wipe her child's forehead, and with no 
 
 change, and without a thought of danger, returns to 
 
376 CARE OF CHILDREN 
 
 her other charges, who cling to her skirts, and are al- 
 most sure to come down with the disease at the end of 
 the usual period. It is almost impossible in a home 
 where the rooms are not large, and where the helpers 
 must be few, to completely isolate patient and nurse, 
 and to observe with absolute consistency all the ideal 
 precautions, but much of the carelessness we remark is 
 quite needless, and is born of lack of thought, rather 
 than of ignorance. 
 
 While speaking of the dangers of contagion it will 
 be well to emphasize also the fact that scarlet fever is 
 extremely infectious as well. 
 
 SCARLET FEVER IS INFECTIOUS 
 
 A nurse who has been caring for a scarlet fever pa- 
 tient should absolutely refuse to go from him to a sur- 
 gical or maternity case. The chances of infection are 
 many where there is an open wound, and in child- 
 birth both mother and child are especially susceptible, 
 and there have been many cases of blood-poisoning re- 
 sulting from lack of knowledge on this subject. The 
 danger is even greater, of course, when the patients are 
 in the same house, and in that case the isolation should 
 be more rigorously enforced, and on no account should 
 the nurses or attendants go from one sick-room to the 
 Safeguard other. A sheet hung across the doorway of. the pa- 
 su S a pended tient's room, and kept wet with a deodorant or with 
 wet sheet pi am wa ter, is an additional safeguard. 
 
 At the end of the convalescence, the nurse and pa- 
 
 Care tient must take baths in bichloride of mercury, fol- 
 
 leaving lowed by warm soap and water. Even the hair should 
 
 room ick " De carefully washed, and afterward the clean clothing 
 
 must be put on outside the sick-room. 
 
 The utmost precautions regarding fumigation 
 should be observed. Anything which can not be ren- 
 
CONTAGIOUS DISEASES 377 
 
 dered absolutely germ free must be destroyed. It is 
 
 wise to provide the child with inexpensive toys and Precautions 
 
 r . regarding 
 
 books which may be burned when he leaves the sick- fumigation 
 room. Most chambers are not very well planned for 
 contagious disease. We hardly realize how many 
 catch-alls for germs there are until we carry a patient 
 through some such illness, and the question of disin- 
 fection comes. 
 
 A thorough fumigation with formaline vapor is 
 probably effective enough to make the ordinary fur- Effective 
 nishings safe for use, but unless one is assured of the furr »g atlori 
 results, the risk seems hardly worth taking. If the 
 walls are papered, it is much wiser to have them 
 scraped and repapered or painted. Woodwork and 
 paint should be washed with a disinfectant, as well as 
 being subjected to the general fumigation. 
 
 When a house is large enough, it is a very good 
 plan to set aside one room as a "hospital ward." It An ideal 
 should be sunny and airy, with facilities for easy venti- "hospital 
 lation, and no furniture which can not be easily cleaned, in the 
 Hardwood floors, painted walls, an iron bedstead, and ome 
 no draperies are some of the essentials, all of which 
 have been more fully discussed in a previous chapter. 
 A bathroom or running water and a closet should be 
 close by, and if there could be a separate staircase, so 
 that the room could be completely isolated, the condi- 
 tions would be still more ideal. 
 
 DIPHTHERIA 
 Diphtheria is also an infectious and contagious dis- 
 ease, often resulting from imperfect sewage. Care- Search 
 ful examination of drains and pipes should be made the 
 
 x * m cause of 
 
 wherever there is a case of diphtheria, in order that diphtheria 
 the spreading of the disease may. be prevented. 
 
 It attacks children of all ages, and adults as well, 
 
378 CARE OF CHILDREN 
 
 and one is not immune after one attack. It results 
 from a micro-organism, which causes the growth of a 
 false membrane over the lining of the throat. 
 
 The tonsils are first attacked, and it is there that 
 Symptoms we first notice the exudation, which is of a character- 
 theria istic gray color. In children, there may be more delay 
 in recognizing the disease, because they do not make us 
 understand their symptoms. Any sore throat with 
 spots on the tonsils should be regarded as suspicious, 
 until it can be proved to be a simple disorder. 
 
 The onset is very like acute tonsilitis, with head- 
 
 The onset ^j^ c hJUy sensations, and pain and soreness in the 
 
 bones and muscles. The glands in the neck are usually 
 
 somewhat enlarged and in very young children this 
 
 may be the earliest noticeable sign. The temperature 
 
 is not always high, though it may run to 105 °. The 
 
 attack may begin twenty-four hours after exposure, 
 
 or it may be three weeks before there is any sign of it. 
 
 Examina- A suspected case of diphtheria should be immedi- 
 
 tion of ately isolated, and a doctor will remove some of the 
 
 exudation J ' 
 
 exudation in the throat, and will subject it to micro- 
 scopical examination, in order to pronounce definitely 
 upon the nature of the trouble. 
 
 In the meantime, the patient must be kept very 
 quiet, great care must be taken to keep up his strength 
 Treatment with nourishment, which should always be liquid, and 
 generally some sort of stimulant will be ordered for 
 the same purpose, as the prostration is extreme. The 
 treatment of diphtheria consists of strict regard to 
 hygienic conditions, in the administration of remedies 
 to counteract the effect of the poisonous germs which 
 produce the disease, and by operation, either intuba- 
 tion or tracheotomy. 
 
 The second form of treatment consists generally of 
 the injection of what is called antitoxin serum. This 
 
CONTAGIOUS DISEASES 379 
 
 treatment is the result of investigations in bacteriolog- 
 
 i • • 1 'Antitoxin 
 
 ical laboratories, in order to find a fluid, which taken serum 
 into the blood of a patient suffering with diphtheria 
 would arrest the growth of the bacteria which cause 
 the disease. This fluid is serum from an animal which 
 has been rendered immune to the disease by inocula- 
 tion with the poison which brings it about. 
 
 When physicians began to use antitoxin, so many 
 disorders seemed to arise in consequence that it came 
 to be regarded very unfavorably by many persons. 
 Its value as a remedial agent in all instances is per- 
 haps not unquestionably established, since its opponents 
 can still point to some cases where its administration 
 has been attended with serious consequences. The 
 conditions under which it is prepared have improved, serum in 
 and the results are in general so good that with most dl P hthena 
 physicians its use is a routine measure in cases of 
 diphtheria. This treatment is, however, left entirely 
 to the doctor's judgment, the attendant's part being to 
 follow orders with explicit exactness. 
 
 The throat and nose will require careful swabbing, 
 and as the discharge is extremely poisonous, the nurse Bum the 
 must be careful not to receive any of it on her face or ^dnose 
 clothing. The cotton used for the throat as well as the swabs 
 cloths which receive the expectoration must be burned. 
 Bed, linen, dishes, and room must be most carefully 
 disinfected before being used again. 
 
 With children, the disease progresses so rapidly 
 that sometimes the breathing and swallowing are al- 
 most entirely obstructed by the swelling of the air- 
 passages before the real nature of the trouble is 
 recognized. In such a case a metal tube is sometimes 
 inserted, either through an incision made from the intuba- 
 outside into the breathing passage, which is called {richest- 
 tracheotomy, or through the mouth, a process known omy 
 
Atmos- 
 
 380 CARE OF CHILDREN 
 
 as intubation. An atmosphere of steam greatly re- 
 lieves the difficult breathing, as it does in bronchitis 
 or in croup. 
 
 The tent and vaporizer described in the foregoing 
 phere of pages on croup may be used here with good results. 
 If any drug is used in this connection, it should be 
 one prescribed by a physician. 
 
 As with scarlet fever, the complications are to be 
 
 most carefully guarded against. The heart becomes 
 
 The weak very weak, and any violent exertion, such as sitting 
 
 heart with 111 • r 
 
 diphtheria up suddenly or reaching for something, is an actual 
 danger. Even very mild cases may be followed by a 
 slight temporary paralysis, more often manifested in 
 the throat, when it interferes with speech in small 
 measure and with swallowing to a considerable degree. 
 The general condition after diphtheria is one of great 
 exhaustion, and associated as it is with weakness of the 
 heart, it needs time and rest and nourishing food in 
 order that health may be firmly re-established. 
 
 While scarlet fever and diphtheria are most serious 
 and heart diseases and are sometimes attended by alarming con- 
 nurSng" sequences, it is a comfort to remember that they may 
 these dis- ta k e a m ild form, when recovery is speedy and un- 
 
 eases 1 
 
 eventful. This does not mean that care and watchful- 
 ness can be relaxed in any case, but it will perhaps re- 
 move some of the unreasoning horror, which really 
 incapacitates a mother from making her best effort. 
 
VII 
 
 PROBLEMS OF PUBERTY 
 
 Development of the Child— Puberty— Instruction to the Child— Masturba- 
 tion— Menstruation— Bathing during Menstruation 
 
 DEVELOPMENT OF THE CHILD 
 
 THE physical and mental development of children 
 proceeds along certain well-defined lines — as 
 their relations to their environment become more com- 
 plex, their needs are correspondingly multiplied. 
 
 The first requirements are the nourishment of the 
 body and the growth of its tissues to fit it for its place festive 6 
 in life, hence the early development of function is tract 
 largely confined to the digestive tract — the increase in 
 the size of the stomach, the appearance of teeth, and 
 the gradually acquired ability to take and digest a 
 varied diet. 
 
 Locomotion opens the world to the child, putting it Locomo- 
 into communication with things and persons outside it- 
 self. The relation, however, lacks the personal element. 
 It is Nature, not personality, that impresses him ; in 
 fact, he is living outside the world of social relations. 
 
 The power of observation comes to him before he The power 
 understands what he sees, and the last faculties to de- £ f OD observa ' 
 velop are those that concern his life with his fellows. 
 
 Interest in them, friendliness and affection are 
 aroused first, and Nature reserves her gift of sexual 
 power till she has fortified her children to withstand its 
 dangers, and has given them power and knowledge to 
 use it wisely. This is what puberty ought to mean — a 
 
 (381) 
 
382 CARE OF CHILDREN 
 
 What P u- coming into the full inheritance of vigor, strength and 
 means power, and that is what it can mean, if we ever open 
 
 our eyes and see where Nature and the evolution of 
 
 her laws are leading us. 
 
 PUBERTY 
 
 The age oi The "age of puberty" extends over the years be- 
 puberty tween thirteen or fourteen and sixteen, various circum- 
 stances modifying the time of development, climate, 
 race, occupation, and method of living causing great 
 differences. The changes that are taking place are those 
 concerned in the growth and development of the gen- 
 erative organs, but this rapid growth entails very sig- 
 nificant changes in the mental and nervous nature, 
 which make the need of oversight and careful guid- 
 ance especially important. In either sex, the changes 
 are preparatory to the establishment of the function of 
 reproduction. 
 
 In both man and woman there is the growth of 
 Physical na i r about the pubis and in the armpits. With males 
 the"boy "* ^ s growth is found also on the face and chin, and 
 often exists more generally over the surface of his 
 body than on that of the female. The shoulders broad- 
 en, the vocal cords lengthen and the voice grows 
 deeper. The changes in the generative organs are the 
 increase in size, the strengthening of muscular power, 
 and the secretion of the fluid containing the repro- 
 ductive germ. 
 
 The physical changes in woman are somewhat 
 
 changes 1 in more general, because her form must be adapted for 
 
 the girl the work of child-bearing. There is a general filling 
 
 out of the frame and a broadening of the hips as 
 
 the pelvis increases in size. The breasts rapidly begin 
 
 to develop, and the quality of the voice is altered. 
 
 The internal changes, however, are more marked. 
 
PROBLEMS OF PUBERTY 383 
 
 Immature ova are present in the ovaries from birth, 
 but at this time there is established the periodic dis- 
 charge of one or more of these ova, which, with the 
 bloody fluid that accompanies it, constitutes men- 
 struation. 
 
 If these functional changes were all, there would 
 be reason enough for increased care regarding the Mental and 
 
 . . -. . . . fe . , , spiritual 
 
 hygienic conditions, m the lives of young girls and changes 
 boys at this period, but the differences that become 
 manifest in their tastes, in their characteristics and in 
 their attitude toward their fellows in the family and out 
 of it, denote a modification in the nervous system 
 which works the miracle of transforming the boy to a 
 man and the girl to a woman. 
 
 This rapid evolution is not without its painful side. 
 The grace and unconsciousness of childhood are gone ; 
 a keener sensitiveness, a fear of criticism, and often 
 an occasional deep depression of spirits make them- 
 selves felt. There is besides a deepening joy in exist- 
 ence. A feeling of responsibility has awakened, which 
 may have interfered with the child's spontaneity, but 
 high ideals, ambition, and the desire for the best 
 things of life are stirring within the heart, and the 
 time is ripe for fixing the nobler aspirations. These 
 feelings are not well defined ideas in the child's mind, 
 which is chiefly a seething chaotic mass awaiting 
 creation. 
 
 INSTRUCTIONS TO THE CHILD 
 
 As the child approaches the age of puberty, spec- 
 ulations inevitably arise in his mind about the prob- problem of 
 
 J r the repro- 
 
 lems of life, which have to do with his own develop- auction of 
 ment and with the reproduction of the race. This is 
 the time when he should have careful, conscientious 
 instruction from his parents or other close friends, 
 
384 CARE OF CHILDREN 
 
 before unscrupulous enlightenment of most repulsive 
 detail has been given him by vulgar and perhaps 
 debased comrades. 
 
 There is no reason why this knowledge should 
 The simple come with a shock to a child, if due preparation for it 
 tkSisTrom has been made by the parents. Life is always an inter- 
 low"? and est i n g subject to him, and it may be studied and its 
 animals different processes explained with absolute simplicity 
 in plants and in the lower animals. He will make no 
 application to human functions until the questionings 
 begin to stir and then he will draw his conclusions 
 quite naturally, and there will be a much less violent 
 adjustment of his point of view. 
 
 A child who knows Miss Morley's "Song of Life," 
 ,. or who has been shown how some plants bear both 
 
 The old- r 
 
 fashioned pistillate and staminate flowers, and the methods of 
 deceptions fertilization when these flowers are borne by different 
 plants, can not long be deceived by the tiresome plati- 
 tude about the new baby's journey in the doctor's bag. 
 Deception is not necessary. It often does not deceive, 
 but almost invariably destroys confidence. It is often 
 legitimate to refuse to answer a child's questions, but 
 one gains more by telling him that he must wait till 
 he is older than by a falsehood that may seem plausi- 
 ble, but which he will inevitably recognize later as a 
 deliberate untruth. 
 
 Nature's work is the mother's best assistant, and 
 work'the the view that one gets of life processes in that way 
 ™ e ° s t t her ' s has a beauty and a dignity which one can ill spare, 
 assistant but which in our halting human account of them we 
 do not always convey. Reverent, dignified, straight- 
 forward expression is what a child should receive. 
 There should be no veiled language, but the portion 
 of the fact which is to be given should be told with 
 simple exactitude. 
 
PROBLEMS OF PUBERTY 885 
 
 Above all he should be made to feel that the ques Donotdis- 
 tioning is expected and that the feelings that prompt confidence 
 it are understood, and that the parents are his natural child 16 
 confidants, with whom he can talk over his perplexi- 
 ties. 
 
 When the mother observes the first changes which 
 accompany puberty, she should explain to the boy or ^ h 
 girl the meaning of them. In the case of the boy plaining 
 
 i • i r ±i • At a ji • the mean- 
 
 there is not the same necessity for this that there is mg of the 
 
 with a girl, though we must not lose sight of the fact changes 
 
 that the same sort of forces are seething within his 
 
 nature and the time is perhaps more critical with 
 
 him than with his sister. The external signs may 
 
 distress her exceedingly, and if the menstrual flow 
 
 comes on before she understands about it there may 
 
 be serious consequences resulting from her ignorance. 
 
 She may resort to hot water or sea baths or some 
 
 such violent measure, which will very probably check 
 
 the flowing, and the nervous shock may have serious 
 
 consequences. 
 
 Not to explain the changes is, besides, unfair 
 treatment — which we should above all things avoid 
 in our dealings with children. 
 
 We have spoken of the gradual evolution of the 
 faculties of a child in the order of their complexity. 
 In the beginning of each, instinct rules its use until 
 reason enters in. , 
 
 The full development of the sexual power brings The in- 
 with it a riotous flood of sensations. The child who ^capacV 
 has always been swayed bv his sensations, who has ty for sen 
 
 . . sation 
 
 gained his knowledge and had his pleasure through 
 the sense-perceptions, finds that with the door to 
 adult life thrown open to him the capacity for sensu- 
 ous enjoyment has deepened. 
 
 This realization of the character of the sexual 
 l 7 Vol. 3 
 
386 
 
 CARE OF CHILDREN 
 
 Teaching 
 self- 
 control 
 
 When the 
 develop- 
 ment has 
 been un- 
 even 
 
 The old 
 fable of 
 woman's 
 creation 
 
 Mother- 
 hood not 
 woman's 
 sole end 
 
 life may be delayed long past the age of puberty, and 
 certainly will not be felt till the development of the 
 sexual function is complete, but certain teachings can 
 forewarn him of the need of self-control and of the 
 danger of following the guidance of instinct. The 
 surest safeguard, the best preparation that can be 
 given a child for the conflict between these surging 
 forces that rise to do battle within him is that health 
 of mind and body which comes from well-balanced 
 development. 
 
 When the physical and emotional sides have been 
 hedged in and their expression restricted or limited 
 tp the playtime, when it is as a rule quite undirected, 
 there are fewer pleasurable activities to absorb the 
 attention, and considerations of the new sensations 
 are held in exaggerated importance. On the other 
 hand the mind is incapable of forming judgments or 
 of exerting will power if the physical education has 
 been at the expense of or unaccompanied by the intel- 
 lectual. A girl needs this balance no less than a boy. 
 
 It is quite time that we, cast aside the notion that 
 the sole purpose of a woman's creation was to serve 
 man's pleasure and bear him children. Nature does 
 not waste forces in that way. Her lower forms that 
 are born, bring forth their young and die, evidently 
 serve an admirable end; but she has used no elabora- 
 tion of design in their construction. 
 
 She has filled a woman's life with possibilities, and 
 has emphasized the fact that motherhood is not the 
 sole end, by extending her life and vigor far beyond 
 the child-bearing period. Even when we believe in 
 the laws of gradual evolution we fail to realize that 
 they are even now in progress and that mankind is 
 reaching out toward a higher degree of development 
 physically, morally, and intellectually. 
 
PROBLEMS OF PUBERTY 887 
 
 Women stand with men in much of the work of in the 
 life. They ought at least to be given equal chances Hf e r £o- 
 in their early education, before they can choose for "^ ^JJ d 
 themselves what they will attempt to accomplish in 
 the later years. 
 
 The sex distinctions in childhood are largely a 
 matter of training. The difference is emphasized by T .he sex 
 adults long before the children themselves are at all in chiid- 
 conscious of it. The dress accentuates it, but most baneful 
 of all the repression of physical activities marks the 
 dividing line. 
 
 Where can the advantage of this method lie? We 
 
 hear it said that a girl loses her femininity when she 
 
 romps and plays with her brothers, and shares their 
 
 active sports. Is it femininity that we want in a ... 
 
 r J Woman- 
 
 woman ? Womanliness is the sweeter quality, and Hness 
 
 gains through vigor of- body and mind, as manliness 
 
 is linked with courage and strength. 
 
 The children then of both sexes should be asso- 
 ciated in their work and play with no attempt at 
 emphasizing sex. They are very primitive little ani- 
 mals, and many of the accepted tenets of civilization 
 seem to them like arbitrary dogmas. Their rules of conduct 
 conduct may be fashioned on very simple lines, being children 
 based largely on the elemental principles of fair play 
 and consideration for other persons who form with 
 them their social world. 
 
 As they gain physical control in their sports and 
 hand work, they will be progressing step by step in 
 mental balance, which will be shown when real de- 
 cisions are to be met. 
 
 In childhood the physical rules ; in youth the mind 
 should hold sway over the emotions. Real self-control JJjL*?, 
 is attained through activity rather than through re- y° uth 
 presston, and the strictly intellectual life represents 
 
388 CARE OF CHILDREN 
 
 the fullest and the richest attainment no more truly 
 than does the strictly physical. 
 
 MASTURBATION 
 
 Educators perhaps even more than parents real- 
 ize the child's peculiar need of oversight not only 
 during puberty, but throughout the earlier years. 
 The habit Their reports show an appalling prevalence of the 
 abuse habit of self-abuse, or masturbation, a habit which 
 may be self-taught, but which is often communicated 
 from older to younger, which possesses an over- 
 mastering power, and which if not overcome is fol- 
 lowed by unmistakable evidences of general deterio- 
 ration. 
 
 The care of the external organs should be taught 
 
 a child, just as dressing himself or bathing is taught 
 
 the^each- him. Careful cleansing should be insisted upon, for 
 
 ing of care the irritation arising from neglect is often the cause 
 
 and clean- ° ° 
 
 Hness of masturbation, but he can be made to understand 
 without a question that the parts are of delicate con- 
 struction, as the eye and ear are, and that there is 
 danger of injury by unnecessary handling. 
 
 Eczema or a like eruption may appear in the 
 groins or about the vulva^ when the irritation is un- 
 difficuities bearable and the concentration of mind on those parts 
 to hl s df- ead an d the nervousness which the intense itching occa- 
 abuse sions are conditions which should receive prompt at- 
 tention. Intestinal worms are also said to have been 
 the reason for a child's contracting the habit. 
 
 With boys the most frequent cause is a slight de- 
 fect in the construction of the penis. This condition 
 is known as phimosis, and is indicated by the tight- 
 ness of the foreskin, which can be rolled back with 
 difficulty. The opening is likewise so small that 
 the urine is voided with great pain and after pro- 
 
PROBLEMS OF PUBERTY 389 
 
 longed effort, and during the process the foreskin is 
 sometimes filled up, causing intense pain. 
 
 Circumcision is the treatment for such a condi- The 
 tion, and as it is a very simple operation, attendant remedy of 
 
 circum- 
 
 with no serious consequences if properly performed, dsion 
 it is always to be advised. 
 
 Parents should make very sure that there are no 
 functional disorders which the child is concealing, 
 either from ignorance or from a feeling of shame. 
 If the parents are also the child's comrades and th^form- 
 f riends, confidence will be natural and one great source j^jj he 
 of danger will be shut out. Children should not 
 sleep together if it can be avoided, and the habit of 
 lying in bed after they are awake should be dis- 
 couraged. 
 
 A mother must be very careful in regulating the 
 dress of her children, to see that the underclothes 
 and the trousers do not constrict the body in any Car eofthe 
 
 , , . , . clothing 
 
 part, and that there is no unnecessary rubbing or 
 pressure. The same care should be taken with the 
 night-clothes, and the closed night-drawers, which 
 are the best for both girls and boys, should be made 
 large and full. 
 
 The position which children take in bed is also 
 important. The rrtother or nurse should look out for i„ bed 
 that as well, and teach, them to lie on one side with 
 the legs flexed. 
 
 Care should always be taken in the choice of 
 companions for a child. As a rule it is better that trades* 
 he associate with those of about his own age and of 
 both sexes. Knowledge of an undesirable sort is so 
 often brought to children by older comrades that 
 unless the character of the older girls and boys is 
 known it is better to avoid close intimacy with 
 them. 
 
390 CARE OF CHILDREN 
 
 The choice of a school is a very important one. 
 Teachers can tell what a tendency there is to this 
 
 Choke of particular evil and how quickly it makes itself ap- 
 parent in a school. There ought to be a stronger 
 spirit of co-operation between school and home, and 
 also a keener sertse of responsibility on the part of 
 teachers. Parents too often resent the interference 
 of teachers, and refuse to recognize wrongdoing 
 in their children, even when it is pointed out to 
 them. 
 
 If it is possible to choose a school where at least 
 half of the working day is given up to hand-work 
 
 Outlet for and physical exercise, a long step toward ensuring 
 
 energy *he safety of the children will be taken. Occupation 
 of the mind is an essential, and that is much more 
 likely to be found with occupation of the hands than 
 when the tasks involve mental processes only. There 
 seems to be a certain amount of animal energy bottled 
 up within most children, and the more natural out- 
 lets are given the less likely he is to find unnatural 
 and harmful ones. 
 
 A watch should be kept over the books that are 
 put before young persons, but it should be apparent 
 as interest rather than as espionage. 
 
 If the best books are placed fn their hands from 
 
 of h b C o h k°s ice ^ e ^ rst > taste f° r them will be acquired and vapid, 
 sensational tales will not appeal to them. Stories of 
 action, of heroic achievement, or of the lives of the 
 humble furred and feathered" folk satisfy the crav- 
 ings of the imagination and emotion, give food for 
 thought, and are an educational force. 
 
 If parents are willing to take these precautions 
 to guard against temptation the girl or boy will very 
 probably pass through the particularly dangerous 
 years in safety, and with the resources of health and 
 
PROBLEMS OF PUBERTY 391 
 
 education can face the later trials, but sometimes the ■ 
 evil is a very real assailant and must be conquered in 
 a hand-to-hand struggle. 
 
 If the parents find that masturbation is being 
 practiced by a child, a possibility' which must be 
 recognized, the duty of a plain explanation becomes Faci the 
 necessarv. Professor William Tames savs that the bad habit 
 
 and calling 
 
 danger of a person's continuing in a bad habit is that it by its 
 he will not face it^ and call it by its name. That "hrchiid 
 danger parents can eliminate, and they should never 
 allow the child to be left in ignorance of the signifi- 
 cance of such a practice and of its effects. 
 
 If he knows that its mastery over a person entails 
 a weakening of the will and the moral sense, a loss 
 of vital force, and a consequent susceptibility to dis- Telling of 
 ease, and an enfeebling of mental power, all of which quent 
 grow more and more marked and more beyond his mental de- 
 control as the habit becomes fixed, he can not fail to tenoratlon 
 wish to make a fight against it. If he lacks confi- 
 dence in the parent and can not be made to appre- 
 ciate the gravity of the danger, there should be no 
 hesitation in requiring him to receive advice from a 
 physician. ' 
 
 Occupation for the mind and hands is here again 
 the cure as well as the prevention. Vigorous sports, 
 life in the open air, a systematic direction of the mind 
 away from self, and a determined seeking for social 
 interests make possible a return to a healthy state 
 of mind and body. 
 
 Physiologically, parentage, or the exercise of the Evils of 
 sexual function, before the aq-e of twentv-three at ear, y 
 
 . ' parentage 
 
 least, except in cases of precocious maturity, threatens 
 health, and indeed life itself. 
 
 We have spoken in another chapter of the gradual 
 hardening or ossification of the bones in children. 
 
392 CARE OF CHILDREN. 
 
 • The vertebrae, or small bones of the spine, are not 
 completely ossified till after the sixteenth year. The 
 two lower bones of the spinal column unite^ to close 
 at the back the bony ring or girdle which we have 
 called the pelvis. The construction of the pelvis, its 
 shape and the position of the bones composing it have 
 much to do w T ith the ease and safety of child-bearing. 
 When we learn that these two vertebrae which form 
 such an important part of the pelvic ring do not 
 Argument begin their slow process of consolidation till the 
 child- eighteenth year we can understand why late mar- 
 riages are desirable. That fact is also a strong argu- 
 ment against child-labor or any overtaxing of the 
 strength in youth. 
 
 MENSTRUATION 
 
 In the girl the age of puberty is indicated, as has 
 been said, by the periodic appearance of the men- 
 strual flow. The term is a derivation from the Latin 
 word menses, meaning month, and the reason for its 
 use is obvious. 
 
 It may be some months before menstruation is 
 regularly established, but that need occasion no un- 
 easiness. Persistent irregularity later, especially if 
 accompanied by symptoms of disease, should not pass 
 unnoticed, as it indicates at least a debilitated condi- 
 tion. 
 
 Vicarious menstruation is a periodic discharge of 
 blood from some other organ or part of the body, 
 Forms of which takes the place of menstruation. It may come 
 from the nose or mouth, from the blood-vessels about 
 the rectum, from the skin, or other parts of the body. 
 It means a serious state of the system, not necessarily 
 alarming if treatment is given in time. Tonics and es- 
 pecially nourishing food are the requirements, and with 
 
 vicarious 
 menstrua- 
 tion 
 
PROBLEMS OF PUBERTY 393 
 
 the return of health, the normal functions will be re- 
 sumed. 
 
 The most hygienic napkin to use at this time is the 
 cheesecloth, and absorbent cotton pad, which is burned 
 after use. These can be bought at any druggist's, or 
 at the large department stores, but the packages are 
 very expensive and often are not as satisfactory as Ma king the 
 those made at home. They will generally be large napkin 
 enough if they are made nine inches long and three 
 wide, and may be sewed at the edges or the absorbent 
 cotton may be sewed or pinned with safety-pins on 
 the- cheesecloth, which is then folded to the desired 
 size. They can be made as thick as necessary. 
 
 If for any reason these can not be used, a dozen 
 squares of the cotton or linen diaper will be needed. 
 If preferred, thin Canton flannel can be substituted. 
 The supporter may be a fitted girdle, which can be 
 bought ready made, a ribbon, or a straight loose belt 
 of elastic tape. 
 
 \Yith some women there is no feeling of discom- 
 fort during this period, but- commonly there is a degree 
 of backache, headache, weariness, and depression of sy m P toms 
 spirits. Nervousness at this time may be very marked, 
 r but as a rule the more normal a girl is in her health, 
 the less she will suffer. The pain is commonly less 
 after the flowing has fairly begun. 
 
 During the establishment of this periodic sickness, 
 great care should be exercised to protect the girl from 
 cold, and to give both body and mind a rest from work g^mus^ 
 of any sort. After she is older, and the menses are exercise 
 appearing with regularity, the need for entire rest will 
 depend on the amount of discomfort she feels. 
 
 Exposure and undue exertion she should always 
 avoid, and she should never take the violent exercise 
 of tennis, dancing, or horseback riding at this time. 
 
394 CARE OF CHILDREN 
 
 If she has much active pain, she' will be more com- 
 simpie f ortable in bed. A hot drink and a hot-water bag gen- 
 erally give relief, but when there are decided cramps, 
 flannels wrung out of hot water and alcohol and ap- 
 plied well down over the pubis will act as a sedative. 
 
 The practice of taking narcotics is very unwise. 
 One speedily grows to be a coward where pain is con- 
 Avoid ail cerned, and the knowledge that relief is so easily ob- 
 spirfts an tained constitutes the subtle power of the drug habit. 
 The morphine preparations are dangerous for this rea- 
 son, and most of the other effective anodynes have an 
 injurious action upon the heart. 
 
 It is much safer to use the local applications, and 
 if the pain persists and returns each month to consult 
 a physician who may discover a simple cause which 
 he can remove by medication. 
 
 If the flowing is delayed past the usual time, it may 
 
 sometimes be brought on by soaking the feet in hot 
 
 hot e foo e t-° f w ater > or by taking a full hot bath, a mild laxative, and 
 
 bath a hot drink, just before going to bed. If there are 
 
 no uncomfortable feelings,, and the health seems good, 
 
 it is as well to wait for Nature to take her course. 
 
 BATHING DURING MENSTRUATION 
 . ., L The use of the tub bath is, of course, forbidden 
 
 Avoid tub 
 
 bath during menstruation, and a cold sponge is not wise, 
 
 even if it is one's daily habit. 
 
 Cleanliness at this time is as essential as at any 
 other, and there is no reason why sponging in warm 
 water should be attended by any unpleasant results. 
 It is, perhaps, better not to put the feet into the water, 
 and if the susceptibility to cold is increased at this time 
 a little extra care should be taken to keep the feet warm 
 during the bath, and the body shielded from draughts, 
 and not exposed too long to the air. Local bathing 
 
 Use rather 
 a warm 
 sponge 
 
PROBLEMS OF PUBERTY 895 
 
 every day is very necessary, and there need be no 
 hesitation or fear of injury to the health in the external 
 use of water at this time. 
 
 The habit, unfortunately growing more common, of 
 using the internal douche each month at the end of Avoid the 
 
 ° douche 
 
 this period is a very unwise practice, as well as being 
 wholly uncalled for. 
 
MAY 22 1905