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THE MOTHER AND HER CHILD 
 
THE SADLER CLASSICS 
 
 THE MOTHER AND HER CHILD. Things 
 that all mothers, fathers, and everyone who has 
 to do with the care of the child should know. 
 Illustrated. 12mo $1.50 
 
 WORRY AND NERVOUSNESS; or, The 
 Science of Self-Mastery. Illustrated. 12 mo. 
 Si. 50 
 
 THE PHYSIOLOGY OF FAITH AND FEAR; 
 or, The Mind in Health and Disease. Illus- 
 trated. Fourth edition. 12mo. . Si. 50 
 
 THE CAUSE AND CURE OF COLDS. Illus- 
 trated. Third edition. 12mo. . . Sl.OO 
 
 THE SCIENCE OF LIVING; or, The Art of 
 Keeping Well. With many drawings. 12mo. 
 Si. 50 
 
 A. C. McCLURG & CO. 
 
 CHICAGO 
 
THE MOTHER 
 AND HER CHILD 
 
 BY 
 
 WILLIAM S. SADLER, M. D. 
 
 PROFESSOR OF THERAPEUTICS, THE POST-GRADUATE MEDICAL 
 SCHOOL OF CHICAGO; DIRECTOR OF THE CHICAGO INSTITUTE 
 OF PHYSIOLOGIC THERAPEUTICS; FELLOW OF THE 
 AMERICAN MEDICAL ASSOCIATION; MEMBER OF 
 THE CHICAGO MEDICAL SOCIETY; THE ILLI- 
 NOIS STATE MEDICAL SOCIETY; THE 
 AMERICAN ASSOCIATION FOR THE AD- 
 VANCEMENT OF SCIENCE, ETC. 
 
 LENA K. SADLER, M. D. 
 
 ASSOCIATE DIRECTOR OF THE CHICAGO INSTITUTE OF PHYSI- 
 OLOGIC therapeutics; fellow of the American medical 
 association; member of the Chicago medical 
 society; the medical women's club of Chi- 
 cago; NATIONAL CONGRESS OF MOTHERS AND 
 PARENT -TEACHER ASSOCIATION; THE 
 CHICAGO WOMAN'S CLUB, ETC. 
 
 ILLUSTRATED 
 
 CHICAGO 
 A. C. McCLURG & CO, 
 
 1916 
 
^\1 
 
 Copyright 
 
 A. C. McClurg & Co. 
 
 1916 
 
 Published August, 1916 
 
 Copyrighted in Great Britain 
 
 (& 
 
 SEP -i 1916 
 
 W. F. HALL PRINTING COMPANY, CHICAGO 
 
 )d.A437502 
 
TO 
 
 "BILLY" 
 WHO, BECAUSE OF HIS UNCONSCIOUS CONTRIBUTIONS TO ITS 
 PRACTICAL FEATURES, SHOULD BE REGARDED AS A 
 CO-AUTHOR, THIS VOLUME IS AFFECTION- 
 ATELY DEDICATED BY HIS PARENTS 
 THE AUTHORS 
 
PREFACE 
 
 FOR many years the call for a book on the mother and her 
 child has come to us from patients, from the public, and 
 now from our publishers — and this volume represents our 
 efforts to supply this demand. 
 
 The larger part of the work was originally written by Dr. Lena 
 K. Sadler, with certain chapters by Dr. William S. Sadler, but 
 in the revision and re-arrangement of the manuscript so much 
 work was done by each on the contributions of the other, that 
 it was deemed best to bring the book out under joint author- 
 ship. 
 
 The book is divided into three principal parts : Part i, deal- 
 ing with the experience of pregnancy from the beginning of 
 expectancy to the convalescence, of labor ; Part n, dealing with 
 the infant from its first day of life up to the weaning time ; Part 
 in, taking up the problems of the nursery from the weaning to 
 the important period of adolescence. 
 
 The advice given in this work is that which we have tried 
 out by experience — both as parents and physicians — and we 
 pass it on to mothers, fathers, and nurses with the belief 
 that it will be of help in their efforts at practical and scientific 
 " child culture." We believe, also, that the expectant mother 
 will be aided and encouraged in bearing the burdens which are 
 common to motherhood by the advice and instruction offered. 
 
 While we have drawn from our own professional and per- 
 sonal experience in the preparation of this book, we have also 
 drawn freely from the present-day literature dealing with the 
 subjects treated, and desire to acknowledge our indebtedness 
 to the various writers and authorities. 
 
 vii 
 
viii PREFACE 
 
 We now jointly send forth the volume on its mission, as a 
 contribution toward lightening the task and inspiring the efforts 
 of those mothers, nurses, and others who honor us by a pe- 
 rusal of its pages. 
 
 William S. Sadler. 
 Lena K. Sadler. 
 Chicago, 191 6. 
 
CONTENTS 
 
 CHAPTER 
 
 I 
 
 II 
 
 III 
 
 IV 
 
 V 
 
 VI 
 
 VII 
 
 VIII 
 
 IX 
 
 X 
 
 XI 
 
 XII 
 
 XIII 
 
 XIV 
 
 XV 
 
 XVI 
 
 XVII 
 
 XVIII 
 
 XIX 
 
 XX 
 
 XXI 
 
 XXII 
 
 PART I 
 
 THE MOTHER 
 
 PAGE 
 
 The Expectant Mother I 
 
 Story of the Unborn Child 7 
 
 Birthmarks and Prenatal Influence ... 14 
 
 The Hygiene of Pregnancy 21 
 
 Complications of Pregnancy 35 
 
 Toxemia and Its Symptoms 47 
 
 Preparations for the Natal Day .... 53 
 
 The Day of Labor 63 
 
 Twilight Sleep and Painless Labor ... 71 
 
 Sunrise Slumber and Nitrous Oxid ... 84 
 
 The Convalescing Mother 93 
 
 PART II 
 
 THE BABY 
 
 Baby's Early Days 103 
 
 The Nursery 114 
 
 Why Babies Cry 123 
 
 The Nursing Mother and Her Babe . . . 133 
 
 The Bottle-Fed Baby . 147 
 
 Milk Sanitation 156 
 
 Home Modification of Milk 165 
 
 The Feeding Problem 177 
 
 Baby's Bath and Toilet 190 
 
 Baby's Clothing 202 
 
 Fresh Air, Outings, and Sleep .... 213 
 ix 
 
CONTENTS 
 
 CHAPTER PAGE 
 
 XXIII Baby Hygiene 222 
 
 XXIV Growth and Development 232 
 
 PART III 
 
 THE CHILD 
 
 XXV • The Sick Child 251 
 
 XXVI Baby's Sick Room 266 
 
 XXVII Digestive Disorders 274 
 
 XXVIII Contagious Diseases 285 
 
 XXIX Respiratory Diseases 300 
 
 XXX The Nervous Child 308 
 
 XXXI Nervous Diseases . 323 
 
 XXXII Skin Troubles 333 
 
 XXXIII Deformities and Chronic Disorders ... 341 
 
 XXXIV Accidents and Emergencies 348 
 
 XXXV Diet and Nutrition 360 
 
 XXXVI Caretakers and Governesses 370 
 
 XXXVII The Power of Positive Suggestions ... 380 
 
 XXXVIII Play and Recreation 390 
 
 XXXIX The Puny Child 400 
 
 XL Teaching Truth 405 
 
 Appendix . 427 
 
 Index 449 
 
ILLUSTRATIONS 
 
 The mother and her child Frontispiece ^ 
 
 FIGURE PAGE 
 
 i Steps in early development . . . . . . . 10 
 
 2 The " expectant " costume 23 
 
 3 The photophore 43^ 
 
 4 Taking the blood pressure 48 '^ 
 
 5 Breast binder 59 s / 
 
 6 How to hold the baby no 
 
 7 Making the sleeping blanket 117 
 
 8 In the sleeping blanket 118 
 
 9 Homemade ice box 149 
 
 10 Heating the bottle 151 
 
 n A sanitary dairy 158 
 
 12 Articles needed for baby's feeding 167 
 
 13 Supporting the baby for the bath 194 
 
 14 Developmental changes 240 
 
 15 The cooling enema 290 
 
 16 X ray showing tuberculosis of the lung .... 346 
 
 17 Father and Mother Corn and Morning Glory . . 406 
 
 XI 
 
PART I 
 THE MOTHER 
 
THE MOTHER AND 
 HER CHILD 
 
 PART I 
 THE MOTHER 
 
 CHAPTER I 
 THE EXPECTANT MOTHER 
 
 THERE can be no grander, more noble, or higher calling 
 for a healthy, sound-minded woman than to become the 
 mother of children. She may be the colaborer of the business 
 man, the overworked housewife of the tiller of the soil, the 
 colleague of the professional man, or the wife of the leisure 
 man of wealth; nevertheless, in every normal woman in every 
 station of life there lurks the conscious or sub-conscious ma- 
 ternal instinct. Sooner or later the mother-soul yearns and 
 cries out for the touch of baby fingers, and for that maternal 
 joy that comes to a woman when she clasps to her breast the 
 precious form of her own babe. 
 
 MOTHERHOOD THE HIGHEST CALLING 
 
 Motherhood is by far woman's highest and noblest profession. 
 Science, art, and careers dwindle into insignificance when we 
 attempt to compare them with motherhood. And to attain 
 this high profession, to reach this manifest " goal of destiny," 
 women are seeking everywhere to obtain the best information, 
 and the highest instruction regarding " mothercraft," " baby- 
 hood," and " child culture." 
 
2 THE MOTHER AND HER CHILD 
 
 In an Indiana town not long ago, at the close of a lecture, 
 a small, intellectual-appearing mother came forward, and, ten- 
 derly placing her tiny and emaciated infant in my arms, said: 
 "O Doctor! can you help me feed my helpless babe? I'm 
 sure it i.s going to die. Nothing seems to help it. My father 
 is the banker in this town. I graduated from high school and 
 he sent me to Ann Arbor, and there I toiled untiringly for four 
 years and obtained my degree of B. A. I have gone as far as 
 I could — spent thousands of dollars of my unselfish father's 
 money — but I find myself totally ignorant of my own child's 
 necessities. I cannot even provide her food. O Doctor ! can't 
 something be done for young women to prepare them for 
 motherhood? " 
 
 MOTHERCRAFT PREPARATION 
 
 The time will come when our high and normal schools will 
 provide adequate courses for the preparation of the young 
 woman for her highest profession, motherhood. This young 
 mother, who had reached the goal of Bachelor of Arts, found 
 to her sorrow that she was entirely deficient in her education 
 and training regarding the duties and responsibilities of a 
 mother. In every school of the higher branches of education 
 that train young women in their late teens there should be a 
 chair of mothercraft, providing practical lectures on baby 
 hygiene, dress, bathing, and the general care of infants, and 
 giving instruction in the rudiments of simple bottle-feeding, 
 together with the caloric values of milk, gruels, and other 
 ingredients which enter into the preparation of a baby's food. 
 
 Young women would most enthusiastically enroll for such 
 classes, and as years passed and marriage came and children 
 to the home, imagine the gratitude that would flood the souls 
 of the young mothers who were fortunate enough to have 
 attended schools where the chairs of motherhood prepared 
 them for these new duties and responsibilities. 
 
 EARLY MEDICAL SUPERVISION 
 
 Just as soon as it is known that a baby is coming into the 
 home, the expectant mother should engage the best doctor 
 
THE EXPECTANT MOTHER 3 
 
 she can afford. She should make frequent calls at his office 
 and intelligently carry out the instruction concerning water 
 drinking, exercise, diet, etc. Twenty-four hour specimens of 
 urine should be frequently saved and taken to the physician 
 for examination. In these days the blood-pressure is closely 
 observed, together with approaching headaches and other evi- 
 dences of possible kidney complications. The early recognition 
 of these dangers is accompanied by the immediate employment 
 of appropriate sweating procedures and other measures designed 
 to promote the elimination of body poisons. Thus science is 
 able effectively to stay the progress of the high blood-pressure 
 of former days, and which was so often followed by eclampsia 
 ■ — uremic poisoning. 
 
 In these days of careful urine analysis, expertly administered 
 anaesthetics, and up-to-date hospital confinements, the average 
 intelligent woman may enter into pregnancy quite free from 
 the oldtime fears, whose only rewards were grief and cankering 
 care. All fear of childbirth and all dread of maternal duties 
 and sacrifices do not in the least lessen the necessary unpleas- 
 antness associated with normal labor. It lies in the choice of 
 every expectant mother to journey through the months of 
 pregnancy with dissatisfaction and resentment or with joy 
 and serenity. " The child will be born and laid in your arms 
 to be fed, cared for, and reared, whether you weep or smile 
 through the months of waiting." 
 
 THE RESENTFUL MOTHER 
 
 A little woman came into our office the day of this writing, 
 saying: " Doctor, I'm just as mad as I can be; I don't want to 
 be pregnant, I just hate the idea." As I smiled upon this 
 girl-wife of nineteen, I drew from my desk a sheet of paper 
 and slowly wrote down these words for the head of a column : 
 " Got a mad on," and for the head of another, " Got a glad on ; " 
 and then we quickly set to work carefully to tabulate all the 
 results that having a " mad on " would bring. We found to 
 her dismay that its harvest would be sadness of the heart, 
 husband unhappy, work unbearable, while all church duties 
 as well as social functions would be sadly marred. Then, just 
 
4 THE MOTHER AND HER CHILD 
 
 as carefully, we tabulated the benefits that would follow having 
 a " glad on." Her face broke into a smile ; she laughed, and as 
 she left the office she assured me that she would accept Na- 
 ture's decree, make the best of her lot, and thus wisely align 
 herself with the normal life demands of old Mother Nature. 
 This view of her experience, she came to see, would bring the 
 greatest amount of happiness to both herself and husband. 
 She left me, declaring that she was just "wild for a baby;" 
 and there is still echoing in my ears her parting words : " I*m 
 leaving you, Oh, such a happy girl ! and I'm going home to 
 Harold a happy and contented expectant mother." 
 
 There often enters on the exit of a discontented and resentful 
 expectant mother, a woman, very much alone in the world — 
 perhaps a bachelor maid or a barren wife, who, as she sits 
 in the office, bitterly weeps and wails over her state of loneliness 
 or sterility; and so we are led to realize that discontentment 
 is the lot of many women; and we are sometimes led to regret 
 that ours is not the power to take from her that hath and give 
 to her that hath not. 
 
 EARLY SIGNS OF PREGNANCY 
 
 Among the first questions an expectant mother asks is: 
 "What are early signs of pregnancy?" The answer briefly is: 
 
 1. Cessation of menstruation. 
 
 2. Changes in the breast. 
 
 3. Morning sickness. 
 
 4. Disturbances in urination. 
 
 Menstruation may be interrupted by other causes than preg- 
 nancy, but the missing of the second or third periods usually 
 indicates pregnancy. Accompanying the cessation of menstrua- 
 tion, changes in the breast occur. Sensation in the breasts 
 akin to those which usually accompany menstruation are mani- 
 fested at this time in connection with the unusual sensations 
 of stinging, prickling, etc. Fully one-half of our patients do 
 not suffer with " morning sickness ; " however, it is the general 
 consensus of opinion that " morning sickness " is one of the 
 
THE EXPECTANT MOTHER 5 
 
 early signs of pregnancy, and these attacks consist of all 
 gradations — from slight dizziness to the most severe vomiting. 
 It is an unpleasant experience, but in passing through it we 
 may be glad in the thought that " it too, will pass." 
 
 Because of the pressure exerted by the growing uterus upon 
 the bladder, disturbances in urination often appear, but as the 
 uterus continues *to grow and lifts itself up and away from the 
 bladder these symptoms disappear. 
 
 Chief of the later signs of pregnancy are " quickening " or 
 fetal movements. The movements are very much like the 
 " fluttering of a young birdling." They usually are felt by the 
 expectant mother between the seventeenth and eighteenth 
 weeks. This sign, together with the noting of the fetal heart- 
 beat at the seventh month, constitute the positive signs of 
 pregnancy. 
 
 PROBABLE DATE OF DELIVERY 
 
 And now our expectant mother desires to know when to 
 expect the little stranger. From countless observations of 
 childbirth under all conditions and in many countries, the preg- 
 nant period is found to cover about thirty-nine weeks, or two 
 hundred and seventy-three days. There are a number of ways 
 or methods of computing this time. Many physicians count 
 back three months and add seven days to the first day of the 
 last menstruation. For instance, if the last menstruation were 
 December 2 to 6, then, to find the probable day of delivery, we 
 count back three months to September 2, and then add seven 
 days. This gives us September 9, as the probable date of 
 delivery. The real date of delivery may come any time within 
 the week of which this calculated date is the center. 
 
 As a rule, ten days to two weeks preceding the day of delivery, 
 the uterus " settles " down into the pelvis, the waist line becomes 
 more comfortable, and the breathing is much easier. 
 
 On the accompanying page, may be found a table for com- 
 puting the probable day of labor, prepared in accordance with 
 the plan just described. 
 
THE MOTHER AND HER CHILD 
 
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CHAPTER II 
 STORY OF THE UNBORN CHILD 
 
 TO every physician in every community, sooner or later in 
 his experience there come thoughtless women making 
 requests that we even hesitate to write about. Their excuses 
 for the crime which they seek to have the physician join them 
 in committing, range all the way from " I don't want to go 
 to the trouble," to " Doctor, I've got seven children now, and 
 I can't even educate and dress them properly ; " or, maybe, " I 
 nearly lost my life with the last one." 
 
 EMBRYOLOGICAL IGNORANCE 
 
 One little woman came to us the other day from the suburbs, 
 and honestly, frankly related this story: 
 
 "We've been married just six months, I have continued my 
 stenographic work to add the sixty-five dollars to our monthly 
 income. Doctor, we must meet our monthly payments on the 
 home, I must continue to work, or we shall utterly fail. I am 
 perfectly willing a baby shall come to us two years from now, 
 but, doctor, I just can't allow this one to go on, you must help 
 me just this once. Why doctor, there can't be much form or 
 life there, it's only three months now, or will be next week, and 
 you know it's nothing but a mass of jelly." 
 
 She had talked with a " confidential friend " in her neighbor- 
 hood, had been told that she " could do it herself," but fearing 
 trouhle or infection, had come to the conclusion she had better 
 go to a " clean, reputable physician," to have the abortion 
 performed. 
 
 This is not the place to narrate the experiences of the unfor- 
 tunate victims of habitual criminal abortion, but we would like 
 to impress upon the reader some realization of the untimely 
 
 7 
 
8 THE MOTHER AND HER CHILD 
 
 deaths, the awful suffering, and the life-long remorse and 
 sorrow of the poor, misguided women who listen to the criminal 
 advice of neighborhood " busybodies." The infections, the 
 invalidism, the sterility that so often follow in the wake of 
 these practices, are well known to all medical people. 
 
 THE STREAM OF LIFE 
 
 And so after the patient's last statement, " It's nothing but 
 a mass of jelly," we began the simple but wonderfully beautiful 
 story of the development of the " child enmothered." Just as 
 all vegetables, fruits, nuts, flowers, and grains come from seeds 
 sown into fertile soil, and just as these seeds receive nourish- 
 ment from the soil, rain, and sunshine, so all our world of 
 brothers and sisters, of fathers and mothers, came from tiny 
 human seeds, and in their turn received nourishment from the 
 peculiarly adapted stream of life, which flows in the maternal 
 veins for the nourishment and upbuilding of the unborn embryo. 
 
 Every little girl and boy baby that comes into the world, has 
 stored within its body, in a wonderfully organized capsule, a 
 part of the ancestral stream of life that unceasingly has 
 flowed down through the centuries from father to son and 
 from mother to daughter. This " germ plasm " is a divine gift 
 to be held in trust and carefully guarded from the odium of 
 taint, to be handed down to the sons and daughters of the 
 next generation. Any young man who grasps the thought that 
 he possesses a portion of the stream of life, that he holds it 
 in sacred trust for posterity, cannot fail to be impressed with 
 a sense of solemn responsibility so to order his life as to be 
 able to transmit this biologic trust to succeeding generations 
 free from taint and disease. 
 
 THE PROCESS OF FERTILIZATION 
 
 Just as within the body of "Mother Morning Glory" (See 
 Fig. 15) may be found the ovary or seed bed, so there are two 
 wonderfully organized bodies about the size of large almonds 
 found in the lower part of the female abdomen on either side of 
 the uterus, and connected to it by two sensitive tubes. There 
 ripens in one of these bodies each month a human baby-seed, 
 
STORY OF THE UNBORN CHILD 9 
 
 which finds its way to the uterus through the little fallopian tube 
 and is apparently lost in the debris of cells and mucus which, with 
 the accompanying hemorrhage go to make up the menstrual flow. 
 This continues from puberty to menopause, each gland alter- 
 natingly ripening its ovum, only to lose it in the periodical 
 phenomenon of menstruation, which is seldom interrupted save 
 by that still more wonderful phenomenon of conception. 
 
 At the time of conception, countless numbers of male germ- 
 cells (sperms) are lost — only one out of the multitude of these 
 perfectly formed sperms made up of the mosaics of heredi- 
 tary depressors, determiners, and suppressors that so subtly 
 dictate and determine the characteristics and qualifications of 
 the on-coming individual — I repeat, only one of these won- 
 derful sperms finds the waiting ovum (Fig. 1). In this search 
 for the ovum, the sperm propels itself forward by means of its 
 tail — for the male sperm in general appearance very much 
 resembles the little pollywog of the rain barrel (Fig. 1). 
 
 The fateful meeting of the sperm and the ovum takes place 
 usually in the upper end of one of the fallopian tubes. It is 
 a wonderful occasion. The wide-awake, vibrating lifelike 
 sperm plunges head first and bodily into the ovum. The tail, 
 which has propelled this bundle of life through the many wan- 
 derings of its long and perilous journey, now no longer needed, 
 drops off and is lost and forgotten. This union of the male 
 and female sex cells is called " fertilization." There immediately 
 follows the most complete blending of the two germ cells — 
 one from the! father and one from the mother — each with 
 its peculiar individual, family, racial, and national character- 
 istics. Here the combined determiners determine the color of 
 the eyes, the characteristics of the hair, the texture of the 
 skin, its color, the size of the body, the stability of the nervous 
 system, the size of the brain, etc., while the suppressors do a 
 similar work in the modification of this or that family or racial 
 characteristic. 
 
 THE FIRST WEEKS OF LIFE 
 
 The fertilized ovum remains in the tube for about one week, 
 when it slowly makes its way down into the uterus, all the 
 
10 
 
 THE MOTHER AND HER CHILD 
 
 Sperm and Ovum 
 
 Cell Division 
 
 Fetus at Six Weeks 
 
 Fetus at Three Months 
 
 Fig. i. Steps in Early Development 
 
STORY OF THE UNBORN CHILD n 
 
 while rapidly undergoing segmentation or division. It does not 
 grow much in size during this first week, but divides and 
 subdivides first, into two parts, then four, then eight, then 
 sixteen and so on, until we have a peculiar little body made 
 up of many equally divided parts, and known as the " Mul- 
 berry Mass" (Fig. i). The blending of the sperm and ovum 
 has been perfect, the division of the original body multitu- 
 dinous. 
 
 While this division of the united sex cells is progressing, 
 a wonderful change is also taking place in the inside lining 
 of the uterus. Instead of the usual thin lining, it has greatly 
 thickened and has become highly sensitized, and as the ovum 
 enters the uterus from the fallopian tube, this sensitized lining 
 catches it and holds it in its folds — actually covers it with 
 itself — holding the precious mass much as the cocoon, you have 
 so often seen fastened to the side of a plant or leaf, holds its 
 treasure of life. 
 
 Just as soon as the new uterine home is found the baby 
 heart begins to make its appearance, as also do many other 
 rudimentary parts. By the end of the third week, our round 
 mass has flattened and curved and elongated, and the nervous 
 system and brain begin to develop, while the primitive ears 
 begin to appear. At this time, the alimentary canal presents 
 itself as one straight tube which is a trifle larger at the head 
 end. And it is interesting to note that at this early date, even 
 the arms and legs are beginning to bud and push out from the 
 body. 
 
 LATER EMBRYONIC DEVELOPMENT 
 
 In the fourth and fifth weeks, the lungs and the pancreas 
 may be found, the heart develops, the nervous system has taken 
 on more definite form, and several of the larger blood-vessels 
 are appearing. 
 
 By the eighth week, by the most wonderful and complicated 
 processes of overlapping, pushing out, indentation, enfolding, 
 budding, pressing, and curving, the majority of the important 
 structures are formed — the eyes, ears, nose, hands, feet, ab- 
 dominal organs, and numerous glands. Thus, at the end of 
 
12 THE MOTHER AND HER CHILD 
 
 two months, almost every structure and organ necessary to 
 life is present in a rudimentary state. 
 
 AT THE END OF THREE MONTHS 
 
 By the close of the third month, witness the work of creation ! 
 From the blending of the two germ cells there has come forth 
 a beautifully formed body (Fig. i). True, it is but three and 
 one half inches in length, but it is nevertheless a perfect body. 
 About this time, the sex may be determined. The eyes, nose, 
 ears, chin, arms and legs and even the fingers and toes may all 
 be clearly distinguished. 
 
 A "jelly mass" at three months? No, by no means! No! 
 Life and form and features are all there. It really has a 
 face, whose features may easily be delineated. 
 
 In all my experience, I have yet to find the woman who 
 wished to continue in her wicked and criminal intent after she 
 had listened to this story of the creative development of the 
 first three months of her " child enmothered." 
 
 During the next four months, which take us to the close of 
 the seventh, rapid growth and farther development take place 
 to the extent, that, should birth occur at that time, life may 
 continue under proper conditions. 
 
 LAST WEEKS OF PREGNANCY 
 
 Everything is now nearing completion — only awaiting fur- 
 ther growth, development, and strength — except some of the 
 bone development, which takes place during the remaining two 
 months. Growth is rapid, strength is doubled, and as the two 
 hundred and seventy-three days draw to a close, everything 
 has been completed. It has all taken place according to the 
 laws of creation in an infinite way and with clock-like precision. 
 
 With the developmental growth of the product of conception, 
 the uterus or room that had been particularly prepared for the 
 " big reception " of the second week, has also grown to great 
 dimensions. It fills almost the entire abdomen and as a result 
 of the pressure against the diaphragm the breathing is some- 
 what embarrassed. 
 
 The door of this " room " has been closed by a special 
 
STORY OF THE UNBORN CHILD 13 
 
 mechanism, while, in the fullness of time, Mother Nature begins 
 the delicate work of opening the door, through whose portals 
 passes out into the world the completed babe. 
 
 The authors feel that this discussion of, and protest against, 
 abortions, should be accompanied by an appropriate consider- 
 ation of the control of pregnancy. We are never going to 
 eliminate the abortion curse of present-day civilization by merely 
 preaching against it — warnings and denouncements alone will 
 not suffice to remove the stain. Notwithstanding our feelings 
 and convictions in this respect, we are also well aware of the 
 fact that public sentiment is not now sufficiently ripe to wel- 
 come such a full and frank discussion of the subject of the 
 prevention of conception as the authors would feel called upon 
 to present; we are equally cognizant of the fact that existing 
 postal regulations and other Federal laws are of such a char- 
 acter (at least capable of such interpretation) as possibly to 
 render even the scientific and dignified consideration of such, 
 subjects entirely out of question. 
 
CHAPTER III 
 BIRTHMARKS AND PRENATAL INFLUENCE 
 
 IN the preceding chapter we learned that when the two 
 germ cells came together, there occurred a complete blending 
 of two separate and distinct hereditary lines, reaching from 
 the present away back into the dim and distant past. By the 
 union of these two ancestral strains a new personality is 
 formed, a new individual is created, with its own peculiar 
 characteristics. 
 
 HEREDITARY TRAITS 
 
 Probably none of the laboriously acquired accomplishments 
 of the present generation can be directly — and as such — 
 handed down to our children. What we are to be and what 
 we will do in this world was largely determined by the laws 
 of heredity by the time we were well started on our develop- 
 ment experience en-utero during the third or fourth week of 
 our prenatal existence, as outlined in a former chapter. 
 
 It is now generally accepted in scientific circles that acquired 
 characteristics are not transmissible. Someone has aptly stated 
 this truth by saying that " wooden heads are inherited, but 
 wooden legs are not." This does not by any means imply that 
 we do not have power and ability to fashion our careers and 
 carve out our own destiny, within the possible bounds of our 
 hereditary endowment and environmental surroundings. He- 
 redity does determine our " capital stock," but our own efforts 
 and acts determine the interest and increase which we may 
 derive from our natural endowment. From the moment concep- 
 tion takes place — the very instant when the two sex cells meet 
 and blend — then and there " the gates of heredity are forever 
 closed." From that time on we are dealing with the problems 
 
 14 
 
BIRTHMARKS AND PRENATAL INFLUENCE 15 
 
 of nutrition, development, education, and environment; there- 
 fore, so-called prenatal influence can have nothing whatever 
 to do with heredity. 
 
 A father may have acquired great talent as a physician or 
 a surgeon, in fact he may hold the chair of surgery in a medical 
 college, but each of his children come into the world without 
 the slightest knowledge of the subject, and, as far as direct and 
 immediate heredity is concerned, will have to work just about 
 as hard to master the subject as will the same average class of 
 children whose parents were not surgeons. This must not be, 
 taken to mean that certain abilities and tendencies are not 
 inheritable — for they are ; but they are inherited through 
 the parents — and not from them — directly. These transmitted 
 charactertistics are largely " stock " traits, and usually have long 
 been present in the " ancestral strain." 
 
 MATERNAL IMPRESSIONS 
 
 A mother may sing and pray all through the nine months 
 of expectancy, or she may weep and scold, or even curse. In 
 neither case can she influence the spiritual or moral tendencies 
 of her child and cause it, through supposed prenatal influence, 
 to be born with criminal tendencies or to grow up a pious 
 lad or become a devout minister. These tendencies and char- 
 acteristics are all largely determined by the " depressors," 
 " suppressors," and " determiners " which were present in the 
 two microscopic and mosaic germ cells which united to start 
 the embryo at the time of conception. 
 
 The child is destined to be born, endowed, and equipped with 
 the mental, nervous, and physical powers which his line has 
 fallen heir to all through the past ages. Down through the 
 ages education, religion, environment, and other special in- 
 fluences have no doubt played a small part in influencing and 
 determining hereditary characteristics; just as environment in 
 the ages past changed the foot of the evolving horse from 
 a flat, " cushiony " foot with many toes (much needed in the 
 soft bog of his earlier existence) into the " hoof foot " of 
 later days, when harder soil and necessity for greater fleetness, 
 assisted by some sort of " selection " and " survival," con- 
 
16 THE MOTHER AND HER CHILD 
 
 spired to give us the foot of our modern horse, and this story 
 is all plainly and serially told in the fossil and other remains 
 found in our own hemisphere. It would appear that many, many 
 generations of education and environment are required to in- 
 fluence markedly the established and settled train of heredity 
 regarding any particular element or characteristic in any par- 
 ticular line or lines of hereditary tendencies. 
 
 EUGENIC SUPERSTITION 
 
 There is probably more misinformation in the minds of the 
 people on the subject of "maternal impressions" and "birth- 
 marks" than any other scientific or medical subject. The 
 popular belief that, if a pregnant woman should see an ugly 
 sight or pass through some terrifying experience, in some 
 mysterious way her unborn child would be " marked," deformed, 
 or in some way show some blemish at birth, is a time-honored 
 and ancient belief. 
 
 Such unscientific and unwarranted teaching has been handed 
 down from mother to daughter through the ages, while the 
 poor, misguided souls of expectant women have suffered untold 
 remorse, heaped blame upon themselves, lived lives literally 
 cursed with fear and dread — veritable slaves to superstition 
 and bondage — all because of the simple fact that a certain per- 
 centage of all children born in this world have sustained some 
 sort of an injury or " embryological accident " during the first 
 days of fetal existence. For instance, take the common birth- 
 mark of a patch of reddened skin on the face, brow, or neck. 
 As soon as the baby is born, the worried mother asks in 
 anxious tones : " Doctor, is it all right, is it perfect, has it 
 got any birthmarks ? " On being told that the baby has a 
 round, red patch on its left brow, the ever-ready statement 
 of the mother comes forth : " Yes, I knew I'd mark it, I was 
 picking berries one day about three months ago, and I ate and 
 ate, until I suddenly remembered I might mark my baby, and 
 before I knew what I was doing, I touched my brow and I 
 just knew I had marked my baby." Do you know, reader, that 
 that birthmark was present fully four months before she passed 
 through that experience in the berry patch ? And yet so worried 
 
BIRTHMARKS AND PRENATAL INFLUENCE 17 
 
 and apprehensive has been the pregnant mother, that, although 
 she can never successfully predict the " birthmarks " and blem- 
 ishes of her child, nevertheless when these defects are disclosed 
 at birth she is unfailingly able immediately to recall some 
 extraordinary experience which she has carefully stored away 
 in her memory and which, to her mind, most fully explains 
 and accounts for the defect. 
 
 Is it much wonder that in the very early days of embryonic 
 existence, during the hours of delicate cell division, indentation, 
 outpushing, elongation, and sliding of young cells — is it much 
 wonder, I repeat — that there occur a few malformations, 
 blemishes, or other accidents which persist as " birthmarks ? " 
 
 CAUSES OF BIRTHMARKS 
 
 There are many factors which may enter into the production 
 of birth-blemishes, deformities, monstrosities, etc. These in- 
 fluences are all governed by certain definite laws of cause and 
 effect. A pre-existent systemic disease in the father, or a co- 
 existent disorder in the mother, may be a leading factor. A 
 mechanical injury, such as a sudden fall, a blow, or a kick, 
 or certain kinds of prolonged pressure, not to mention restric- 
 tions and contractions of the maternal bony structures, may 
 all possibly contribute something to these prenatal miscarriages 
 of growth and development. Maternal or prenatal embryonic 
 infections could bring about many sorts of birthmarks and 
 malformations. These defects might also be caused by certain 
 types of severe inflammatory disorders in the uterus during 
 the early days of pregnancy. 
 
 The same factors that produce the accidents of embryology 
 resulting in malformations or monstrosities in the human family, 
 are also operative in the case of our lesser brethren of the 
 animal kingdom, for monstrosities and birth-defects are very 
 common among the lower animals, notwithstanding the fact 
 that the animal mother probably does not " believe in birth- 
 marks." 
 
 " It is a striking fact that during the nineteenth century, 
 the teratologists, those who have scientifically investigated the 
 causes of monstrosities and fetal morbid states, have almost 
 
18 THE MOTHER AND HER CHILD 
 
 without exception, rejected the theory of maternal impres- 
 sions." Scientists and physicians are coming to recognize the 
 fact that fears and frights do not in any way act as causes in 
 the production of monstrosities and deformities. Let us seek 
 forever to liberate all womankind from the common and harass- 
 ing fear and the definite dread and worry that, because they 
 failed to control themselves at the instant of some terrifying 
 sight or experience, they were directly responsible for the mis- 
 fortune of their abnormal offspring. 
 
 It should be remembered that there exists no direct connec- 
 tion whatsoever between the nervous system of the unborn 
 child and the nervous system of the mother. The only phys- 
 iological or embryological relationship is of a nutritional order, 
 and even that is indirect and remote. 
 
 ROLE OF THE PLACENTA 
 
 By the end of the third month, the " cocoon " attachment 
 described in chapter two has disappeared; the fetus is slowly 
 pushed away from the uterus which has so snugly held it for 
 more than eleven weeks; while upon the exact site of its pre- 
 vious attachment the thickened uterine membrane undergoes a 
 very interesting and important change — definite blood vessels 
 begin to form — which begin indirectly to form contact with 
 the maternal vessels, and thus it is that the placenta, or " after 
 birth" is formed; and then, by means of the umbilical cord, 
 nourishment from the mother's blood-stream is carried to the 
 growing and rapidly developing child. In exchange for the 
 nourishing stream of life-giving fluid by which growth and 
 development take place, the embryo gives off its poisonous ex- 
 cretions which are carried back to the placenta, from which 
 they are absorbed into the veinous circulation of the mother; 
 so, while the mother does, through the process of nutrition, 
 influence growth and development in the embryo, she is wholly 
 unable to produce specific changes and such definite develop- 
 mental errors as birthmarks and other deformities. 
 
 Just as truly as it would be impossible so to frighten a setting 
 hen as to " mark " or otherwise influence the form or char- 
 acter of the chicks which would ultimately come forth from 
 
BIRTHMARKS AND PRENATAL INFLUENCE 19 
 
 the eggs in her nest, it is just as truly impossible to frighten 
 the pregnant mother and thereby influence the final develop- 
 mental product of the human egg which is so securely tucked 
 away in its uterine nest; for, when conception has occurred, 
 the human embryo is just as truly an egg — fashioned and 
 formed — as is the larger and shell-contained embryo of the 
 chick which lies in the nest of the setting hen. 
 
 And so we are compelled to recognize the fact that there 
 is little more danger to the unborn child when the mother is 
 frightened than when the father is scared. The one con- 
 tributes as much as the other to the general character of the 
 child, while neither is to blame for development errors and 
 defects. 
 
 SUGGESTION AND HEREDITY 
 
 Certain fears are suggested to children. For twenty years 
 I lived under the delusion that I was terribly afraid of snakes 
 — more so than any other human being ; for I was told when 
 a mere child that I had been " marked with the fear of snakes," 
 that just two months before I saw the peep of day, my esteemed 
 mother had been terrified by a snake. Everywhere I went, I 
 announced to sympathizing and ofttimes mischievous friends, 
 that " I was marked with the fear of snakes and must never be 
 frightened with them." It is needless to add in passing, that 
 I -was teased and frightened all through my girlhood days. 
 I was a veritable slave to the bondage of snake-fear. Every- 
 where I went I looked for my dreaded foe, expecting to sit 
 on one, step on one, or to have one drop into my lap from the 
 roof. 
 
 The day of deliverance came after marriage, when in a 
 supreme effort to deliver me from the shackles of fear, the 
 goodman of the house tenderly, but firmly, maneuvered a morn- 
 ing walk so that it halted in front of a large plate-glass window 
 of the Snake Drug Store in San Francisco. Just back of this 
 plate glass, and within eighteen inches of my very nose, were 
 fifty-seven varieties of the reptiles, big and small, streaked and 
 checkered, quiet and active. After much remonstrance and 
 waiting, I came-to — gazed at the markings, beautiful in their 
 
20 THE MOTHER AND HER CHILD 
 
 exactness — while slowly the change of mind took place. Faith 
 took the place of fear, calmness subdued panic, and I was 
 wondrously delivered from the veritable bondage of a score 
 of years. And so it is that the mother suffers and then the 
 child suffers, ofttimes a living death, because of the super- 
 stition " I'm marked," while there is ever present the fear or 
 dread that " something is going to happen, because I'm different 
 from all other individuals — because ' I'm marked ! ' " 
 
CHAPTER IV 
 THE HYGIENE OF PREGNANCY 
 
 AS soon as a woman discovers that she is pregnant, she 
 should sit down and quietly think out the plan for the 
 nine months of expectancy. 
 
 The cessation of the menses may come as a surprise to her, 
 and for a while she is more or less confused; she must go 
 over the whole situation and adjust future plans to fit in with 
 this new and all important fact. From a large experience with 
 maternity cases, I have reached the conclusion that the larger 
 percentage of pregnancies do come as a surprise, and in many 
 instances a complete change of program must be painstakingly 
 thought out. This is especially true of the business woman, 
 the professional woman, the busy club woman, or the active 
 society woman. 
 
 EARLY PLANNING 
 
 Let me say to the woman who is pregnant for the first time, 
 the experiences of the pregnant state should cause you no fear, 
 worry, or anxiety. Giving birth to a baby is a perfectly natural, 
 normal procedure, and if you are in reasonable health — if 
 your physician tells you you are a fairly normal woman — then 
 you can dismiss further thought of danger and go on your way 
 rejoicing. For thousands of years maternity has been women's 
 exclusive profession and no doubt will continue to be many ages 
 hence. 
 
 By far the most important and the first thing to do is care- 
 fully to select the best physician your means will allow, and 
 place yourself under his or her care. Your doctor will help 
 you to plan wisely and intelligently during the waiting time, 
 for physicians have learned from experience that the better 
 
 21 
 
22 THE MOTHER AND HER CHILD 
 
 care the pregnant woman receives, the easier will be her labor, 
 and the more speedy and uneventful the recovery. 
 
 And now, we proceed to take up one by one the particular 
 phases of the hygiene of pregnancy which touch the comfort, 
 convenience, and health of both the mother and her unborn 
 child. 
 
 THE CLOTHING 
 
 At all times and under all circumstances the pregnant woman's 
 clothing should be comfortable, suitable for the occasion, ar- 
 tistic, and practical. And to be thus beautifully clothed is to 
 be as inconspicuous as is possible. Of all times, occasions, and 
 conditions, that of pregnancy demands modesty in color, sim- 
 plicity in style, together with long straight lines (Fig. 2). For 
 the " going out " dress, select soft shades of brown, blue, wine, 
 or dark green. Let the house dresses be simple, easy to launder, 
 without constricting waist bands, of the one-piece type, in every 
 way suitable for the work at hand. Under this outer dress, a 
 princess petticoat should cover a specially designed maternity 
 corset (if any corset at all be worn), to which is attached 
 side hose-supporters. A support for the breasts may be worn 
 if desired, it should be loose enough to allow perfect freedom 
 in breathing. 
 
 The union suit may be of linen, silk, or cotton, with the weight 
 suitable for the season. Stockings and shoes should be of a 
 comfortable type, straight last, low or medium heel and at 
 least as wide as the foot. There are two or three shoes on 
 the market that are particularly good, whose arches are flexible, 
 heels comfortable, straight last, and whose soles look very much 
 like the lines of the foot unclothed. This style is particularly 
 good during the maternity days. Painful feet are a great 
 strain upon the general nervous system. Who of us has not 
 seen women with strained, tense faces hobbling about in high- 
 heeled, narrow-toed shoes? And if we followed them we would 
 not only see tenseness and strain in the features of the face, 
 but could hear outbursts of temper on the least provocation. 
 Aching feet produce general irritability. If ease of body and 
 calmness of spirit is desired, wear shoes that are comfortable, 
 
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 v* W 
 
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 Ik 
 
 
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 rBmj^^^y 
 
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 ft 
 
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 1 * /iS^^^^^^^^^^^^Z\ 
 
 Fig. 2. The " Expectant " Costume 
 
 The long lines, so admirable for maternity wear are portrayed in this handsome afternoon 
 costume. Tunic waist is made with shoulder yoke from which fullness hangs in tine 'plait- 
 ing, with panel at back, front and under arms. The set-in vest is of black -striped gold cloth. 
 trimmed with gold thread crochet buttons and with tiny waistcoat of black moire. Sleeves 
 are of Georgette crepe. Loose adjustable girdle of black moire ribbon. Full skirt is attached 
 on elastic to china silk underbodice. Material: Crepe de chine or any other soft, clinging 
 fabric. 
 
24 THE MOTHER AND HER CHILD 
 
 and the surprising part of it is that many of them are very good 
 looking. 
 
 Toward the end of pregnancy ofttimes the feet swell, in 
 which instance larger shoes should be worn in connection with 
 the bandaging of the ankles and legs. 
 
 During the latter days of expectancy an abdominal supporter 
 may be worn advantageously. Much of the backache and heavi- 
 ness in the pelvis is entirely relieved by the supporting of the 
 pendulous abdomen with a well-fitted binder. An ordinary piece 
 of linen crash may be fitted properly by the taking in of darts 
 at the lower front edge; or elastic linen, or silk binder may be 
 secured ; in fact, any binder that properly supports the abdomen 
 will answer the purpose. 
 
 It should be within the means of every pregnant woman to 
 have a neat, artistic out-door costume, for social, club and 
 church occasions (Fig. 2). For no reason but illness should 
 an expectant mother shut herself up in doors. 
 
 True men and true women hold the very highest esteem for 
 the maternal state, and the opinion of all others matters not; 
 so joyfully go forth to the club, social event, concert, or church ; 
 and to do this, you must have a well-designed, artistic dress. 
 The material does not matter much, but the shade and style are 
 important. 
 
 DIET 
 
 There are certain laws which govern the diet at all times; 
 for instance, the man who digs ditches requires more of a 
 certain element of food and more food in general, than does 
 the man who digs thoughts out of his brain. The growing 
 child requires somewhat different elements of food than does 
 an adult. In other words, " The diet should suit the times, 
 occasions, occupations, etc." 
 
 In the case of the expectant mother it should be remembered 
 that the child gains nine-tenths of its weight after the fifth 
 month of pregnancy, and it is, therefore, not necessary that 
 a woman shall begin " eating for two " until after the fifth 
 month. And since it is also true that the baby doubles its 
 weight during the last eight weeks of pregnancy, it follows that 
 
THE HYGIENE OF PREGNANCY 25 
 
 then is the time when special attention must be given to the 
 quantity as well as the quality of " mothers' food." 
 
 During the first five months, if the urine and blood-pressure 
 are normal, the " lady in waiting " should follow her usual 
 dietetic tastes and fancies so long as they do not distress or 
 cause indigestion. Because of the additional work of the 
 elimination of the fetal wastes, much water, seven or eight 
 glasses a day, should be taken ; while one of the meals — 
 should there be three — may well consist largely of fruit. All 
 of the vegetables may be enjoyed; salads with simple dressings 
 and fruits may be eaten liberally. Of the breads, bran, whole 
 wheat, or graham are far better for the bowels than the finer 
 grain breads, or the hot breads. 
 
 Something fresh — raw — should be taken every day, such as 
 lettuce, radishes, cabbage salad, and fresh fruits. 
 
 If the prospective mother is accustomed to the liberal use of 
 meat, providing the blood-pressure and urine are normal, she 
 may be able to indulge in meat once a day. Many physicians 
 believe that the maternal woman should eat meat rather spar- 
 ingly — from once a day to once or twice or three times a 
 week. 
 
 Of the desserts, gelatine, junket, ice cream, sponge cake, and 
 fruit are far better than the rich pastries, which never fail even 
 in health to encourage indigestion and heart burn. The fruit- 
 ades are all good. Candies and other sweets may be eaten in 
 moderation. Alcohol should be avoided. Tea and coffee should 
 be restricted, and in many cases abandoned. For many, two 
 meals and a lunch of fruit or broth are better than three full 
 meals. There is a continual and increased accumulation of 
 waste matter which must be thrown off by the lungs, kidneys, 
 bowels, and skin ; so that clogging of one channel of elimination 
 makes more work for one or more of the other eliminative 
 organs. 
 
 Sometimes the craving for food is excessive, and the desire 
 to nibble between meals is quite troublesome. These unusual 
 feelings should be controlled or ignored. A glass of orangeade 
 will sometimes satisfy this unnatural craving. Save your appe- 
 tite for meal time — for a good appetite means good digestion 
 
26 THE MOTHER AND HER CHILD 
 
 — all things equal. The woman who habitually eats between 
 meals is the sluggish, constipated individual who needs to acquire 
 self-control and learn self-mastery. 
 
 WATER DRINKING 
 
 Water is the circulating medium of the body, from which the 
 digestive secretions are formed, and by which the food is 
 assimilated and distributed to individual cells. And, finally, 
 water is the agent for dissolving and removing waste products 
 from the body through the various eliminating organs. We 
 literally live, think, and have our being, as it were, under water. 
 The tiny cell creatures of our bodies, from the humble bile 
 workers of the liver to the exalted thinking cells of the brain, 
 all carry on their work submerged. Accordingly, the amount 
 of water we drink each day, determines whether the liquids 
 circulating through our tissues shall be pure, fresh, and life- 
 giving, or stagnant, stale, and death-dealing. 
 
 Thirst is the expression of the nervous system, constituting 
 a call for water, the same as hunger represents a call for food. 
 Pure water, free from all foreign substances, is the best liquid 
 with which to quench this thirst. 
 
 It is just as important to supply abundance of water for 
 the proper bathing and cleansing of the internal parts of the 
 body, as it is to wash and bathe the external skin frequently. 
 The living tissues are just as literally soiled and dirtied by their 
 life action and their poisonous excretions, as is the skin soiled 
 by its excretions of sweat and poisonous solids. Thus the 
 regular drinking of water is absolutely necessary to enable the 
 body to enjoy its internal bath, and this internal cleansing is 
 just as grateful and refreshing to the cells and tissues, as is the 
 external bath to the nerves which exist in the skin. 
 
 The total amount of water necessary varies according to the 
 nature of one's work, the amount of sweating from the skin, 
 the moisture of the atmosphere, the amount of water in the 
 food, etc. We believe the average person requires about eight 
 glasses of liquid a day; that is, about two quarts. By the 
 word " glass " we refer to the ordinary glass or goblet, two 
 of which equal one pint. This amount of water should be 
 
THE HYGIENE OF PREGNANCY 27 
 
 increased, if anything, throughout pregnancy; while, during 
 the later months, the amount of water taken each day should 
 be at least doubled. 
 
 In the condemnation of so-called artificial beverages, an 
 exception should be made of the fruit juices. The fresh, 
 unfermented juices of various fruits come very near being 
 pure, distilled water, as they consist of only a little fruit sugar 
 and acid, together with small amounts of flavoring and coloring 
 substances, dissolved in pure water. None of these substances 
 contained in pure fruit juice needs to be digested. 
 
 Lemonade not too sweet, and taken in moderate quantities, 
 is certainly a beverage free from objection when used by the 
 average pregnant woman. Unripe or overripe fruits frequently 
 cause bowel disturbances; as also do the millions of germs 
 which lurk upon the outside of fruits, and which find their 
 way into the stomach and bowels when these fruits are eaten 
 raw without washing or paring. Otherwise, the juices of fruits 
 and melons are wholesome food beverages when consumed in 
 moderation. 
 
 EXERCISE 
 
 It should be the regular practice of every expectant mother 
 to spend a portion of each day in agreeable, suitable exercise or 
 physical work of some description. This exercise will be far 
 more beneficial if it can be taken in the open air. The weather 
 and the strength of the patient must be taken into consideration 
 and the necessary modifications of the daily exercise should be 
 made. 
 
 An expectant mother living in the city and enjoying the 
 average health and strength, should engage in such agreeable 
 exercise as the raising of flowers, the training of vines, with 
 brisk walks in the fresh air. As much time as possible should 
 be spent in the parks. 
 
 The rural " mother in waiting," may do light gardening, rais- 
 ing of chickens, or pigeons, training of vines, or other outdoor 
 work she may enjoy. 
 
 No matter what kind of weather prevails, a daily brisk walk- 
 should be taken, out of doors, on the porch or in a room with 
 
2& THE MOTHER AND HER CHILD 
 
 open windows. A daily sweat, as well as the daily prayer, is 
 good for the well-being of the expectant mother. All forms 
 of light housework are commendable. Keep out of crowds. 
 Spend more time in the parks than in the department stores. 
 An occasional evening at the concert or theater is diversion 
 and harmless provided the ventilation is good. Such exercises 
 as horseback riding, bicycling, dancing, driving over rough 
 roads, lifting and straining of any kind, and all other forms of 
 fatiguing exercise should be avoided. 
 
 REST 
 
 Rest and relaxation are quite necessary for men and women 
 even in the best of health. A kind providence has arranged 
 that we spend a large portion of our time resting, and sleeping. 
 In addition to unbroken rest at night it is well for the pros- 
 pective mother quietly to withdraw from the family circle, 
 when the first signs of fatigue begin to appear, and indulge in 
 a little rest, before she gets into a state of nervousness — where 
 nerves twitch and she becomes irritable. 
 
 A mother who has borne six children, who has had little domestic 
 help, and who yet retains her youthful appearance and energy, thinks 
 her present condition due to the fact that while carrying and nursing 
 her babies she never permitted herself to reach that stage of exhaus- 
 tion where her nerves twitched, her voice shrilled, and she became 
 irritable. She made it a practice to drop her work when these 
 symptoms began to appear, and to seek the sanctuary of a quiet room 
 apart from her family, if only for ten or fifteen minutes. And, 
 most important, from the very start she trained her household to 
 respect her right thus to draw apart. 
 
 I have told many women whose household duties press 
 hard : " Your husband would rather see a cold lunch on the 
 table, or ' go out ' for dinner, while his wife rested, smiling 
 and happy, than to have a most sumptuous meal spread before 
 him and the wife tired, and fretful." Every woman should 
 make it the rule of her life to stop just this side of the outburst 
 of words, and lie down long enough, breathing deeply, to calm 
 the spirit. 
 
THE HYGIENE OF PREGNANCY 29 
 
 FRESH AIR 
 
 " With all persons plenty of fresh air, night and day, is 
 indispensable to health, and to none more than the pregnant 
 woman. She should sleep with the windows open, or out of 
 doors, at all seasons of the year; of course, making due allow- 
 ance for the severity of the winters in the North. It is not 
 only necessary to provide for the adequate ventilation of 
 sleeping-rooms, but also for that of the living-rooms of the 
 house- 
 Many persons, who are quite particular to open wide the 
 windows of the bedrooms, forget that the other rooms need it 
 quite as much. All the rooms of the house which are occupied 
 should be thoroughly ventilated by throwing doors and windows 
 open every morning; at night when the family is assembled the 
 air must be changed now and then or it will become unfit for 
 human lungs." 
 
 Men and women are outdoor animals. They were made to 
 live in a garden, not a house. Remember that each person 
 requires one cubic foot of fresh air every second. Don't allow 
 the temperature of living-rooms, during the winter season, to 
 go above sixty-eight degrees. If your home has no system of 
 ventilation, open wide the windows and doors several times a 
 day and enjoy the blessings of a thorough-going flushing with 
 fresh air. 
 
 Oxygen is the vital fire of life. Our food, however well 
 digested and assimilated, is just as useless to the body without 
 oxygen, as coal is to the furnace without air. It is equally 
 important to keep up the proper degree of moisture in the air 
 of the living-rooms. 
 
 BATHING 
 
 Bathing is made necessary by the clothes we wear and by 
 our indoor life. If the skin were daily exposed to sunshine and 
 fresh air, it would seldom be necessary to bathe. The neglect 
 of regular bathing results in overworking the liver and kidneys, 
 and debilitates the skin. Regular bathing — ofttimes sweating 
 baths — is very essential to the hygiene of pregnancy. 
 
3 o THE MOTHER AND HER CHILD 
 
 The neutral bath (97 F.) is excellent to quiet the nerves 
 and induce sleep. Morning bathing is an exceedingly valuable 
 practice. If properly taken before breakfast or midway between 
 breakfast and lunch, it is found to be refreshing and tonic in 
 nature. The feet should be in warm water, the application of 
 cold should be short and vigorous. A rough mit dipped in cold 
 water, rubbed over the body until the skin is pink, is a splendid 
 tonic. 
 
 Warm cleansing baths should be taken twice a week at night. 
 There is no good reason for the use of the vaginal douche 
 during pregnancy. 
 
 THE TEETH 
 
 Because the mother's system is drained of the lime salts 
 which aid in building up the bones of the child, along with 
 other metabolic changes which cause the retention of certain 
 acids which ofttimes affect the teeth, they should be frequently 
 examined and carefully guarded. Severe dental work should 
 be avoided, but all cavities should receive temporary fillings' 
 while the teeth are kept free from deposits. 
 
 As a preventive to this tendency of the teeth to decay, a 
 simple mouth wash of one of the following may be used after 
 meals : 
 
 1. One teaspoon of milk magnesia. 
 
 2. One tablespoon of lime water. 
 
 3. One-half teaspoon common baking soda. 
 Any one to be dissolved in a glass of water. 
 
 DIRECTIONS FOR SAVING URINE SPECIMENS 
 
 Beginning with the second voiding of urine after rising on 
 the morning of the day you are to save the specimen, save all 
 that is passed during the following twenty-four hours, including 
 the first voiding on the second morning. Measure carefully the 
 total quantity passed in the twenty-four hours. Shake thor- 
 oughly so that all the sediment will be mixed, and immediately 
 after shaking take out eight ounces or thereabouts for delivery 
 to the physician the same forenoon. The following items 
 
THE HYGIENE OF PREGNANCY 31 
 
 should be noted, and this memoranda should accompany the 
 specimen : 
 
 1. Patient's name. 
 
 2. Address. 
 
 3. This specimen was taken from a twenty-four hour void- 
 ing of urine, which began at .... a. m , and ended at 
 
 .... a. m 
 
 4. The total quantity voided during this twenty-four hours 
 Was .... pints. 
 
 This specimen should reach the laboratory by ten o'clock 
 the same morning. 
 
 It is of utmost importance the specimen should be taken to 
 your physician every two weeks, and oftener if conditions 
 indicate it. Take it yourself at the appointed time. 
 
 THE BOWELS 
 
 Owing to the increasing pressure exerted upon the intestines, 
 most expectant mothers experience a tendency to sluggish 
 bowels and constipation. This unpleasant symptom is usually 
 increased during the later months. 
 
 In the first place, a definite time must be selected for bowel 
 action. It may ofttimes be necessary, and it is far less harmful, 
 to insert a glycerine suppository into the rectum, than to get 
 into the enema habit. The injection of a large quantity of 
 water into the lower bowel will mechanically empty it; but the 
 effects are atonic and depressing as regards future action. 
 
 Before we take up the advisability of taking laxatives let us 
 consider what foods will aid in combating constipation. The 
 following list of foods are laxative in their action and will 
 be found helpful in overcoming the constipation so often associ- 
 ated with pregnancy: 
 
 1. All forms of sugar, especially fruit sugar, honey, syrup, 
 and malt. All the concentrated fruit juices. Sweet fruits, such 
 as figs, raisins, prunes, fruit jellies, etc. 
 
 2. All sour fruits, and fruit acids: Apples, grapes, goose- 
 berries, grape fruit, currants, plums, and tomatoes. 
 
 3. Fruit juices, especially from sour fruits: Grape juice, 
 lemonade, fruit soup, etc. 
 
32 THE MOTHER AND HER CHILD 
 
 4. All foods high in fat: Butter, cream, eggs, eggnog, ripe 
 olives, olive oil, nuts — especially pecans, brazil nuts, and pine 
 nuts. 
 
 5. Buttermilk and koumiss. 
 
 6. All foods rich in cellulose: Wheat flakes, asparagus, 
 cauliflower, spinach, sweet potatoes, green corn and popcorn, 
 graham flour, oatmeal foods, whole-wheat preparations, bran 
 bread, apples, blackberries, cherries, cranberries, melons, 
 oranges, peaches, pineapples, plums, whortleberries, raw cab- 
 bage, celery, greens, lettuce, onions, parsnips, turnips, lima 
 beans, and peanuts. 
 
 White bread should be tabooed, and in its place a well-made 
 bran bread should be used. Two recipes for bran bread follow, 
 one sweetened and containing fruit, the other unsweetened: 
 
 BRAN BREAD RECIPES 
 
 1. Two eggs, beaten separately; three-fourths cup of molasses, 
 plus one round teaspoon of soda; one cup of sour cream; one cup 
 of sultana seedless raisins; one cup of wheat flour, plus one 
 heaping teaspoon baking powder; two cups of bran; stir well 
 and bake one hour. 
 
 2. One cup of cooking molasses; one teaspoon of soda; one 
 small teaspoon of salt, one pint of sour milk or buttermilk, 
 one quart of bran, one pint of flour. Stir well, and bake for 
 one hour in a very slow oven. It may be baked in loaf, or 
 in gem pans, as preferred. The bread should be moist and 
 tender, and may be eaten freely, day after day, and is quite 
 sure to have a salutary effect if used persistently. 
 
 The drinking of one-half glass of cold water on rising in 
 the morning often aids in keeping the bowels active. Of the 
 laxative drugs which may be used at such a time, cascara 
 sagrada and senna are among the least harmful. Two recipes 
 of senna preparation follow, and may be tried in obstinate cases : 
 
 1. Senna Prunes. Place an ounce of senna leaves in a jar 
 and pour over them a quart of boiling water. After allowing 
 them to stand for two hours strain, and to the clear liquid add a 
 pound of well-washed prunes. Let them soak over night. In 
 the morning cook until tender in the same water, sweetening 
 
THE HYGIENE OF PREGNANCY 33 
 
 with two tablespoons of brown sugar. Both the fruit and 
 the sirup are laxative. Begin by eating a half-dozen of the 
 prunes with sirup at night, and increase or decrease the amount 
 as may be needed. 
 
 2. Senna with prunes and figs. This recipe does not call 
 for cooking. Take a pound of dried figs and a pound of dried 
 prunes, wash well. Remove the stones from the prunes and if 
 very dry soak for an hour. Then put both fruits through the 
 meat chopper, adding two ounces of finely powdered senna 
 leaves. Stir into this mixture two tablespoons of molasses to 
 bind it together, the result being a thick paste. Begin by eating 
 at bedtime an amount equal to the size of an egg, and increase 
 or decrease as may be necessary. Keep the paste tightly cov- 
 ered in a glass jar in a cool place. If the senna is distasteful 
 a smaller quantity may be used at first. 
 
 CARE OF THE BREASTS 
 
 The breasts are usually neglected during the months of 
 pregnancy, and as a result complications occur after the baby 
 comes which cause no end of discomfort to the mother. If, 
 during the pregnancy, the breasts are washed daily with liquid 
 soap and cold water, and rubbed increasingly until all sensitive- 
 ness has disappeared, they may be toughened to the extent that 
 no pain whatsoever is experienced by the mother when the babe 
 begins to nurse. During the last month of pregnancy a solution 
 of tannin upon a piece of cotton may be applied after the usual 
 vigorous bathing. If the nipples are retracted they should be 
 massaged until visible results are attained. 
 
 THE MENTAL STATE 
 
 Keep the mind occupied with normal, useful, and healthy 
 thoughts. Listen to no tales of woe. Stay away from the 
 neighborhood auntie dolefuls. Keep yourself happy and free 
 from all worry, care, and anxiety. 
 
 " Put no faith in fables of cravings, markings, signs, or 
 superstitions. They are all unfounded vagaries of ignorant 
 old women and will not bear investigation." 
 
 Don't take drugs for worry and sleeplessness. Take a bath. 
 
34 THE MOTHER AND HER CHILD 
 
 The secret of deliverance from worrying is self-control. 
 Minimize your difficulties. Cultivate faith and trust. 
 
 The conditions which favor sound sleep are: Quiet, mental 
 peace, pure blood, good digestion, fresh air (the colder the 
 better), physical weariness (but not fatigue), mental weari- 
 ness (but not worry). 
 
 When tempted to borrow trouble, when harassed by fictitious 
 worries, remember the old man who had passed through many 
 troubles, most of which never happened. Train the mind to 
 think positive thoughts. Replace worry-thought with an oppo- 
 site thought which will occupy the mind and enthuse the soul. 
 Drive out fear-thought by exercising faith-thought. Cultivate 
 the art of living with yourself as you are, and with the world 
 as it is. Learn the art of living easily. Associate with children 
 and learn how to forget the vexing trifles of everyday life. 
 
 There is something decidedly wrong with one's nerves when 
 everybody is constantly " getting on them." They are either 
 highly diseased or abnormally sensitive. Every woman is a 
 slave to every other that annoys her. 
 
 Fear is capable of so disarranging the circulation as to con- 
 tribute to the elevation of blood-pressure — which will be more 
 fully considered in a later chapter. 
 
CHAPTER V 
 COMPLICATIONS OF PREGNANCY 
 
 IT is the purpose of this chapter to take up the various com- 
 plications which may appear in the course of an otherwise 
 normal pregnancy, and offer advice appropriate for their 
 management. 
 
 MORNING SICKNESS 
 
 About one-half of the expectant mothers that come under 
 our care and observation, experience varying degrees of nausea 
 or " morning sickness." This troublesome symptom makes its 
 appearance usually about the fourth week of pregnancy and 
 lasts from six to eight weeks. 
 
 On attempting to rise from the bed, there is an uncomfortably 
 warm feeling in the stomach followed by a welling up into the 
 throat of a warmish, brackish tasting liquid which causes the 
 patient to hasten to rid herself of it; or, as she rides on the 
 train, on the street cars, in a carriage or automobile, she fre- 
 quently senses the same unpleasant and nauseating symptoms 
 during the second and third months of pregnancy. Normally, 
 this uncomfortable symptom quite disappears by the end of the 
 third month. A number of remedies have been suggested for 
 it, but that which seems to help one, gives little or no relief to 
 another; we therefore mention a variety of remedies which 
 may be tried. 
 
 First and most important of all remedies — is to keep the 
 bowels open. Sluggishness of the intestinal tract greatly 
 increases the tendency to dizziness and nausea. During the 
 attack, it is advisable not to attempt to brush the teeth, gargle, 
 or even drink cold water. While you are yet lying down, the 
 maid or the goodman of the house should bring to you a piece 
 
 35 
 
36 THE MOTHER AND HER CHILD 
 
 of dry, buttered toast, a lettuce sandwich with a bit of lemon 
 juice, or perhaps a cup of hot milk or hot malted milk. Coffee 
 helps to raise the blood-pressure, and all articles of diet that 
 tend to raise the blood-pressure are best avoided during preg- 
 nancy. A cup of cocoa may be tried, but, as a rule, women at 
 this time do not relish anything sweet. Oftentimes a salted 
 pretzel is just the thing, or a salted wafer will greatly help. 
 Remain in bed from one-half to one hour and then rise very 
 slowly. There should be plenty of fresh air in the room, as 
 remaining in overheated places is quite likely to produce a feel- 
 ing of sickness at the stomach. 
 
 When the attack comes on during a train ride, open the 
 window and breathe deeply, this, with the aid of a clove or the 
 tasting of a bit of lemon, will usually give relief. In extreme 
 instances the patient should lie down flatly on the back, with 
 the eyelids closed. Go to the rear of the street car, so that you 
 can get off quickly if necessity demands ; breathe deeply of the 
 air; resort to the use of cloves or lemons; and thus by many 
 and varied methods will the expectant mother be enabled to con- 
 tinue her journey or finish her shopping errand. We would 
 suggest that, as far as possible, walking should be substituted 
 for riding. I have never heard of a woman being troubled with 
 nausea while walking in the parks, on shady streets, along the 
 country road, or on the beach. 
 
 Of the medicines prescribed for " morning sickness " and the 
 nausea of pregnancy, cerium oxalate taken three times a day in 
 doses of five grains each, is probably one of the best. 
 
 The persistent or pernicious vomiting which continues on 
 through pregnancy will be spoken of later. 
 
 HEARTBURN 
 
 Acid eructations are spoken of as " heartburn," and are 
 occasioned by the increased activity of the acid making glands 
 of the stomach. Under certain conditions this acid content 
 of the stomach is regurgitated back into the throat and even 
 belched up into the mouth. In this condition it is well to avoid 
 most acid fruits. Ice cream and other frozen desserts are 
 beneficial. The lowered temperature of cold foods depresses 
 
COMPLICATIONS OF PREGNANCY 37 
 
 the activity of the acid glands, as also does the fats of the 
 cream, while protein food substances such as white of egg, 
 cheese, and lean meat, help by combining with the excess of 
 acid present in the stomach. Buttermilk or the prepared lactic 
 acid milk, if taken very cold, is often helpful, notwithstanding 
 it is an acid substance, in connection with the dietetic manage- 
 ment of heartburn. If the acid eructations be troublesome 
 between the meals, the taking of calcined magnesia (one round 
 teaspoon in a glass of cold water), or, one-half teaspoon of 
 common baking soda in a glass of water, will afford immediate 
 and temporary relief. Simply nibbling a little from a block of 
 magnesia will often give instant relief. These alkalines effect- 
 ively neutralize the mischievous acids which cause the so-called 
 " heartburn." 
 
 IRRITABILITY OF THE BLADDER 
 
 The flexing or bending forward of the gravid uterus, by mak- 
 ing pressure on the bladder, sets up more or less irritation and 
 consequent disturbance of the urinary function. The capacity 
 of the bladder is actually diminished, and this produces frequent 
 urination. There is usually no pain connected with this annoy- 
 ing symptom — the chief discomfort is the frequent getting up 
 at night. This inconvenience may be lessened by drinking less 
 water after six p. m. These bladder disturbances are most 
 marked in the earlier months, and gradually disappear as the 
 uterus raises higher up into the abdomen ; although this symptom 
 may reappear in the last two weeks, as the head descends down- 
 ward on its outward journey. 
 
 Should the urine at any time become highly colored, take a 
 specimen to your physician at once. Twenty-four hour speci- 
 mens of urine should be taken by the patient to her physician 
 every two weeks. Do not send it — take it. 
 
 LEUCORRHEA 
 
 While leucorrhea is an unusual complication of pregnancy. 
 it is often very troublesome and sometimes irritating. Do not 
 take a vaginal douche unless it has been ordered by your phy- 
 sician, and even then make sure that the force of the flow of 
 
38 THE MOTHER AND HER CHILD 
 
 water is very gentle. The bag of the fountain syringe should 
 be hung only about one foot above the hips. Soap and water 
 used externally, followed by vaseline or zinc ointment, will 
 usually relieve the accompanying irritation. 
 
 THREATENED ABORTION 
 
 In the third chapter attention was called to the formation of 
 the placenta or " after birth," on the site of the attachment of 
 the cocoon embryo. At this particular time of the pushing away 
 of the embryo from the uterine wall, one of the accidents of 
 pregnancy occurs, in which the embryo becomes completely 
 detached and starts to escape from the uterus, accompanied by 
 varying degrees of pain and hemorrhage. The symptoms of 
 this threatened abortion are: 
 
 i. Heavy menstrual pains. 
 
 2. Backache. 
 
 3. Hemorrhage. 
 
 The approach of the calendar date of the third month of 
 pregnancy should be watched for, and all work of a strenuous 
 nature studiously avoided; while at the first signs of the back- 
 ache or any unusual symptom, the expectant mother should 
 immediately go to bed and send for the physician. One patient 
 who had aborted on four different occasions was able to pass 
 this danger period by adhering to a rigid program of pre- 
 vention during her fifth pregnancy. Two weeks before the 
 third month arrived she discontinued her teaching and went 
 to bed. She remained there four weeks, thus running over into 
 the middle of the following month. Gradually, she resumed her 
 duties of teaching, carried her precious bundle of life to full 
 term, and is now the proud and happy mother of a splendid 
 baby girl. 
 
 Should abortion seem imminent, from one-eighth to one- 
 fourth of a grain of morphine sulphate will greatly reduce all 
 uterine contractions, and this, with the general quieting effect 
 on the whole system, will usually suffice to prevent an abortion. 
 The patient should quietly remain in bed from three days to one 
 week. 
 
COMPLICATIONS OF PREGNANCY 39 
 
 If the abortion takes place — if a clot accompanied by hemor- 
 rhage is passed — save everything, lie in bed very quietly and 
 send for your physician at once ; and when he does arrive, be 
 content if he does not make an internal examination at once, 
 for if he should there is more or less danger of infection. And 
 I repeat — throw nothing away — burn nothing up, save every- 
 thing that passes until your physician has carefully examined it. 
 
 SUDDEN ABDOMINAL PAIN 
 
 Sudden or severe pains in the abdomen should be reported at 
 once to your physician, while you should immediately go to bed 
 and quietly remain there until you receive further instruction 
 from your doctor when he calls. 
 
 In the later stages of pregnancy any appearance of blood 
 should likewise be noted and reported without delay. These 
 symptoms may not always be serious, but they are also associ- 
 ated with grave complications, and should, therefore, be given 
 prompt attention. 
 
 MISCARRIAGE 
 
 Abortion is a term used to designate the loss of the embryo 
 prior to or at the third month. Miscarriage applies to the 
 expulsion of the fetus or emptying of the uterus after the 
 third month. It is possible for a miscarriage to occur anytime 
 during the interim between the fourth and ninth months. After 
 the uneventful passing of the third month, if an accident threat- 
 ens, we instruct the mother to remain quietly in bed three to 
 five days at the calendar date comparable with each menstrual 
 period; and as she approaches the seventh month, we adjure 
 her to be unusually careful and prudent. 
 
 The causes of miscarriages are many : Disease of the embryo, 
 imperfect fetal development, some constitutional disease of the 
 mother, a faulty position of the uterus, or it may result from 
 something unusual about the lining of the uterus such as an 
 endometritis — an inflammation of the mucus membrane. 
 
 Expectant mothers who manifest symptoms of a threatened 
 miscarriage should studiously avoid such exercises as climbing, 
 riding, skating, tennis, golf, dancing, rough carriage or auto- 
 
4 o THE MOTHER AND HER CHILD 
 
 mobile riding, and such taxing labor as sweeping, lifting, wash- 
 ing, running the sewing machine, window cleaning, the hanging 
 of pictures, draperies, etc. 
 
 CRAVINGS 
 
 Within reason, a pregnant mother should follow her natural 
 appetite and satisfy her dietetic longings. Should she desire 
 unusual articles of food, as far as possible she should have 
 them. The idea has long prevailed that if the mother does not 
 get what her longing soul supremely desires, that the on-coming 
 baby is going to cry and cry until it is given what the mother 
 wanted with all her heart and did not get. Such an idea is the 
 very quintessence of folly and the personification of foolishness 
 and superstition. 
 
 Many a precious babe has suffered as a victim of this notion 
 of " craving " and " marking." One mother gave her baby a 
 huge mouthful of under-ripe banana because " she knew that 
 was just what he wanted, because, when pregnant, she had 
 craved and craved bananas and for some reason or another she 
 did not get them." The soft, smooth piece of banana slipped 
 down the baby's throat — on into the stomach and intestines — 
 caused intestinal obstruction and finally the end came; and we 
 registered one more victim to the fallacies of fear and the 
 superstitious belief in " cravings " and " markings." Occasion- 
 ally some cravings are unusual and freakish, for instance, egg 
 shells, leather, candles, chalk, and other abnormal tastes are 
 developed. Of these we have only to say, " Rise above them, 
 become mistress of the situation and change your longings." 
 If such abnormal cravings come to you in the kitchen, don your 
 bonnet and go at once out of doors and take a walk. Don't be 
 foolish just because somebody told you foolish stories about 
 these things. 
 
 CONSTIPATION 
 
 Bowel hygiene is an important part of the management of 
 pregnancy. Constipation often proves to be very troublesome. 
 In another chapter this subject is treated at some length. Here, 
 we pause only long enough to say that habit has much to do 
 
COMPLICATIONS OF PREGNANCY 41 
 
 with this difficulty. A regular time should be set apart each 
 day for attending to this important matter. 
 
 HEMORRHOIDS 
 
 Of all the maladies that the human family falls heir to, hemor- 
 rhoids are among the commonest and, we may add, the most 
 neglected. Any woman who enters pregnancy, suffering from 
 hemorrhoids, is going to have her full share of suffering and 
 pain before she has finished with her labors. Taken early, 
 they may be greatly helped, if not entirely relieved, by the 
 daily use of the medicated suppository (See Appendix). The 
 bowel movements should never be allowed to become hard, the 
 dietetic advice of another chapter should be carefully followed 
 and the oil enema, as described in the appendix, should be used 
 if necessary. For immediate relief, hot witch-hazel compresses 
 may be applied; or, in the case of badly protruding piles, the 
 patient should immerse the body in a warm bath and by the 
 liberal use of vaseline they can usually be replaced. The phy- 
 sician should be called and he will advise any further treatment 
 the case may require. 
 
 VARICOSE VEINS 
 
 Varicose veins or the distension of the surface veins of the 
 legs are very common among women in general and pregnant 
 women in particular. The legs should be elevated whenever 
 the patient sits, while in bad cases they should be bandaged 
 while standing. There are many elastic surgical stockings on 
 the market today that, if put on before rising in the morning, 
 will give much relief and comfort all during the day. Any large 
 medical house or physician's supply house can furnish them 
 according to your measurements — which should be taken before 
 getting out of bed in the morning. These measurements are 
 taken according to instructions and usually are of the instep, 
 ankle, calf of leg, length of ankle to knee, etc. 
 
 CRAMPS 
 
 Cramps are sharp, exceedingly painful muscular spasms occur- 
 ring in the muscles of the calf of the leg, the toes, etc. The 
 
42 THE MOTHER AND HER CHILD 
 
 expectant mother in the later months of pregnancy awkwardly 
 turns in bed, is suddenly awakened and without a moment's 
 warning, is seized with a most excruciating pain in her leg or 
 toe. The most effectual treatment for these cramps is quickly 
 to apply a very cold object to the cramping muscle. Extremes 
 of either heat or cold usually relieve as well as the vigorous 
 grasping or kneading of the muscle. A hot foot bath on going 
 to bed will often prevent an attack. A long walk in the latter 
 months of pregnancy should invariably be followed by a short 
 hot bath or a foot bath. Many attacks may be avoided by this 
 procedure. 
 
 SWELLINGS 
 
 All swellings should be taken seriously by the pregnant mother 
 to this extent, that she save a twenty-four hour specimen of 
 urine and that she personally take it to her physician, with a 
 report of her " swellings." This symptom may or may not 
 indicate kidney complications. The blood-pressure together with 
 chemical and microscopical analysis of the urine will determine 
 the cause. 
 
 Slight swelling of the feet is often physiological and is due 
 to pressure of the heavily weighted uterus upon the returning 
 veins of the legs. The progress of the veinous blood is some- 
 what impeded, hence the accumulation of lymph in the tissues 
 of the legs, ankles, and feet. 
 
 Never allow yourself to guess as to the cause of swellings, 
 always take urine to the physician and allow him definitely to 
 ascertain the true cause. All tight bands of the waist and knee 
 garters must be discarded at this time. The same general 
 treatment suggested for varicose veins holds here. 
 
 GOITRE 
 
 The enlargement of the thyroid gland — goitre — is physi- 
 ological during pregnancy, and is believed to be caused by the 
 throwing into the maternal blood stream of special protein 
 substances derived from the fetus. As just stated, this is more 
 or less physiological, will usually pass away after the babe is 
 born, and, therefore, need give the mother no particular con- 
 
COMPLICATIONS OF PREGNANCY 
 
 43 
 
 cern. Tight neck bands should be replaced by low, comfortable 
 ones. The bowels should move freely every day, and water 
 drinking be increased as well as sweating of the skin encour- 
 aged by a short, hot bath, followed by the dry blanket pack, 
 while the head is kept cool by compresses wrung from cold 
 water. In this manner the elimination of these poisons is 
 increased through both the skin and the kidneys. 
 
 BACKACHE 
 
 The backache of the later months of expectancy is very 
 annoying and often spoils an otherwise restful night's sleep. 
 
 -5 to 7 ft Length 
 
 •9 in. Diameter 
 
 12 in. Diameter 
 
 Fig. 3. The Photophore. 
 
 This is probably also a pressure symptom, if the physician's 
 analysis of the urine proves that the kidneys are not at fault. 
 If you have electric lights in the home, a very useful contrivance 
 can be made which will give you great relief. The light end of 
 an extension cord, five to seven feet in length, is soldered into 
 the center of the bottom of a bright, pressed tin pail about 
 twelve inches in diameter at the top and nine or ten inches 
 deep. With the bail removed, screw in a sixteen or thirty-two 
 candle power bulb and attach the extension cord to a nearby 
 
44 THE MOTHER AND HER CHILD 
 
 wall or ceiling socket. This arrangement supplies radiant heat 
 and is called a photophore (See Fig. 3). Apply this twofold 
 remedial agent — light and heat combined — to the painful back 
 (underneath the bed clothing) and our restless mother will go 
 to sleep very quickly. This may safely be used as often and as 
 long as desired. 
 
 PERNICIOUS VOMITING 
 
 Persistent, prolonged, and very much aggravated cases of 
 morning sickness are termed pernicious vomiting. The patient 
 emaciates because of the lack of ability to keep food long 
 enough to receive any benefits therefrom. 
 
 In treating these cases the sufferer should be put to bed in 
 a room with many open windows, or, if the weather permit, 
 should be out of doors on a comfortable cot. She should 
 remain in bed one hour before the meal is served and from 
 one to three hours afterward. The mind should be diverted 
 from her condition by good reading, friends, or other amuse- 
 ments. The utmost care and tact should be used in the prepara- 
 tion of her food, and art should be manifested in the daintiness 
 of the tray, etc. We found one mother was nauseated even 
 at the sight of her tray and so we planned a call that should 
 bring us to her home at the meal hour. The tray came in with 
 the attendant in unkempt attire, who said, as she placed it care- 
 lessly down on a much-loved book our patient had been reading : 
 " I heard you say you liked vegetable soup so I brought you a 
 big bowl full." As I gazed at the tray, I saw a large, thick, 
 gravy bowl running over with the soup. I usually like vegetable 
 soup, but at the sight of that sloppy looking bowl — well, I 
 thought I should never care for it again. 
 
 After installing a new maid who had a sense of service and 
 daintiness, and who took real pleasure in the selection of the 
 dishes for the tray, as well as the quality and quantity of food 
 served in them, our patient made speedy recovery, went on to 
 full term and became a happy mother. 
 
 There is no doubt that the mind has very much to do with 
 this vexing complication of pregnancy. One mother immedi- 
 ately stopped vomiting everything she ate when told by her 
 
COMPLICATIONS OF PREGNANCY 45 
 
 husband that " the doctor said he was coming in the morning 
 to take you away from me to the hospital if you didn't stop 
 vomiting." Everything known should be tried for the relief 
 of these patients and in extreme cases, when the mother's life 
 is endangered, pregnancy should be terminated. 
 
 INSOMNIA 
 
 The neutral full bath, temperature 97 F., maintained for 
 twenty minutes to one-half hour, should be taken, just on going 
 to bed. The patient must not talk — must rest in the bath — 
 absolutely quiet. The causes of insomnia should be determined 
 if possible, and proper measures employed to remove them. 
 They may consist of backache, cramps, frequent urination, 
 pressure of the uterus on the diaphragm or pressure against 
 the sides of the abdomen. The bed should be large, thus giving 
 the patient ample room to roll about. 
 
 The following procedures may be tried in an effort to relieve 
 the sleeplessness: 
 
 Rubbing of the spine, alcohol or witch-hazel rubbing of the 
 entire body, the neutral bath, or the application of the electric 
 photophore — described a few pages back — may be made to 
 the painful part. Do not resort to drugs, unless you are directed 
 to do so by your physician. 
 
 HEADACHE 
 
 Headaches should not be allowed to continue unobserved by 
 the attending physician. Measure the daily output of urine, 
 which should be at least three pints or two quarts. In case of 
 daily or frequent headaches, notify your physician at once and 
 take a twenty-four hour specimen of urine to him. Headache 
 is an early symptom of retained poisons and if early reported 
 to the physician quick relief can be given the patient and often 
 severe kidney complications be avoided by the proper adminis- 
 tration of early sweating procedures. Water drinking should 
 be increased to two quarts (about ten glasses) a day. Less food 
 and more water are the usual indications in the headaches of 
 pregnancy. 
 
46 THE MOTHER AND HER CHILD 
 
 HIGH BLOOD-PRESSURE 
 
 Blood-pressure is called high when the systolic pressure 
 registers above 150 to 160 millimeters of mercury. Pressure 
 above 165 should be taken seriously and the patient should keep 
 in close touch with her physician. Tri-weekly examinations of 
 the urine should be made, while eliminating baths should be 
 promptly instituted. The subject of blood-pressure in relation 
 to pregnancy will be fully dealt with in the next chapter — in 
 connection with toxemia, eclampsia, etc. 
 
CHAPTER VI 
 
 TOXEMIA AND ITS SYMPTOMS 
 
 AT the close of the preceding chapter on the complications of 
 l\ pregnancy, brief mention was made of blood-pressure as a 
 possible source of anxiety. This chapter will be devoted to a 
 further discussion of the subjects of toxemia, eclampsia, con- 
 vulsions, and especially blood-pressure — in connection with 
 other leading symptoms of these serious complications of preg- 
 nancy. 
 
 TOXIC SYMPTOMS 
 
 In a former chapter we learned that the developing child 
 nearly doubled its weight in the last two months of pregnancy. 
 As the child grows, its metabolic waste matter is greatly 
 increased, while all these poisonous substances must finally be 
 eliminated by the mother. Now, the mother's waste matter is 
 of itself considerably increased; and so, if the kidneys, the liver, 
 and the skin are already over-taxed in their work of normal 
 elimination — if they are already doing their full quota of 
 work — we can readily see that the additional waste matter 
 of the unborn child will throw much extra work on the already 
 overworked eliminative organs, and this results in a condition 
 of toxemia. Certain symptoms accompany this state of consti- 
 tutional poisoning or auto-intoxication — ■ the chief of which are : 
 
 i. Headache. 
 
 2. Dizziness. 
 
 3. Blurring of the vision. 
 
 4. Swelling of the feet and hands, or pufnness of the face. 
 
 5. Diminished urine. 
 
 6. Vomiting. 
 
 7. High blood-pressure. 
 
 8. Albumin and casts in the urine. 
 
 47 
 
48 THE MOTHER AND HER CHILD 
 
 Any one of these symptoms may or may not indicate toxemia ; 
 but it should be reported at once to the attending physician. 
 In the presence of one or more of these symptoms an expectant 
 mother is always safe, while awaiting the physician's advice, 
 in carrying out the following program: 
 
 i. Drink more water or lemonade. 
 
 2. Take a mild cathartic. 
 
 3. Avoid eating much meat and other highly protein foods. 
 
 CONVULSIONS OF PREGNANCY 
 
 This serious complication of the last weeks of pregnancy 
 demands immediate attention. They may almost invariably be 
 avoided if the blood-pressure and the urine are studiously 
 watched during the latter part of the expectant period. 
 
 If you are unable to get your physician at once, the following 
 treatment should be administered immediately. 
 
 1. A hot colonic flushing (See Appendix). 
 
 2. A hot bath followed by the hot blanket pack (See Appen- 
 dix). 
 
 3. One drop of croton oil on a bit of sugar may be placed 
 on the back of the tongue. 
 
 4. Chloroform may be administered, provided a competent 
 nurse or other medical person is present. 
 
 The appearance of convulsions which have been preceded by 
 one or more of the symptoms noted under the head of " tox- 
 emia," indicates that the patient has become so profoundly 
 intoxicated and poisoned by the accumulating toxins, that the 
 lives of both mother and child are jeopardized by threatened 
 eclampsia. At such a time, the attending physician will immedi- 
 ately set about to bring on labor, and thus seek to empty the 
 uterus at the earliest possible moment. 
 
 CARDINAL SYMPTOMS OF TOXICITY 
 
 Since toxemia (eclampsia) is one of the complications of 
 pregnancy most to be dreaded, it is fortunate that it almost 
 invariably exhibits early danger signals which, if recognized 
 and heeded, would enable the patient and physician to initiate 
 

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 p — £ — , — - _ 
 
 
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 4 i 
 
 mfsH I 
 
 I £SS 
 
 W- 
 
 si 
 
 jjjim *iVi 
 
 asr l*^ 
 
 mm —m 
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 ■ 1 
 
 
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 <4t& 
 
 ppi 
 
 ^ - 
 
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 fe. 
 
 v 
 
 <hI i 
 
 ■ jWUfr ^^^^^ 
 
 
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 H^ ' 
 
 
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 Fig. 4. Taking the Blood Pressure 
 
TOXEMIA AND ITS SYMPTOMS A9 
 
 proper measures to avert danger and escape the threatened 
 disaster. The presence of this toxic danger is indicated by the 
 persistent presence of the following three symptoms: 
 
 1. Persistent, dull headache. 
 
 2. Presence of casts in the urine. 
 
 3. Persistent high blood-pressure, with tendency to increase. 
 
 Of course, albumin will probably appear in the urine along 
 with the casts, but it is the continued appearance of the casts 
 that is of more importance as a danger signal. Albumin is 
 quite common in the urine of the expectant mother, but casts 
 — long continued — suggest trouble. Headache as an indicator 
 of toxemia is of special significance when coupled with the 
 other two cardinal symptoms of eclampsia — urinary casts and 
 increasing high blood-pressure. Therefore, the necessity for 
 frequent urinary tests and blood-pressure examinations during 
 the last weeks of pregnancy — especially, if the patient has suf- 
 fered from headaches and has been running albumin in the 
 urine. 
 
 HIGH BLOOD-PRESSURE 
 
 Blood-pressure is a term used to indicate the actual pressure 
 of the blood stream against the walls of the blood vessels. 
 The blood-pressure machine tells us the same story about our 
 circulatory mechanism, that a steam gauge does about a high- 
 pressure boiler (See Fig. 4). The normal blood-pressure varies 
 according to the age of the patient. For instance, the normal 
 pressure of a young person, say up to twenty years of age, 
 runs from 100 to 120 millimeters of mercury; and then, as the 
 age advances, the blood-pressure increases in direct ratio; for 
 every two years additional age the blood-pressure increases 
 about one point — one millimeter. 
 
 The average pregnant woman starts in her pregnancy with 
 a blood-pressure of say, 125 millimeters, but as pressure symp- 
 toms increase, and as constipation manifests itself, and as the 
 circulating fluids are further burdened with the toxins which 
 are eliminated from the child, the blood-pressure normally 
 increases to about 140 mm., and later, possibly to 150 mm. 
 
50 THE MOTHER AND HER CHILD 
 
 If the pressure goes no higher, we are not alarmed, for we 
 have come to recognize a blood-pressure of 140 as about the 
 normal pressure of the pregnant woman. 
 
 There are a number of factors which enter into the raising 
 of the blood-pressure. For instance, at any time during the 
 pregnancy, if the eliminative organs of the mother are doing 
 inefficient work, if she falls a victim to a torpid liver, diseased 
 kidneys, decreased skin elimination, or sluggish bowels, then, 
 with the added and extra excretions from the child, there is 
 superimposed upon the mother far more than the normal 
 amount of eliminative work — and then, because of improper 
 and incomplete elimination, the blood-pressure is increasingly 
 raised. 
 
 ECLAMPSIA PREVENTED 
 
 This whole subject can best be illustrated by relating a story, 
 the actual experience of Mrs. A. This patient came to the 
 office with a history of Bright's disease (albumin and casts 
 in the urine), and chronic appendicitis. While treating her 
 for the kidney condition, preparatory to an operation for the 
 removal of the troublesome appendix — in the very midst of 
 this treatment — she became pregnant, and great indeed was 
 our dismay. We entertained little hope of getting both the 
 mother and child safely through. Frequent examination of 
 urine was instituted, the albumin did not increase and the 
 blood-pressure remained at normal — about 124 m m. She 
 paid weekly or bi-weekly visits to the office and carefully fol- 
 lowed the regime outlined. She drank abundantly of water 
 and strictly followed the dietary prescribed. Weeks and 
 months passed uneventful, until we approached the last six 
 weeks of pregnancy, and then we found to our surprise one 
 day that the blood-pressure had made a sudden jump up to 
 175 m m., while the urine revealed the presence of numerous 
 casts and albumin — in the meantime the albumin had entirely 
 disappeared. There were also other urinary findings which 
 showed that the liver was not doing its share in the work of 
 burning up certain poisons. 
 
 In her home we began the following program: Every day 
 
TOXEMIA AND ITS SYMPTOMS 51 
 
 we had her placed in a bathtub of hot water, keeping cold cloths 
 upon her brow, face and neck, and then, by increasing the 
 temperature of the bath, we produced a very profuse perspira- 
 tion. She was taken out of this bath and wrapped in blankets, 
 thus continuing the sweat. All meat, baked beans, and such 
 foods as macaroni and other articles containing a high per cent 
 of protein were largely eliminated from her diet. At times 
 she did not even eat bread. Her chief diet was fruit, vegetables, 
 and simple salads, and yet the albumin and casts continued to 
 increase in the urine and the blood-pressure climbed up to 190 
 m m. 
 
 As we approached the last two weeks of pregnancy, this 
 little woman was taken to the hospital and systematic daily 
 treatment with sweating procedures was begun. Among other 
 things, she had a daily electric light bath. After each of these 
 baths she was wrapped in blankets and the sweating continued 
 for some time. Careful estimations of albumin were made daily 
 and the blood-pressure findings noted three times a day. During 
 the last week of pregnancy she lived on oranges and grapes. 
 Day by day she was watched until the eventful hour arrived. 
 She went into the delivery room and gave birth to a perfectly 
 normal child. The albumin and casts quickly cleared up, the 
 blood-pressure lowered, and today the little woman is a fond 
 mother of a beautiful baby boy. 
 
 It is hard to estimate what might have taken place had not 
 her elimination been stimulated. The blood-pressure was our 
 guide. Had the albumin (without casts) appeared in the latter 
 weeks of pregnancy with a blood-pressure of 140 or 150 m m., 
 we would not have become excited, for the reason that in every 
 normal pregnancy there is often present a trace of albumin in 
 the latter weeks; but when the blood-pressure jumped to 170 
 or 190, then we knew that toxemia — eclampsia — convulsions 
 — were imminent. So we have in recent years, come to look 
 upon the blood-pressure as an exceedingly important factor — 
 as an infallible indicator of approaching trouble — as a red 
 signal light at the precipice or the point of danger; and it not 
 only warns us of the danger, but it tells us about how near 
 the boilers are to the bursting point. The glassy eye, the head- 
 
52 THE MOTHER AND HER CHILD 
 
 ache, the full bounding pulse and the blurring of vision, are 
 all symptoms accompanying this high blood-pressure, so that 
 in these enlightened days no practitioner can count himself 
 worthy the name, or in any way fit to carry a pregnant woman 
 through the months of waiting, unless he sees, appreciates, 
 and understands the value of blood-pressure findings in 
 pregnancy. 
 
CHAPTER VII 
 PREPARATIONS FOR THE NATAL DAY 
 
 TWO months before baby is to arrive, the expectant mother 
 should pay particular attention to the conservation of her 
 strength. The woman who is compelled to leave her home for 
 the factory, the laundry, the office, or other place of employ- 
 ment, should stop work during these last two or three months. 
 The active club woman should pass the burdens on to others, 
 and the woman of leisure should withdraw from active social 
 life with its varied obligations. During the final weeks of preg- 
 nancy, the prospective mother needs the same hygienic care 
 regarding fresh air, exercise, diet, and water drinking, as out- 
 lined in a former chapter. 
 
 THE FINAL WEEKS 
 
 As the gravid uterus rises higher in the abdomen, increased 
 pressure is exerted on the stomach, the lungs, and upon the 
 nerve centers of the back; and it is because of this situation, 
 that the duties and obligations of the prospective mother should 
 be reduced to a minimum, that she may feel at liberty to lie 
 down several times during the day on the porch or in a well- 
 ventilated room, in the midst of the best possible surroundings. 
 Sexual intercourse should be largely discontinued during the 
 last months of pregnancy. 
 
 I sometimes wish the prospective mothers in our dispensary 
 districts might have some of the care and the kind treatment 
 which is bestowed upon an ordinary prospective mother horse, 
 which at least enjoys a vacation from heavy labor, and whose 
 food is eaten with calm nerves and in the quietness of a clean 
 stall. While the state of the mother's mind does not materially 
 influence the child; nevertheless, the state of the mother's body, 
 
 53 
 
54 THE MOTHER AND HER CHILD 
 
 the weary over-worked muscles and nerves of hot, tired women, 
 bending over cook stoves, laundry tubs, or scrubbing floors, does 
 materially derange the mother's health and digestion, which in 
 turn, reflexly interferes with the growth and physical develop- 
 ment of her child. Extra strength is required for the day of 
 labor, and since the baby doubles its weight during the last 
 two months, the mother is living for two, and should, therefore, 
 avoid extreme fatigue, over tiring, and irksome labor during 
 these final weeks of watchful waiting. 
 
 SELECTION OF THE HOME 
 
 It may or may not be within the province of prospective 
 parents to rearrange, rebuild, or otherwise change the home. 
 Usually the size of the pocketbook, the bank account, or the 
 weekly pay envelope decide such things for us. The home may 
 be in the country or suburbs, with its wide expanse of lawns, 
 its hedges of shrubbery, and with its spacious rooms and 
 porches ; or it may be a beautifully equipped, modern apartment 
 on the boulevard of a city, with its sun parlors, large back 
 porches, conveniently located near some well-kept city park, 
 or it may be one of those smaller but " snug as a bug in a rug " 
 apartments, in another part of the city, where usually there is 
 a sunny back porch; or again some of my readers may them- 
 selves be, or their friends may be, in a darkened basement with 
 broken windows, illy ventilated rooms, with no porches, no 
 yards, no bright rays to be seen coming in through windows — 
 and yet into all of these varied homes there come little babies 
 — sweet, charming little babies, to be cared for, dressed, fed, 
 and reared. And we must now proceed to the subject of mak- 
 ing the most of what we have — to create out of what we have, 
 as best we can, that which ought to be. 
 
 SANITARY PREMISES 
 
 In both the country and city place, yards and alleys should 
 be cleaned up. Garbage — the great breeding place of flies — 
 should be removed or burned. The manure pile of the stable 
 or alley should also be properly covered and cared for. In 
 this way breeding places for flies are minimized and millions 
 
PREPARATIONS FOR THE NATAL DAY 55 
 
 and billions of unhatched eggs are destroyed. In the large 
 cities, provision is made for the prompt disposal of garbage, 
 and laws are beginning to be enforced regarding the covering 
 and the weekly removal of manure, and thus in many of our 
 large cities flies are diminishing in numbers each year. Fly 
 campaigns and garbage campaigns are teaching us all to realize 
 the dangers of infection, contagion, and disease as a result of 
 filth; while through the schools, the children of even our foreign 
 tongued neighbors take home the spirit of " cleaning up week." 
 Even in the rural districts we hope for the dawning of the day 
 when filth, stagnant pools, open manure piles, and open privies, 
 will be as much feared as scorpions or smallpox. 
 
 ENGAGING THE DOCTOR 
 
 As suggested elsewhere, as soon as the expectant mother is 
 aware that she is pregnant, she should engage her physician. 
 And since these are days of specialists, he may or may not be 
 the regular family doctor. The husband and friends may be 
 consulted, but the final choice should be made by the prospective 
 mother herself. " The faith which casts out fear, the indefin- 
 able sense of security which she feels in her chosen physician, 
 supports her through the hours of confinement." Twenty-four 
 hour specimens of urine should be saved and taken to the 
 physician twice each month and oftener during later months 
 of pregnancy. The chosen physician's instructions and sug- 
 gestions should be carried out and counsel should be sought 
 of him as to the place of confinement. 
 
 THE PLACE OF CONFINEMENT 
 
 There are a number of factors that enter into the selection 
 of the place of confinement. In the first place, if the home 
 be roomy, bathroom convenient, if the required preparation 
 of all necessities for the day of labor can be effected, and it is 
 further possible to prepare a suitable delivery-room at home 
 with ample facilities for emergencies and complications, and 
 you can persuade your physician to do it — then the best place 
 in the world for the mother to be confined is within the walls 
 of her own home. But such is the case in but one home out 
 
56 THE MOTHER AND HER CHILD 
 
 of hundreds, and I regret that time and space will not allow me 
 to describe and portray the many untimely deaths that might 
 have been avoided if this or that supply had only been ready 
 at the moment of the unexpected complication of delivery. 
 Why should we needlessly risk the lives of prospective mothers, 
 when, in every up-to-date hospital delivery-room, all these life- 
 saving facilities are freely provided? Here in the modern 
 hospital, the mothers from small homes and apartments, the 
 mothers who live in stuffy basements, as well as those from 
 the average home in the average neighborhood, can come with 
 the assurance of receiving the best possible care and attention. 
 Every woman who can arrange or afford it, should plan to 
 avail herself of the benefits, comforts, quietness, and calm of a 
 well-equipped hospital and the surgical cleanliness and safety 
 of its aseptic delivery-room. 
 
 Fortunately, the mother of the basement home may have the 
 same clean, sterile dressings used upon her as does the mother 
 of the boulevard mansion. The maternity ward bed at $8.00 
 to $10.00 a week can be just as clean as the bed of the $40.00 
 a week room. The methods and procedures of the delivery- 
 room can be just as good in the case of the very poor woman 
 as in the case of the magnate's wife. In no way and for no 
 reason fear the hospital. It is the cleanest, safest, and by far 
 the cheapest way. The weekly amount paid includes the board 
 of the patient, the routine care, and all appliances and supplies 
 of every sort that will be used. Under no circumstances should 
 a midwife be engaged. Any reputable physician or any intel- 
 lectual minister will advise that. Let your choice be either the 
 hospital or the home; but always engage a physician, never a 
 midwife. 
 
 THE NURSE 
 
 After selecting the place of confinement, the question of the 
 nurse may next be considered. If it is to be the hospital, you need 
 give little further thought to the nurse, for your physician will 
 arrange for the nurse at the time you enter the hospital. She 
 will be a part of the complete service you may enjoy. You 
 will find her on duty as you, quietly resting in your room, awaken 
 
PREPARATIONS FOR THE NATAL DAY 57 
 
 in the sweet satisfaction that at last it is all over — at last your 
 baby is here. 
 
 A competent nurse is a necessity, if the confinement takes 
 place in the home. She may be a visiting nurse, who, for a 
 small fee, will not only come on the day of labor, but will 
 make what is known as " post-partum calls " each day for ten 
 or twelve days. These are short calls, but are long enough to 
 clean up the mother and wash and dress the babe. She is not 
 supposed to prepare any meals or care for the home. Then 
 there is the practical nurse — women who have prepared them- 
 selves along these lines of nursing, whose fees range from 
 $12.00 to $18.00 a week. If your physician recommends one 
 to you, you may know she is clean and dependable. The 
 trained nurse, who has graduated from a three years' course of 
 training, is prepared for every emergency, and will intelligently 
 work with the physician for the patient's welfare and comfort. 
 Her fees range from $25.00 to $35.00 a week. 
 
 Both the practical and the trained nurses are human beings, 
 and require rest and sleep the same as all other women do. 
 One nurse, after having faithfully remained at her post of duty 
 some sixty hours reminded the husband and sister of the 
 patient that she must now have five hours of unbroken rest and 
 they replied in a most surprised manner, " Why we are paying 
 you $30.00 a week, and besides, we understood you were a 
 trained nurse." 
 
 The physician usually makes arrangement with the family 
 for competent relief for the nurse. She should have at least 
 one to two hours of each day for an airing, and six hours out 
 of the twenty-four for sleep. 
 
 PREPARATIONS FOR A HOME DELIVERY 
 
 The supplies should all be in the home and ready, as the 
 seventh month of pregnancy draws near. In the first place, 
 select the drawer or closet shelf where the supplies are to 
 remain, untouched, until your physician orders them brought 
 out. The supplies requiring special preparation and steriliza- 
 tion are: 
 
58 
 
 THE MOTHER AND HER CHILD 
 
 Three pounds of absorbent 
 
 cotton. 
 One large package of sterile 
 
 gauze (25 yards). 
 Four rolls of cotton batting. 
 Two yards of stout muslin for 
 
 abdominal binders. 
 Two old sheets. 
 
 Twelve old towels or diapers. 
 One yard of strong narrow tape 
 
 for tying the cord. 
 Three short obstetrical gowns 
 
 for the patient. 
 Two pairs of extra long white 
 
 stockings. 
 Four T-binders. 
 
 Other articles needed by physician, nurse, and patient are 
 
 Fifty bichloride of mercury tab- 
 lets (plainly marked "poison"). 
 
 Four ounces of lysol. 
 
 Two ounces of powdered boric 
 acid. 
 
 One half ounce of 20% argyrol. 
 
 One quart of grain alcohol. 
 
 One pound jar of surgeon's 
 green soap. 
 
 One half pound of castile soap. 
 
 One bottle white vaseline. 
 
 One drinking tube. 
 
 One medicine glass. 
 
 One two-quart fountain syringe. 
 
 One covered enamel bucket or 
 slop jar. 
 
 One good sized douche pan. 
 Three agateware bowls, holding 
 
 two quarts each. 
 Two agateware pitchers, holding 
 
 two quarts each. 
 Two stiff hand-brushes. 
 One nail file. 
 
 One pair surgeon's rubber gloves. 
 One and one-half yards rubber 
 
 sheeting $& inches wide. 
 Two No. 2 rubber catheters. 
 Two dozen large safety pins. 
 Small package of tooth picks, to 
 
 be used as applicators. 
 Six breast binders (Fig. 5). 
 Six sheets. 
 
 Just before confinement send for one ounce of fluid extract 
 of ergot and an original pint bottle of Squibb's Chloroform. 
 
 THE PREPARATION OF THE SUPPLIES 
 
 I. The sanitary pad is used to absorb the lochia after con- 
 finement, and needs to be changed many times during the day 
 and night; fully five or six dozen will be required. They are 
 usually made from cotton batting and a generous layer of 
 absorbent cotton.. If made entirely from absorbent cotton they 
 mat down into a rope-like condition. They are four and one-half 
 to five inches wide and ten inches long. The sterile cheese- 
 cloth is cut large enough to wrap around the cotton filling and 
 extends at both ends three inches, by which it is fastened 
 
PREPARATIONS FOR THE NATAL DAY 
 
 59 
 
 to the abdominal binder. With a dozen or fifteen in each 
 package these vulva pads are wrapped loosely in pieces of old 
 sheets and pinned securely and marked plainly on the outside. 
 
 2. Delivery pads. These pads should be thirty-six inches 
 square and about five inches thick, three or four inches of 
 which may be the cotton batting and the remainder absorbent 
 cotton. Three of these are needed. Each should be folded, 
 wrapped in a piece of cloth and likewise marked. 
 
 3. Gauze squares. Five dozen gauze squares about four 
 inches in size may be cut, wrapped and marked. These are 
 needed for the nipples, baby's eyes, etc. 
 
 3 ft. 
 
 Fig. 5. Breast Binder 
 
 4. Cotton pledgets. These are cotton balls, made as you 
 would a light biscuit with the twist of the cotton to hold it in 
 shape. They should be about the size of the bottom of a tea- 
 cup. These are thrown in a couple of pillow slips and wrapped 
 and marked. 
 
 5. The Bobbin. Cut the bobbin or tape into four nine-inch 
 lengths and wrap and mark. 
 
 6. The tooth picks are left in the original package and do 
 not require sterilization. 
 
 7. Sterilization. Before steaming and baking, wrap each 
 bundle in another wrapping of cloth and pin again securely. Mark 
 each package plainly in large letters or initials. These packages 
 may be sent to the hospital for sterilization in the autoclave 
 
60 THE MOTHER AND HER CHILD 
 
 or they may be steamed for one hour in the large wash boiler, 
 by placing them loosely into a hammock-like arrangement made 
 by suspending a firm piece of muslin from one handle of the 
 boiler to the other. The center of the hammock should come 
 to within five inches of the bottom of the boiler which con- 
 tains three inches of boiling water. The cover of the boiler 
 is now securely weighed down and the water boils hard for one 
 hour, at the end of which time they are removed and placed in 
 a warm oven to dry out. The outer wrapping may be slightly 
 tinged with brown by this baking. After a thorough drying 
 they are allowed to remain in the same wrappings into which 
 they were first placed and put away in a clean drawer awaiting 
 the "Natal Day." 
 
 REQUISITES FOR THE HOSPITAL 
 
 Each hospital has its own methods and regulations for caring 
 for obstetrical patients and it is well for the expectant mother 
 to visit the obstetrical section, the delivery-room and the baby's 
 room, that she may personally know more about the place where 
 she is to spend from ten days to two weeks. Here she may 
 ascertain from the superintendent just what she will need to 
 bring for the baby. Many of the hospitals furnish all the 
 clothes needed for the baby while in the hospital; in such in- 
 stances, the hospital also launders them. Other hospitals require 
 the baby's clothes to be brought in, in which case the mother 
 looks after the laundry. The mother always takes her toilet 
 articles, a warm bed jacket with long sleeves, several night 
 dresses and a large loose kimono or wrapper to wear to the 
 roof garden or porch in the wheel chair. Warm bedroom 
 slippers and a scarf for the head completes the outfit. 
 
 BABY'S NECESSITIES 
 
 Baby's basket on the day of confinement should contain: 
 
 One pound of absorbent cotton. A powder box containing pow- 
 
 One pint of liquid albolene. der and puff, 
 
 One half ounce of argyrol An old soft blanket in which to 
 
 (mentioned in the mother's receive the child after birth. 
 
 list). A soft hair brush. 
 
 Safety pins of assorted sizes. Three old towels. 
 
PREPARATIONS FOR THE NATAL DAY 61 
 
 Small package of sterile gauze A pair of silk and wool stock- 
 squares, ings. 
 
 Scales. A flannel skirt. 
 
 Diapers. An outing-flannel night dress. 
 
 A silk and wool shirt '(size A woolen wrapper. 
 No. 2). 
 
 An abdominal band to be sewed 
 on with needle and thread. 
 
 THE CONFINEMENT ROOM 
 
 By special preparation, the ordinary bedroom may be fash- 
 ioned into a delivery-room. Carpets, hangings and upholstered 
 furniture must be removed. Clean walls, clean floors, and a 
 scrupulously clean bed must be maintained throughout the 
 puerperium. Bathroom, and if possible, a porch should be 
 near by. In the wealthy home, a bedroom, bathroom and the 
 nursery adjoining is ideal; but I find that real life is always 
 filled with anything but the ideal. 
 
 The dispensary doctor is compelled to depend upon clean 
 newspapers to cover everything in the room he finds his 
 patient in. The only sterile things he uses he brings with him, 
 and should he have to spend the night, the floor is his only 
 bed. A student who was in my service told me that there was 
 not one article in the entire home, which consisted of but one 
 room, that could be used for the baby. He wrapped his own 
 coat about it and laid it carefully in a market basket and 
 placed it on the floor at the side of the pallet on which the 
 mother lay and by the aid of a nearby telephone secured 
 clothes from the dispensary for the babe. 
 
 Always select the best room in the house for a home con- 
 finement. If the parlor is the one sunny room, take it; remove 
 all draperies, carpet, etc., and make it as near surgically clean 
 as possible. While sunshine is desirable, ample shades must 
 be supplied, as the eyes of both mother and babe must be 
 protected. 
 
 THE BED 
 
 A three-quarter bed is more desirable than a double bed. 
 If it is low, four-inch blocks should be placed under each leg, 
 
62 THE MOTHER AND HER CHILD 
 
 the casters having been removed to prevent slipping. The 
 bed should be so placed that it can be reached from either 
 side by the nurse and physician. The mattress may be reen- 
 forced by the placing of a board under it if there is a tendency 
 to sag in the middle. Over this mattress is securely pinned the 
 strip of rubber sheeting or- table oilcloth. A clean sheet covers 
 mattress and rubber cloth and at the spot where the hips are 
 to lie may be placed the large sterile pad to absorb the escap- 
 ing fluids. The floor about the bed is protected by newspapers or 
 oilcloth. Good lighting should always be provided. Much 
 trouble and possible infection may be avoided by clean bedding, 
 plenty of clean dressings, boiled water, rubber gloves, and 
 clean hands. 
 
CHAPTER VIII 
 THE DAY OF LABOR 
 
 AS the two hundred and seventy-three days come to a close, 
 our expectant mother approaches the day of labor with 
 joy and gladness. The long, long waiting days so full of 
 varied experiences, so full of the consciousness that she, the 
 waiting mother, is to bring into the world a being which may 
 have so many possibilities — well, even the anticipated pangs 
 of approaching labor are welcomed as marking the close of the 
 long vigil. These days have brought many unpleasant symptoms, 
 they have been days of tears and smiles, of clouds and sun- 
 shine. 
 
 THE TIME OF WAITING 
 
 The prospective mother has thought many times, " Will my 
 baby ever come?" But nature is very faithful, prompt, and 
 resourceful. She ushers in this harvest time under great stress 
 and strain, for actual labor is before us — downright, hard 
 labor — just about the hardest work that womankind ever 
 experiences — and, as a rule, she needs but little help — good 
 direction as to the proper method of work and the economical 
 expenditure of energy. In the case of the average mother this 
 is about all that is needed, and if these suggestions come from 
 a wise and sympathetic physician — one who understands and 
 appreciates asepsis — she may count herself as fortunately 
 situated for the oncoming ordeal. 
 
 In the days of our grandmothers it was almost the exception 
 rather than the rule to escape " child-bed fever," " milk leg," 
 etc. ; but in these enlightened days of asepsis, rubber gloves, 
 and the various antiseptics, puerperal infection is the exception, 
 while a normal puerperium is the rule; and this work of pre- 
 
 63 
 
64 THE MOTHER AND HER CHILD 
 
 vention lies in the scrupulous care taken by anyone and every- 
 one concerned in any way with the events of the day of labor. 
 
 On this day of labor, the mother, who has gone through 
 the long tedious days of waiting, should see to it that nothing 
 unclean — hands, sponges, f orcep, water, cloth — is allowed 
 to touch her. Above all things do not employ a physician who 
 has earned the reputation of being a " dirty doctor." Puerperal 
 infection is almost wholly a preventable disease and every 
 patient has a right to insist upon protection against it, 
 
 In a former chapter will be found a detailed description of the 
 " delivery bed." Beside this bed, or near by, are to be found 
 the rack on which are airing the necessary garments for the 
 baby's reception — the receiving blanket and other requisites 
 for the first bath — together with numerous other articles essen- 
 tial to safety and comfort. 
 
 There should be an easy chair in the room for the mother 
 to rest in between her walking excursions during the first 
 stages of labor. The sterilized pads and necessary articles men- 
 tioned in an earlier chapter are, of course, close at hand. 
 
 FIRST SYMPTOMS OF LABOR 
 
 Regular, cramp-like pains in the lower portion of the abdomen 
 which are frequently mistaken for intestinal colic, often begin- 
 ning in the lower part of the back, and extending to the front 
 and down the thigh, are often the first symptoms of the ap- 
 proaching event. With each cramp or pain the abdomen gets 
 very hard and as the pain passes away the abdomen again as- 
 sumes its normal condition. These regular cramp-like pains 
 are the result of the early dilation of the cervix — the first 
 opening of the door to the uterine room which has housed our 
 little citizen through the developmental stages of embryonic 
 life — and as a result of this stretching and dilating there soon 
 appears that special blood-tinged mucus flow commonly known 
 as "the show." 
 
 THE PRELIMINARY BATH 
 
 At this time a very thorough-going colonic flushing should 
 be administered. The patient takes the " knee-chest " position, 
 
THE DAY OF LABOR 65 
 
 or the " lying-down " position, and there should flow into the 
 lower bowel three pints of soapy water ; this should be retained 
 for a few moments; and after its expulsion, a short, plain 
 water injection should be given. Now follows the preliminary 
 general bath. 
 
 Just prior to the bath, the pubic hair should be clipped closely, 
 or better shaved. Then should follow a thorough soap wash, 
 with patient standing up in the tub, using plenty of soap, applied 
 with a shampoo brush or rough turkish mit. The rinsing now 
 takes place by either a shower or pail pour. Do not sit down 
 in the tub. This is a rule that must not be broken, because of 
 the danger of infection in those cases where the bag of waters 
 may have broken early in the labor. 
 
 A weak antiseptic solution, prepared by putting two small 
 antiseptic tablets into one pint and a half of warm water, is 
 now applied to the body from the breasts to the knee. Put 
 on a freshly laundered gown, clean stockings and wrapper. The 
 head should be cleansed and hair braided in two braids. 
 
 THE PROGRESS OF LABOR 
 
 If all the mothers who read this volume could bear children 
 with the comfort Mrs. C. does, I should be happy, indeed. 
 
 At four o'clock one morning a very much excited father 
 telephoned me, " Hurry, quick, Doctor, it's almost here." It 
 was well that we did hurry, for the first sign the little mother 
 had was the deluge of the waters — at this point the husband 
 ran to telephone for the doctor — no more pains for thirty- 
 eight minutes (just as we entered the door) and the baby 
 was there. But such is not usually the case, nor will it be, as labor 
 usually progresses along the lines of conscious dilating pains, 
 occurring at intervals twenty minutes apart at first, later draw- 
 ing nearer together until they are three to five minutes apart. 
 This " first stage of labor " lasts from one to fifteen hours — 
 during which time the tiny door to the uterine room which 
 was originally about one-eighth of an inch open — dilates suf- 
 ficiently to allow the passage of the head, shoulders and body 
 of the fully developed child. 
 
 About this time the bag of waters usually bursts, and, as a 
 
66 THE MOTHER AND HER CHILD 
 
 rule, this marks the beginning of the " second stage of labor." 
 The amount of water passed varies in amount. Should the 
 rupture take place before the door is fully open, then labor 
 proceeds with difficulty and the condition is known as " dry 
 labor." 
 
 The head after proper rotation now begins the descent; 
 and here the pains begin to change from the sharp, lancinating, 
 cramp-like pains which begin in the back and move around to 
 the front, to those of the " bearing down " variety, while at the 
 same time there begins to appear the bulging at the perineum, 
 which means that the head is about to be born. At this time 
 great stress is brought to bear upon the perineum and often, 
 in spite of anything that can be done to prevent it, the perineum 
 is more or less lacerated. 
 
 As soon as the baby is born the "second stage of labor " 
 has passed and within thirty to fifty minutes the close of the 
 third stage of labor is marked by the passage of the placenta 
 or " afterbirth." 
 
 FALSE LABOR PAINS 
 
 Sometimes, as long as two weeks before the birth of the 
 child, certain irregular, heavy, cramp-like pains occur in the 
 abdomen and back. For a half-dozen pains they may show 
 some signs of regularity; but they usually die down only to 
 start up again at irregular intervals. These are known as 
 " false pains." 
 
 When the pains begin to take on regularity and gradually 
 grow heavier and it is near the appointed time for the labor, 
 the patient should prepare to start for the hospital; or, if it is 
 to be a home delivery, the physician should be called. As 
 noted above, the first subjective symptom may be the rupture 
 of the bag of waters, and it is imperative to prepare at once 
 for the labor. It is far better to spend the day at the hospital, 
 or even two days waiting, rather than to run the risk of giving 
 birth to the child in a taxicab or street car; or, in the event 
 of a home labor, to have the child born before the doctor 
 arrives. 
 
THE DAY OF LABOR 67 
 
 WHAT TO DO IN THE ABSENCE OF A DOCTOR 
 
 It is often the case that when we need our physician the 
 most, he is busy with another patient and cannot come, or 
 perhaps an automobile accident detains the man of the hour. 
 The hospital delivery always possesses this advantage over the 
 home — physicians are always on hand. We deem it wise to 
 relate in detail the method of procedure during the rapid birth 
 of a child; that the husband or nurse may give intelligent 
 and clean service. 
 
 After the patient has been given the enema and has been 
 shaved and the bath has been administered as previously 
 directed, the helper most vigorously " scrubs up." There are 
 three distinct phases to the " scrubbing up " : First, the three- 
 minute scrubbing of the hands and forearms with a clean brush 
 and green soap; to be followed by, second, the trimming and 
 cleaning of the finger nails, for it is here, under the nails, that 
 the micro-organism lives and thrives that causes child-bed 
 fever or septicemia; and, third, the final five-minute scrubbing 
 of the fingers, hands, and forearms. An ordinary towel is not 
 used to dry the well-cleansed hands, but they are now dipped 
 in alcohol and allowed to dry in the air. 
 
 And now if the pains are returning every three to five minutes 
 or if the bag of waters has broken, the patient should go to 
 bed. She will lie down on her back with the knees drawn up 
 and spread apart. The patient, having had the cleansing bath, 
 is now washed with the disinfectant bath (2 antiseptic tablets 
 to 1^2 pints of water), from the breasts to the knees. Another 
 member of the family takes the outer wrappings off the 
 sterilized delivery pad and the " clean " helper places the sterile 
 delivery pad under the expectant mother, who is directed to 
 " bear down " when her pains come. She may be supported 
 during these pains by pulling on a sheet that has been fastened 
 to the foot of the bed. 
 
 The clean helper then sits by her constantly until the baby 
 is born but under no circumstances should touch her until after 
 the head appears. Immediately after the birth of the head, the 
 shoulders usually follow with the next pain, which ought to 
 
68 THE MOTHER AND HER CHILD 
 
 occur within two or three minutes. Occasionally the face turns 
 blue, in such an instance, the mother is directed to strain 
 vigorously and presses down heavily on the abdomen with 
 both her hands, this usually hurries matters materially, and the 
 body of the child follows quickly. The baby should cry at 
 once. If the child does not show signs of life, quick, brisk 
 slapping on the back usually brings relief. During the birth 
 of the head it is imperative that, in the event of liquid passing 
 at the same time, no water or blood be sucked into the mouth 
 by the baby. Great care must be exercised in this matter. 
 Should the baby remain blue, lay it quickly upon its right side 
 near the mother, and after the pulse of the cord has stopped 
 beating the clean helper ties the cord twice, two inches from 
 the child and again two inches from this tying toward the 
 mother, and then the cord is cut between the two tyings with 
 scissors that have been boiled twenty minutes. 
 
 Should there be more difficulty with the breathing of the 
 new born child, if slapping it on the back brings no relief, its 
 back (with face well protected) may be dipped first in good 
 warm water, then cold, again in the warm, again in the cold — 
 this seldom fails. The child should then be kept very warm, 
 lying on its right side. 
 
 CARE OF THE MOTHER 
 
 All this time, a member of the family has been firmly grasp- 
 ing the mother's abdomen, and within an hour the afterbirth 
 passes out through the birth canal. If the physician has not 
 yet arrived, all dressings, the pad, the afterbirth, must all be 
 saved for his inspection. 
 
 The inside of the thighs and the region about the vagina is 
 now washed with bichloride solution, the soiled delivery pad 
 removed, a clean delivery pad is placed under her; an abdom- 
 inal binder is applied and two sterile vulva pads are placed 
 between the legs, and hot water bottles are put to her feet, as 
 usually at this stage there is a slight tendency toward chilliness. 
 She should now settle down for rest. Fresh air should be ad- 
 mitted into the room. There may be some hemorrhage, and 
 if it is excessive, grasp the lower abdomen and begin to knead 
 
THE DAY OF LABOR 69 
 
 it until you distinctly feel a change in the uterus from the soft 
 mass to a hard ball about the size of a large grape fruit; thus 
 contraction has been brought about which causes the hemor- 
 rhage to decrease. If the doctor has not yet arrived put the 
 baby to the breast, and place an ice bag for ten or fifteen 
 minutes on the abdomen just over the uterus. Should there 
 be lacerations, the doctor will attend to their repair when he 
 comes. One teaspoonful of the fluid extract of ergot is usually 
 given at this time, if possible get in touch with the physician 
 before it is administered. 
 
 CARE OF THE BABY 
 
 After the mother is comfortable, your attention is directed 
 to the baby; the condition of the cord is noted; should it be 
 bleeding, do not disturb the tying, but tie again, more tightly 
 just below the former tying, and with the long ends of the 
 tape, tie on a sterile gauze sponge or a piece of clean untouched 
 medicated cotton, thus efficiently protecting the severed end of 
 the cord. No further dressing is needed until the doctor 
 arrives. 
 
 Grave disorders have arisen from infection through the 
 freshly cut umbilical cord. 
 
 Should the doctor be longer delayed, one drop of twenty 
 per cent argyrol should be dropped in each of the infant's 
 eyes and separate pieces of cotton should be used for each 
 eye to wipe the surplus medicine away. 
 
 This application must not be long neglected, for a very large 
 per cent of all the blindness in this world might have been 
 avoided had this medicine been placed in each eye soon after 
 birth. 
 
 The warmed albolene is now swabbed over the entire body 
 of the infant (this is done with a piece of cotton), the arm 
 pits, the groins, behind the ears, between the thighs, the bend 
 of the elbow, etc., must all receive the albolene swabbing. In 
 a few minutes, this is gently rubbed off with a piece of gauze 
 or an old soft towel, and the baby comes forth as clean and as 
 smooth as a lily and as sweet as a rose. 
 
 The garments are now placed on the child — first the band, 
 
70 THE MOTHER AND HER CHILD 
 
 then shirt, diaper, stockings, flannel skirt, and outing flannel 
 gown — and it is put to rest after the administration of one 
 teaspoonful of cooled, boiled water. In six to eight hours 
 it will be put to the breast. 
 
CHAPTER IX 
 TWILIGHT SLEEP AND PAINLESS LABOR 
 
 IN recent years much has appeared in both the popular mag- 
 azines and the medical press concerning the so-called " twi- 
 light sleep " and other methods of producing " painless child- 
 birth." Many of these popular articles in the lay press cannot 
 be regarded in any other light than as being in bad taste and 
 wholly unfortunate in their method and manner of presenting 
 the subject; nevertheless, these writings have served to arouse 
 such a general public interest in the subject of obstetric 
 anesthetics, that we deem it advisable to devote two chapters 
 to the brief and concise consideration of the subjects of pain 
 and anesthetics in relation to the day of labor. 
 
 THE PAIN OF LABOR 
 
 First, let us briefly consider the question of pain in con- 
 nection with childbirth. Many women — normal, natural, and 
 healthy women — suffer but comparatively little in giving birth 
 to an average-sized baby during an average and uncomplicated 
 labor. Like the Indian squaw, they suffer a minimum of pain 
 at childbirth — at least this is largely true after the birth of 
 the first baby; and so there is little need of discussing any sort 
 of anesthesia for this group of fortunate women ; for at most, 
 all that would ever be employed in the nature of an anesthetic 
 in such cases, would be a trifle of chloroform to take the edge 
 off the suffering at the height or conclusion of labor. 
 
 But the vast majority of American mothers do not belong to 
 this fortunate and normal class of women who suffer so little 
 during childbirth; they rather belong to that large and growing- 
 class of women who have dressed wrong; who have lived un- 
 healthful and sometimes indolent lives; who are more or less 
 
 7i 
 
72 THE MOTHER AND HER CHILD 
 
 physically and temperamentally unfitted to pass through the 
 experiences of pregnancy and the trials of labor. 
 
 The average American woman shrinks from the thought and 
 prospect of suffering pain ; she is quite intolerant with the idea 
 of undergoing even the few brief moments of physical suffer- 
 ing attendant upon childbirth. She refuses to contemplate the 
 day of labor in any other light than that which insures her 
 against all possible pain and other physical suffering. 
 
 And it is just this unnatural and abnormal fear of labor- 
 pains — this unwomanly dread of the slightest degree of 
 physical suffering — that has indirectly led up to so much dis- 
 cussion regarding the employment of " twilight sleep " and 
 other forms of obstetric anesthesia. 
 
 While the authors recognize the great blessing of anesthesia 
 to the woman in labor — and almost unfailingly make use of 
 it in some form — nevertheless, we also recognize that it would 
 be a fine form of mental discipline and mighty good moral 
 gymnastics, if a great many self-centered and pampered women 
 would " spunk right up " and face the ordeal of labor with 
 natural courage and normal fortitude. It would be " the mak- 
 ing of them," it would make new women out of them, it would 
 start them out on the road to real living. At the same time 
 we do not mean to advocate that women should suffer unneces- 
 sary pain in childbirth any more than we allow them to suffer 
 in connection with surgery. 
 
 PREPARATION FOR LABOR 
 
 While so much is being written about " twilight sleep " and 
 " painless labor," it might be well to remind the American 
 mother that much can be done to lessen the sufferings of the 
 day of labor by one's method of living prior to the confine- 
 ment. 
 
 We believe that child-bearing is a perfectly normal physical 
 function for a healthy and normal woman — that it is even es- 
 sential to her complete physical health, mental happiness, and 
 moral well-being. Theoretically, child-bearing ought to be but 
 little more painful than the functionating of numerous other 
 vital organs — stomach, heart, bladder, bowels, etc. — and, in- 
 
TWILIGHT SLEEP AND PAINLESS LABOR 73 
 
 deed, it is not in the case of certain savage tribes and other 
 aboriginal people, such as our own North American Indian. 
 
 But we must face the facts. The average American woman 
 does suffer at childbirth; and she suffers more than we are 
 disposed to allow her, or more than she, as a general rule, is 
 willing to suffer. So, while we discuss appropriate methods 
 of lessening the pain of labor and the pangs of childbirth by 
 the scientific use of anesthetics, let us also call attention to 
 certain things which may aid in decreasing the amount of pain 
 which may reasonably be expected to attend child bearing. 
 
 To assist in bringing about this preparation for decreased 
 pain at childbirth, mothers should teach their daughters how 
 to develop, strengthen, and preserve their physical, mental, and 
 moral resistance. The young mother should be taught by both 
 her mother and her physician how to dress, how to work, and 
 how to eat. Every care should be given to the hygiene of 
 pregnancy and labor. 
 
 The expectant mother should have plenty of fruits and fruit 
 juices, and if not physically well endowed to give birth to a 
 large babe, she should have her diet restricted in meat, bread 
 and milk, as well as the cereals. Overeating during preg- 
 nancy should be carefully guarded against, as emphasized in 
 an earlier chapter. Deformities of the pelvis, etc., should rule 
 out a consideration of pregnancy. 
 
 While artificial painless childbirth by means of " twilight 
 sleep " and other similar methods all have their place ; neverthe- 
 less, these procedures should not lead to the neglect of those 
 natural methods and preventive practices which aid in pre- 
 paring the normal expectant mother for nature's relatively 
 painless labor. When so much anesthesia has to be used in a 
 normal labor, it cannot but strongly suggest that both patient 
 and physician have neglected those common but efficient 
 methods which contribute indirectly to lessening the pangs of 
 child bearing. 
 
 WHAT IS TWILIGHT SLEEP? 
 
 " Twilight sleep " is a recent term which has become asso- 
 ciated in the public mind with " painless labor." The reader 
 
74 THE MOTHER AND HER CHILD 
 
 should understand that " twilight sleep " is not a new method 
 of obstetric anesthesia. While this method of inducing 
 " painless labor " has been brought prominently before the 
 public mind in recent years by much discussion and by numerous 
 magazine articles — being often presented in such a way as 
 sometimes to lead the uninstructed layman to infer that a new 
 method of obstetric anesthesia had just been discovered — it 
 has, nevertheless, been known and more or less used since 1903, 
 Later known as the " Freiburg Method," and as the " Dammer- 
 schlaf " of Gauss, and still later popularized as " twilight 
 sleep," this " scopolamin-morphin " method of obstetric 
 anesthesia, has gained wide attention and acquired many zealous 
 advocates. 
 
 " Twilight sleep " is, therefore, nothing new — it is simply 
 a revival of the old combination of scopolamin and morphin 
 anesthesia. While many different methods of administering 
 " twilight sleep " have been devised, the following general plan 
 will serve to inform the reader sufficiently regarding the tech- 
 nic of this much-talked-of procedure. 
 
 The scopolamin must always be fresh, although different 
 forms of the drug are used. It tends quickly to decompose — 
 forming a toxic by-product — and, according to some author- 
 ities, this decomposed scopolamin is responsible for many un- 
 desirable results which have attended some cases of " twilight 
 sleep." Various forms of morphin are also used, as also is 
 narcophin. 
 
 TECHNIC OF " TWILIGHT SLEEP " 
 
 The "twilight-sleep" injections are not started until the 
 patient is in the stage of active labor. The initial injection 
 consists of the proper dose of scopolamin and morphin (or 
 some of their derivatives), while the patient's pupils, pulse, and 
 respiration are carefully noted, as also are the character of 
 the uterine contractions and the character of the fetal heart 
 action. 
 
 Usually within an hour, a second dose of scopolamin is given, 
 while the application of so-called " memory tests " serves to 
 indicate whether it is advisable to administer additional injec- 
 
TWILIGHT SLEEP AND PAINLESS LABOR 75 
 
 tions. Some leading advocates of this method claim that the 
 majority of the unfavorable results attendant upon " twilight 
 sleep " are the direct result of failure to control the dosage 
 of the drug by these " memory tests ; " and they call attention 
 to the large percentage of " painlessness " as proof of probable 
 overdosing. If the patient's memory is clear and she is not 
 yet under the influence of the drug, a third dose is soon given. 
 If, however, the patient is in a state of amnesia (lack of 
 memory), this third injection is not commonly given mi til 
 about one hour after the second injection. The amount of 
 amnesia present is used as a guide for repeated injections at 
 intervals of one to one and a half hours. As a rule, the mor- 
 phin is not repeated. 
 
 It must be evident that the success of such a method of 
 anesthesia must depend entirely upon thoroughgoing personal 
 supervision of the individual patient by a properly trained 
 and experienced physician; and it is for just these reasons 
 that " twilight sleep " is destined to remain largely a hospital 
 procedure for a long time to come. 
 
 Experience has shown that those cases of " twilight sleep " 
 that are not under the influence of scopolamin over five or six 
 hours do vastly better than those under a longer time. When 
 employed too long before labor this method seems to favor 
 inertia and thus tends to increase the number of forceps 
 deliveries. 
 
 The number of injections may run from one to a dozen or 
 more, and patients have come through without accident with 
 fifteen or more doses, running over a period of twenty-four 
 hours. 
 
 THE CLAIMS OF " TWILIGHT SLEEP " 
 
 While " twilight sleep " as a method of anesthesia is not alto- 
 gether new, many of the claims made for it by recent advocates 
 are more or less new; and, to enable the reader clearly to com- 
 prehend both the advantages and disadvantages of this method, 
 both the favorable and unfavorable facts and contentions will 
 be summarized in this connection. The favorable claims made 
 for " twilight sleep " are : 
 
y6 THE MOTHER AND HER CHILD 
 
 i. That eighty to ninety per cent of all women who use this 
 method can be carried through a practically painless labor. 
 
 2. That there is practically no danger to the mother (some 
 degree of danger to the child is admitted by most of its cham- 
 pions) other than those commonly attendant on the older and 
 better known methods in general use. 
 
 3. That "twilight sleep," being almost exclusively a hospital - 
 procedure, would result in more women going to the hospital 
 for their confinement — if it were used more; and would, there- 
 fore, tend to bring about more careful supervision and individual 
 care on the part of the attending obstetrician. 
 
 4. That by lessening the dread of labor and the fear of 
 painful childbirth, there will probably occur an increase in the 
 birth rate of the so-called "higher classes of society" — the 
 social circles which now show the lowest birth rates. 
 
 5. That it is of special value in the cases of certain neurotic 
 women and those of low vital resistance ; especially those patients 
 suffering from certain forms of heart, respiratory, kidney, and 
 other organic diseases. 
 
 6. Some , authorities maintain that " twilight sleep " is of 
 value even in threatened eclampsia, although they admit it tends 
 to produce a rise in blood-pressure. 
 
 7. It is supposed to shorten the first stage of labor — by 
 facilitating the dilation of the cervix — owing to the painless 
 stretching; although the majority of its special advocates admit 
 that it lengthens the second stage of labor, during which the 
 patient must be very closely watched. 
 
 8. That even in those cases where the sense of pain is not 
 entirely destroyed, the patient seems to possess little or no 
 subsequent memory of any physical suffering or other disagree- 
 able sensations. 
 
 9. That the method is of special value in sensitive, high- 
 strung, nervous women of the " higher classes," who so habit- 
 ually shun the rigors of child bearing — especially in the in- 
 stance of their first child. 
 
 10. That the action of scopolamin is chiefly upon the central 
 nervous system — the cerebrum — that it diminishes the per- 
 ception of pain without apparently decreasing the contractile 
 
TWILIGHT SLEEP AND PAINLESS LABOR 77 
 
 power of the uterus; labor may, therefore, proceed with little 
 or no interruption, while the patient is quite oblivious to the 
 accompanying pains. 
 
 11. That the physical and nervous exhaustion is quite en- 
 tirely eliminated — especially in the case of the first labor — 
 that patients who have had this method of anesthesia appear 
 refreshed and quite themselves even the first day after labor. 
 
 12. That there is decidedly less "trauma" (appreciable 
 injury) to the nervous system and therefore less " shock; " and 
 that all this saving of nervous strain tends greatly to hasten 
 convalescence. 
 
 13. And, finally, that " twilight sleep " does not interfere 
 with the carrying out of any other therapeutic measures which 
 may be deemed necessary for a successful termination of the 
 labor. 
 
 DANGERS OF TWILIGHT SLEEP 
 
 While we are recounting the real and supposed advantages 
 of " twilight sleep " — especially in certain selected cases — it 
 will be wise to pause long enough to give the same careful 
 consideration to the known and reputed dangers and drawbacks 
 which are thought to attend this method of anesthesia in con- 
 nection with labor cases. 
 
 We desire to state that these expressions, both for and 
 against " twilight sleep," are not merely representative of our 
 own experience and attitude; but that they also represent, as 
 far as we are able to judge at the time of this writing, the 
 consensus of opinion on the part of the most reliable and 
 experienced observers and practitioners who have used and 
 studied this method in both this country and Europe. The 
 dangers and difficulties of " twilight sleep " may be summarized 
 as follows: 
 
 1. That this method tends to weaken the mental resistance 
 of many women ; to lessen their natural courage and to decrease 
 that commendable fortitude which is such a valuable feature 
 of the character endowment of the normal woman. 
 
 2. That " twilight sleep " is essentially a hospital method and 
 is, therefore, inaccessible to the vast majority of women belong- 
 
78 THE MOTHER AND HER CHILD 
 
 ing to the middle and lower classes of society, as well as to 
 those women who live in rural communities. 
 
 3. That in fifteen or twenty per cent, the method fails to 
 produce the desired results — at least, when administered in 
 amounts which are deemed safe. 
 
 4. That this method does decrease the baby's chances of 
 living; that the second stage of labor is definitely prolonged; 
 that from ten to fifteen per cent of the babies are sufficiently 
 under the influence of the anesthesia when born as to be unable 
 to breathe or cry without artificial stimulus. 
 
 5. That it is a method requiring special training and expe- 
 rience; that it will be many years before the average practi- 
 tioner will become proficient in its use; and that the older 
 methods are probably far safer for the average physician. 
 
 6. That the method requires more care in its administration 
 than can be expected outside of the hospital in order to avoid 
 the dangers of fetal asphyxiation — which danger has led 
 not a few obstetricians to abandon it. 
 
 7. That a satisfactory technic is almost impossible of de- 
 velopment; that every patient must be individualized; that the 
 chief dangers are connected with the over dosage of morphin; 
 that the method is not adaptable to the general practice of the 
 average doctor. 
 
 8. That by prolonging the second stage of labor and by 
 sometimes giving too much morphin, the number of forceps 
 deliveries is greatly increased, with their attendant and in- 
 creased, dangers to both mother and child. 
 
 9. That the prospects of passing through labor which may be 
 rendered painless by artificial methods, tends to produce an atti- 
 tude of carelessness and indifference towards those natural- 
 methods of living and other hygienic practices which so greatly 
 contribute to naturally painless confinements. 
 
 10. That this method as sometimes practiced greatly increases 
 the dangers of a general anesthetic, if such should be found 
 necessary later on during the labor. 
 
 11. That "twilight sleep" is contra-indicated (should not 
 be used) in the following conditions: primary inertia (abnor- 
 mally delayed and slow labor); expected short labor — espe- 
 
TWILIGHT SLEEP AND PAINLESS LABOR 79 
 
 cially in women who have already borne children; when the 
 fetal head is known to be large and the mother's pelvis small; 
 placenta praevia (abnormal placental attachment) ; accidental 
 hemorrhage; absent or doubtful fetal heart beat; when labor 
 is already far advanced; and in threatened convulsions and 
 eclampsia. 
 
 CONCLUSIONS REGARDING TWILIGHT SLEEP 
 
 Having presented the evidence both for and against " twi- 
 light sleep," it may be of assistance to the lay reader to have 
 placed before her the personal conclusions and working opinions 
 of the authors. We, therefore, undertake to summarize our 
 present attitude and outline our practice as follows: 
 
 1. " Twilight sleep " as a method of obstetric anesthesia in 
 certain selected cases and in well-equipped hospitals, and in the 
 hands of careful and experienced practitioners, has demon- 
 strated that it is a scientific reality — and has probably come 
 to stay — at least until better and safer methods of affecting a 
 relatively painless confinement are discovered; although we are 
 compelled to state that it is not the panacea the lay press has 
 led many of our patients to believe. (That we believe a much 
 better and safer method has been devised, the next chapter 
 will fully disclose.) 
 
 2. We do not expect this method ever to become general 
 in its use; we do not look for a chain of special "twilight hos- 
 pitals " to stretch across the continent and then to overrun the 
 country. We expect much of the recent forced enthusiasm to 
 die down, while scopolamin-morphin anesthesia takes it proper 
 place among other scientific methods of alleviating the pangs 
 of labor. 
 
 3. We know that standard and fresh solutions — as already 
 noted — are absolutely essential for the success of this method. 
 
 4. We are certain that no routine method or technic can 
 be developed. Each patient must be individualized. The method 
 does not consist in injecting scopolamin every so often. The 
 patient's mental and physical condition — as also that of the 
 unborn child — must control the administration of " twilight 
 sleep." 
 
80 THE MOTHER AND HER CHILD 
 
 5. The patient must be in a quiet and partially darkened 
 room. She must not be disturbed; while the physician, or a 
 competent trained nurse, must be in constant attendance. 
 
 6. While this method of treatment is best carried out in the 
 well-appointed hospital, there is no real reason why it cannot 
 be fairly well carried out in a well-regulated private home, 
 provided the necessary preparations have been made, a trained 
 nurse is present, and provided, further, that the physician is 
 willing to remain in the home with the patient the length of 
 time required properly to supervise the treatment. 
 
 7. Even when the treatment is not instituted early in labor, 
 it can, in certain selected and appropriate cases, be utilized even 
 in the second stage of labor — thus saving these special cases 
 much unnecessary pain ; in fact, some authorities regard it as 
 a valuable adjunct in the management of " borderland con- 
 tractions " as it allows the patient a full test of labor. 
 
 8. In our opinion, his method has little effect on the first 
 stage of labor if properly administered; but it does undoubtedly 
 prolong and tend to complicate the second stage ; in fact, we 
 are coming to look upon " twilight sleep " as being more dis- 
 tinctly a first stage procedure; that it bears the same relation 
 to the first stage of labor that chloroform bears to the second 
 stage — relieving the pain but not stopping the progress of labor. 
 
 9. That when safe amounts of the drug are used the pain 
 is greatly lessened in all cases — the subsequent memory of pain 
 is absent in the majority of the patients — but the labor is not 
 always entirely painless as is popularly supposed. 
 
 10. We do not believe that this method when properly ad- 
 ministered increases the number of forceps deliveries — at least 
 not in the case of high forceps operations. It undoubtedly does 
 cover up the symptoms of a threatened rupture of the uterus, 
 and thus increases danger from that source; nevertheless it 
 may be safely stated that this method does not in any way 
 greatly interfere with any other measures which might be 
 found necessary to institute in order to bring about a success- 
 ful termination of the labor. 
 
 11. The baby's heart beat must be carefully and constantly 
 watched; sudden slowing means that the treatment must be dis- 
 
TWILIGHT SLEEP AND PAINLESS LABOR 81 
 
 continued and the child delivered as soon as possible ; even then, 
 difficulty may be experienced in getting the baby's breathing- 
 started after it is born. In the vast majority of cases where the 
 baby does not cry or breathe at birth, the usual methods em- 
 ployed in such cases serve quickly to establish normal respira- 
 tion, and the baby seems to be but little the worse for the 
 experience. 
 
 12. While altogether too much has been claimed for " twi- 
 light sleep " at the same time many false fears have also been 
 suggested, among which may be mentioned the fear of the mother 
 losing her mind after the treatment; the undue fear of asphyxia- 
 tion on the part of the baby; the fear of post-partum hemor- 
 rhage; and the fear that it will lessen the milk supply. We cannot 
 deny that the child's dangers are often increased; but in other 
 respects, this method (in properly selected cases) presents 
 little more to worry us than the older methods of anesthesia. 
 
 13. We are inclined to the belief that this method has but 
 little influence on the course of convalescence following labor. 
 Certain nervous and highly excitable women certainly seem to 
 do better, as a result of experiencing less pain and nervous 
 shock; while other cases do not turn out so well. It certainly 
 does not retard repair and recovery during the puerperium. 
 
 14. This method seems to have its greatest field of useful- 
 ness in those cases of highly intelligent but excessively neurotic 
 women who have an abnormal dread of pain and child bearing; 
 or women who have suffered unusually at the time of a previous 
 confinement — perhaps in the case of the first baby — or from 
 other complications; women such as these, and other special 
 cases, are the ones to benefit most from the employment of 
 " twilight sleep." 
 
 15. This method as has already been intimated, is most useful 
 in the case of the first baby, or in the case of women who have 
 established a record of tedious and painful labors. It has no 
 place in normal and short labors; although it may be used to 
 great advantage in certain cases during the first stage of labor 
 — being carefully and lightly administered — while chloroform 
 or gas is utilized at the end of the second stage just as has been 
 our custom for a s;eneration. 
 
82 THE MOTHER AND HER CHILD 
 
 16. As noted under the special claims made for this method, 
 it is (as also is nitrous oxid) the ideal procedure in cases of 
 heart, respiratory, kidney, and other organic difficulties, the 
 details of which have already been noted, and their repetition 
 here is not necessary. 
 
 17. It must be remembered that scopolamin and morphin are 
 more or less uncertain in their action; scopolamin is variable 
 in its results, often producing such marked nervous excite- 
 ment in the patient as greatly to interfere with the carrying out 
 of an aseptic technic; while morphin has been shunned by ob- 
 stetricians for a whole generation, because of its well-known 
 bad effects on the unborn child as well as its interference with 
 muscular activity on the part of the mother. 
 
 In Germany, it is said, that a great many damage suits 
 against prominent physicians have resulted because of the 
 alleged ill effects which have followed the use of " twilight 
 sleep." 
 
 18. In presenting these facts and opinions regarding "twi- 
 light sleep," the reader should bear in mind that we are not 
 only endeavoring to state our own views and experience, but 
 also to give the reader just as clear and fair an idea of what 
 other and experienced physicians think of the method, both 
 favorably and unfavorably; and we will draw these conclusions 
 to a close by citing the opinion of one or two who have had 
 considerable experience with the method and who, in summing 
 up their observations, say: 
 
 The disadvantages of the method are entirely with the accoucheur 
 and not to the mother or child. It requires his presence at the bed- 
 side from the time the treatment is undertaken until the completion 
 of labor, not so much because of any danger, but to keep the patient 
 evenly under anesthesia on a line midway between consciousness 
 and unconsciousness, for if she is allowed to go above that line in 
 several instances she will have several so-called "isles of memory," 
 and will be able to draw a picture of her labor in her mind and 
 thus lose the benefit of the treatment. 
 
 These methods of anesthesia are very important and have merit. 
 They should be used when properly indicated. No one should limit 
 himself to a routine method. Each case should be individualized 
 
TWILIGHT SLEEP AND PAINLESS LABOR 83 
 
 and the form of anesthesia best suited to the case in hand should be 
 employed. For instance, in dealing with a primipara — one who is 
 full of fear, who cannot stand pain, who is of an hysterical nature — 
 morphin-scopolamin anesthesia is best suited in that particular case, 
 because these drugs have a selective action when it comes to allay 
 fear and produce amnesia. On the other hand, in a multipara who 
 has had three or four children, whose soft parts are relaxed and 
 who has short labors, the anesthetic of choice would be a few 
 whiffs of chloroform as the head passes over the perineum. It is 
 ridiculous to try to give such women the " twilight sleep." Further- 
 more, take the cases you see for the first time at the end of the first 
 stage of labor, or during the second stage; these cases are best 
 treated with the nitrous oxid and oxygen method. You have to indi- 
 vidualize your cases. The prospective mother now consults the 
 obstetrician early to find out if her particular case is suitable for the 
 " twilight sleep." She has been informed that certain examinations — 
 urine, blood pressure, etc. — are necessary. She knows that these 
 examinations have to be made at regular intervals. In other words, 
 we get the patients early and we can give them good prenatal care. 
 
 This chapter has been devoted to " twilight sleep ; " the fol- 
 lowing chapter will consider " nitrous oxid " and other methods 
 of anesthesia in connection with labor, and should be read along 
 with the foregoing discussion in order to obtain an intelligent 
 view of the whole subject of " painless labor." 
 
CHAPTER X 
 SUNRISE SLUMBER AND NITROUS OXID 
 
 SINCE the public has already been told so much about ob- 
 stetric anesthesia, we deem it best to go into the whole 
 subject thoroughly, so that the expectant mothers who read this 
 book will be able to form an intelligent opinion regarding the 
 question, and thus be in a position to give hearty cooperation 
 to the decision of their physician to employ, or not to employ, 
 any special form of anesthesia or analgesia in their particular 
 case. In order to give the reader a complete understanding of 
 " painless labor," it will be necessary to give attention to that 
 newer and more safe method of obstetric anesthesia called 
 " sunrise slumber." This method of anesthesia consists in the 
 employment of nitrous oxid or " laughing gas," and will be 
 fully considered in this chapter. 
 
 OBSTETRIC FEAR 
 
 In this connection we desire to reiterate and further emphasize 
 some statements made in the preceding chapter concerning the 
 unnatural fear and abnormal dread of childbirth. 
 
 We feel that it is very important in connection with this 
 new movement in obstetrics to reduce the woman's pain and 
 suffering to the lowest possible minimum, that the trials of 
 labor should not be overdrawn and the pangs of confinement 
 overestimated. We must not educate the normal woman to 
 look upon labor as a terrible ordeal — something like a major 
 surgical operation — which, since it cannot be escaped, must 
 be endured with the aid of a deep anesthesia. 
 
 The facts are that a very small per cent of healthy women 
 suffer any considerable degree of severe pain — at least not 
 after the first child. We often observe that judicious mental 
 
 8 4 
 
SUNRISE SLUMBER AND NITROUS OXID 85 
 
 suggestion on the part of the physician or nurse in the form of 
 encouraging words and supporting assurances tends to exert 
 a marked influence in controlling nervousness and subduing the 
 sufferings of the earlier labor pains. 
 
 We must not allow the efforts of medical science to lessen the 
 sufferings of child-bearing, to rob womankind of their natural 
 and commendable courage, endurance, and self-reliance. 
 
 We do not mean to perpetuate the old superstition that pain 
 and suffering are the necessary and inevitable accompani- 
 ments of child-bearing — that the pangs of labor are a divine 
 sentence pronounced upon womankind — and that, therefore, 
 nothing should be done to lessen the sufferings of confinement. 
 Severe and unnatural pain is not at all necessary to childbirth, 
 and there exists no reason under the sun why women should 
 suffer and endure it, any more than they should suffer the hor- 
 rors of a very painful surgical operation without an anesthetic. 
 In this connection, it should be recalled that analgesic drugs have 
 been introduced into obstetric practice only during the last fifty 
 years, while such methods of relieving pain have been used 
 in general surgery for a much longer period. It is now only 
 sixty-nine years since Simpson first employed anesthetic in 
 obstetrics, while six years afterwards Queen Victoria gave her 
 seal of approval to the use of chloroform in labor cases. 
 
 Thirty years ago, in speaking of the expectant mothers, Lusk 
 warned us: 
 
 As the nervous organization loses in the power of resistance as 
 the result of higher civilization and of artificial refinement, it 
 becomes imperatively necessary for the physician to guard her from 
 the dangers of excessive and too prolonged suffering. 
 
 NITROUS OXID ^LAUGHING GAS " 
 
 Nitrous oxid, or " laughing gas," was first used in labor cases 
 in 1880 by a Russian physician. During the last twenty-five 
 years it has been used off and on by numerous practitioners in 
 connection with confinement, but not until the last few years 
 has this method of relieving labor pain come into prominent 
 notice. 
 
 While the " laughing gas " method of obstetric anesthesia did 
 
86 THE MOTHER AND HER CHILD 
 
 not gain notoriety and publicity from being exploited in mag- 
 azines and other lay publications, it did get its initial boost 
 in a very unique and unusual manner. A gentleman who 
 manufactured and sold a " laughing gas " and oxygen mixing 
 machine for the use of dentists, insisted that this method of 
 anesthesia should be used in the case of his daughter, who was 
 about to be confined. This patient was kept under this nitrous 
 oxid anesthetic for six hours — came out fine — no accidents 
 or other undesirable complications affecting either mother or 
 child, and thus another and safe method of reducing the suf- 
 ferings of childbirth has been fully demonstrated and confirmed, 
 although it had previously been known and used in labor cases 
 to some extent. 
 
 Starting from this particular case in 1913, many obstetricians 
 began experimental work with " gas " in labor cases ; and, at 
 the time of this writing, it has come to occupy a permanent place 
 in the management of labor, alongside of chloroform, ether, 
 and " twilight sleep." 
 
 ANALGESIA VS. ANESTHESIA 
 
 The reader should understand the difference between 
 analgesia and anesthesia. Anesthesia refers to the condition 
 in which the patient is more or less unconscious — wholly or 
 partially oblivious to what is going on, and, of course, entirely 
 insensible to all pain. Analgesia is a term applied to the loss 
 of pain sensation. The patient may not be wholly or even par- 
 tially unconscious — merely under the influence of some agent 
 which dulls, deadens, or otherwise destroys the realization of 
 pain. This is the condition aimed at by the proper administra- 
 tion of any form of " twilight sleep," whether by the scopolamin- 
 morphin method, or by the nitrous oxid ("sunrise slumber") 
 method. 
 
 Any method of treatment which can more or less destroy the 
 pain of labor without in any way interfering with its progress, 
 and which in no way complicates its course or leaves behind 
 any bad effects on either mother or child, must certainly be 
 hailed with joy by both the patient and the physician. While 
 chloroform has served these purposes fairly well, there have 
 
SUNRISE SLUMBER AND NITROUS OXID 87 
 
 been numerous drawbacks and certain dangers; and it was the 
 knowledge of these limitations in the use of both chloroform 
 and ether, that has led to further experimentation and the 
 development of these newer methods of producing satisfactory 
 analgesia — freedom from pain — without bringing about such 
 a state of profound anesthesia as accompanies the administra- 
 tion of the older methods. 
 
 It should be borne in mind that in using " sunrise slumber " 
 (nitrous oxid) for labor pains, the gas is so administered that 
 the patient is just kept on the " borderline " — in a typical " twi- 
 light " state — and not in the condition of deep anesthesia which 
 is developed when nitrous oxid is employed by physicians and 
 dentists as an anesthetic for major and minor surgical opera- 
 tions. 
 
 Analgesia is the first stage of anesthesia — the " twilight 
 zone " of approaching unconsciousness — in which the sense 
 of pain is greatly dulled or entirely lost, while even that which 
 is experienced is not remembered. It seems to the authors that 
 "gas" is the ideal drug for producing this condition whenever it 
 is necessary, as nitrous oxid is the most volatile of anaesthetics, 
 acts most quickly, and its effects pass away most rapidly, while 
 its administration is under the most perfect control — it may be 
 administered with any desired proportion of oxygen — and may 
 be discontinued on a moment's notice. It is practically free 
 from danger even when continued as an analgesic for several 
 hours. Nitrous oxid never causes any serious disturbance in the 
 unborn child, as chloroform sometimes does when used 
 too liberally. 
 
 EFFECTS OF NITROUS OXID 
 
 It will not be necessary to compare the favorable and un- 
 favorable claims for nitrous oxid as we did the contentions for 
 and against " twilight sleep." Whatever service " laughing- 
 gas " or " sunrise slumber " can render the cause of obstetrics 
 we can accept, knowing full well that, in competent hands, it 
 can do little or no harm ; and this we know from the facts here- 
 with recited and from the further fact that we have gained a 
 wide experience with this agent in the practice of both dentistry 
 
88 THE MOTHER AND HER CHILD 
 
 and surgery. In a general way, the influence of " sunrise slum- 
 ber " on mother and child may be summarized as follows : 
 
 1. It can accomplish its purpose — can quite satisfactorily 
 relieve the mother of severe pain — when employed as an 
 analgesic. It is not necessary to administer the gas to the point 
 of anesthesia except at the height of suffering at the end of the 
 second stage of labor, when the head of the child is passing 
 through the birth canal. 
 
 2. This method can be stopped at any moment — the patient 
 can be brought out from under its influence entirely and almost 
 instantaneously. It is not like a hypodermic injection of a drug 
 which may exert a varying and unknown influence upon the 
 patient, and which, when once given, cannot be recalled. 
 
 3. It is a method which may be used in the patient's home 
 just as safely as in a hospital; the only drawback being the 
 inconvenience of transporting the gas-containing cylinders back 
 and forth. This is even now partially overcome by the improved 
 combination gas and oxygen form of apparatus which has been 
 devised. 
 
 4. The administration of nitrous oxid analgesia or anesthesia 
 does not interfere with or lessen the uterine contractions or 
 expulsive efforts on the part of the mother — at least not to 
 any appreciable extent. 
 
 5. Just as soon as a severe uterine contraction — attended by 
 its severe pain — begins to subside, the gas inhaler is immedi- 
 ately removed, and in a few seconds the patient is again 
 conscious. It is not necessary to keep the patient continuously 
 under the influence of the drug, as in the case of the scopolamin- 
 morphin method of " twilight sleep." 
 
 6. This method ("sunrise slumber") is certainly far more 
 safe in ordinary and unskilled hands than the " twilight sleep " 
 procedure. The patient is more safe with this method in the 
 hands of the average doctor or trained nurse. 
 
 7. It has been our experience that nitrous oxid in the smaller, 
 interrupted and analgesic doses, actually tends to stimulate the 
 uterine pains and contractions, while at the same time rendering 
 the patient quite oblivious to their presence. When properly 
 administered, the freedom from pain is perfect. 
 
SUNRISE SLUMBER AND NITROUS OXID 89 
 
 8. Under the influence of " gas," patients often appear to 
 " bear down " with increased energy. It certainly does not 
 lessen their cooperation in this respect. 
 
 9. We have not observed, nor have we learned of, any cases 
 of inertia (weak and delayed contractions), post partum hemor- 
 rhage, or shock, as a result of " laughing gas " or " sunrise 
 slumber " analgesia. 
 
 10. This method lends itself to perfect control — it may be 
 decreased, increased, or discontinued, at will; it may be given 
 light now and heavy at another time; while, at the height of 
 labor, it may be pushed to the point of complete anesthesia, if 
 desired. 
 
 11. We have found "sunrise slumber" (nitrous oxid) anal- 
 gesia to be the ideal obstetric anaesthetic, and have adopted it 
 quite to the exclusion of both chloroform and " twilight sleep." 
 We find that this form of analgesia has all the advantages of 
 " twilight sleep " without any of its dangers or disadvantages. 
 
 12. A possible objection to the nitrous-oxid method is the 
 cost, especially in the private home. The average cost in the 
 hospitals where we are using this method runs about $2.00 for 
 the first hour and $1.50 for each hour thereafter. This is the 
 cost when using large tanks of gas, and is, of course, somewhat 
 increased when the smaller tanks are used in the patient's 
 home. 
 
 METHOD OF ADMINISTRATION 
 
 Since it was thought best to give the reader some idea of the 
 technic for the administration of " twilight sleep," it may not 
 be amiss to explain how " sunrise slumber " is usually employed 
 in labor cases. The technic is very simple. The administration 
 of the gas is generally begun about the time the patient begins 
 seriously to complain of the severity of the second stage pains; 
 although, of course, the gas can be given during the first stage 
 pains if desired. In the vast majority of cases, however, we 
 think it is best to encourage the patient to endure these earlier 
 and lighter pains without resorting to analgesic procedures. 
 
 The form of apparatus used is the same as that employed 
 by dentists and contains both nitrous oxid and oxygen cylinders. 
 
9 o THE MOTHER AND HER CHILD 
 
 A small nasal inhaler is best, although the ordinary mouth- 
 piece will do very well. The gasbag attached to the tank 
 should be kept under low pressure and, as a pain begins, the 
 patient is told to breathe quietly, keeping the mouth closed. 
 As a rule this sort of light inhalation serves to produce the 
 desired analgesic effect. It is not necessary to put the patient 
 deeply under in order to relieve the pain. 
 
 It is our custom to begin " sunrise slumber " as soon as the 
 uterine contractions become painful. The earlier the gas is 
 started, the more oxygen should be used. Two or three in- 
 halations will suffice to take the " edge " off the earlier and 
 lighter pains. When the pains grow heavier we use less oxygen 
 and permit three or four deep inhalations just before a bearing- 
 down pain. At the first suggestion of a contraction, the patient 
 must begin to inhale the gas ; while after the patient has pulled 
 hard on the traction strops — just as the contraction pain is 
 passing — she is given an inhalation containing a larger per- 
 centage of oxygen. 
 
 At the beginning of a pain, pure nitrous oxid is administered, 
 and the patient is instructed to breathe deeply and rapidly 
 through the nose. The gasbags should be about half filled. 
 The mixture of gas and oxygen must be determined by the 
 severity of the pains and individual behavior of the patient. 
 
 Four to six inhalations of the gas are sufficient to produce 
 the required analgesia in the average case. Following the first 
 few deep inspirations through the nose, the patient can be in- 
 structed to breathe through the mouth, while the gas is well 
 diluted with oxygen and continued until the end of the pain. 
 In this way a satisfactory analgesia is maintained throughout 
 the " pain " with a minimum of " gas." The proportion of 
 oxygen used will run from nothing up to ten per cent. This 
 procedure is repeated with the occurrence of each pain. 
 
 The use of the " mask " is just as effective as a nasal inhaler, 
 but wastes more gas and so is more costly. 
 
 When the head is passing the perineum the gas should be 
 pushed to the point of anesthesia, while the patient's color will 
 suggest the amount of oxygen to be used as well as serve to 
 control the administration of the nitrous oxid. 
 
SUNRISE SLUMBER AND NITROUS OXID 91 
 
 CHLOROFORM AND ETHER 
 
 For many years chloroform and ether have been "used to 
 alleviate the pains of women in labor. Valuable as these agents 
 are when deep anesthesia is required for the carrying out of 
 operative procedures, they have not proved satisfactory as 
 analgesic agents. If administered in small quantities at the com- 
 mencement of a strong uterine contraction, the patient does not 
 usually inhale sufficient to abolish pain. She is then apt to be 
 irritated and is certain to insist on being given a larger quantity. 
 If a sufficient amount be administered to satisfy the woman, the 
 continued repetition gradually inhibits the power both of the 
 uterus and of the accessory muscles, so that labor is unneces- 
 sarily prolonged, and, possibly, the life of the fetus endangered. 
 Physicians have, therefore, been accustomed to employ these 
 drugs very sparingly, restricting their use to the very end of 
 the second stage, during the painful passage of the head through 
 the vulva. The results of the administration at this time are 
 also uncertain. If delivery be rapid the woman may not be 
 able to inhale sufficient to abolish her consciousness of pain. 
 If it be slow she may take too much and weaken the muscular 
 powers, thereby prolonging labor and, often, necessitating for- 
 ceps delivery. It is not surprising, therefore, that the medical 
 profession has long been hoping that a more satisfactory method 
 of relieving the pain of labor would be found. 
 
 CONCLUSIONS 
 
 In summing up our conclusions regarding analgesia and anes- 
 thesia in labor cases, the authors would state their present posi- 
 tion as follows: 
 
 1. That anesthetics or analgesics are a necessary accompani- 
 ment of confinement in this day and age; that the average 
 labor case demands some sort of pain-relieving agent at some 
 time during its progress; but that intelligent efforts should be 
 put forth to limit and otherwise control their use. While we 
 recognize the necessity for avoiding needless suffering, at the 
 same time we must also avoid turning our women into spineless 
 weaklings and timid babies. 
 
92 THE MOTHER AND HER CHILD 
 
 2. That we should seek to develop, strengthen, and train our 
 girls for a normal and natural maternity; that we should study 
 to attain something of the naturalness and the painlessness of 
 the labors of Indian tribes ; and, even if we partially fail in this 
 effort, we shall at least leave our women with ennobled char- 
 acters and strengthened wills. 
 
 3. That the scopolamin-morphin method of inducing " twilight 
 sleep " has its place — in the hands of experts — and in the 
 hospital; and that in many cases it probably represents the best 
 method of obstetric anesthesia which can be employed. 
 
 4. That as a general rule and in general practice, the safest 
 and best method of inducing the " twilight " state of freedom 
 from severe pain, is by the use of nitrous oxid or " laughing 
 gas " — the " sunrise slumber " method. It has been our prac- 
 tice to start all general ether anesthetics with "gas" for a 
 number of years, while we have been doing an increasing num- 
 ber of both minor and major operations with " gas " alone. 
 
 5. That we still employ general ether or chloroform anes- 
 thesia in Cesarean sections and other major obstetric operations, 
 although several operators are beginning to use " gas " in even 
 these heavy cases. 
 
 6. That the intelligent and careful use of pituitary extract 
 in certain cases of labor serves greatly to shorten the second 
 stage; that it is of great value in certain "slow cases," and 
 serves greatly to reduce the use of low forceps. 
 
 We have treated the subject of obstetric anesthesia in this 
 full manner, because of the fact that so much has appeared 
 in the public press on these subjects, and, further, because we 
 desired that our readers should have placed before them the 
 facts on all sides of the question just as fully as a work of 
 this scope would permit. 
 
CHAPTER XI 
 THE CONVALESCING MOTHER 
 
 POPULARLY spoken of as the " lying-in period," and 
 medically known as the puerperium, this time of conva- 
 lescence immediately following childbirth is usually occupied by 
 two important things: the restoration of the pelvic organs to 
 their normal condition before pregnancy, and the starting of 
 that wonderfully adaptative mechanism concerned with the pro- 
 duction of the varying and daily changing food supply of the 
 offspring. 
 
 The uterus, now more than fifteen times its normal size and 
 weight, begins gradually to contract and assume its normal 
 weight of about two ounces; and it requires anywhere from 
 four to eight weeks to accomplish this involution. In view of 
 all this it is obvious that there can be no fixed time to " get up." 
 It may be at the end of two weeks, or it may not be until the 
 close of four or five weeks, in the case of the mother who cannot 
 nurse her child; for the nursing of the breast greatly facili- 
 tates the shrinking of the uterus. Extensive lacerations may 
 hinder the involution as well as other accidents of childbirth, 
 so it must be left with the physician to decide in each individual 
 case when the mother may enter into the activities of life and 
 assume the responsibilities of the care of the baby and the 
 management of her home. 
 
 THE NURSE 
 
 During this period of the puerperium a member of the family, 
 a neighbor, a visiting nurse, a practical nurse, or a trained 
 nurse, looks after the mother and gives to the babe its first 
 care; whoever it may be, certain laws of cleanliness must be 
 carried out if infection is to be guarded against. If there are 
 
 93 
 
94 THE MOTHER AND HER CHILD 
 
 daily or semi-daily calls made by the physician, a member of 
 the family may be trained to care for the mother with proper 
 cleanliness and asepsis; but it is far better for the mother, if 
 possible, to secure the services of a trained nurse, or the visiting 
 nurse, in which instance she will call each day, wash and dress 
 the baby, clean up the mother and care for the breasts. She is 
 not supposed to clean the room, make the bed or prepare the 
 food. If a trained nurse can be in charge, the convalescing 
 time is usually shortened as the responsibilities are taken from 
 the mother, her mind freed from care and it is her's to improve, 
 rest, and wait for the restoration of the pelvic organs, when she 
 may again go forth among her family. 
 
 The nurse may have to sleep in the same room; but, if it be 
 possible, she should occupy an adjoining room, she should have 
 a regular time each day for an hour's walk in the fresh air, she 
 should be served regular meals, and be allowed some time out 
 of the twenty-four hours for unbroken slumber. In return she 
 will intelligently cooperate with the physician in bringing about 
 the restoration of body and upbuilding of the mother's nerves. 
 
 REST AND EXERCISE 
 
 From a monetary standpoint there can be nothing so wasteful 
 or extravagantly expensive in the home as to allow the mother 
 to drag about from day to day and week to week with chronic 
 weakness or invalidism because she did not have proper care 
 during her already too short puerperium, or because she got 
 up too soon. 
 
 Having a baby is a perfectly normal, physiological procedure. 
 It is also, usually, downright hard work; and, beside the hard 
 laborious work, there is not only a wearied and severely shocked 
 nervous system to be restored, but there is also a certain amount 
 of uterine shrinkage which must take place — and this requires 
 from four to eight weeks; and so our mother must be allowed 
 weeks or even a month or two to rest, to enjoy a certain amount 
 of well-directed exercise, to have an abundance of fresh air, 
 to be wheeled or lifted out of doors if possible into the sunshine, 
 that she may be the better prepared for the additional duties 
 and responsibilities the little new comer entails. Sunshine and 
 
THE CONVALESCING MOTHER 95 
 
 fresh air are wonderful health restorers as is also a well-directed 
 cold water friction bath administered near the close of the 
 second week of a normal puerperium. During the second week 
 a few carefully selected exercises such as the following are not 
 only beneficial, but tend to increase circulation and thus to pro- 
 mote the secretion of milk and the shrinking of the uterus. 
 
 1. Head raising, body straight and stiffened. 
 
 2. Arm raising, well extended. 
 
 3. Leg stretching, with knees stretched and toe extended. 
 
 4. Massage, administered by the nurse. 
 
 A splendid tonic circulatory bath may be administered at the 
 close of the second week (in normal puerperium), known as the 
 " cold mitten friction," which is administered as follows : The 
 patient is wrapped in a warm blanket, hot water bottle at feet, 
 and each part of the body — first one arm then the other ; the 
 chest, the legs, one at a time — is briskly rubbed with a coarse 
 mit dipped in ice water. As one part is dried it is warmly 
 covered, while the next part is taken, and so on until the entire 
 body has been treated. The body is now all aglow, the blood 
 tingling through the veins, and the patient refreshed by this 
 wide-a-wake bath. Properly given, the cold-mitten friction bath 
 is one of the most enjoyable treatments known and under 
 ordinary conditions, if intelligently administered, may be given 
 as early as the eighth day. 
 
 AFTER PAINS 
 
 After the birth of the first baby the uterus usually is in a 
 state of constant contraction, hence there are no " after pains ; " 
 but after the birth of the second or third child, the uterine 
 muscle has lost some of the tone of earlier days — there is a 
 tendency toward relaxation — so that when the uterine muscle 
 does make renewed efforts at contraction, these " after pains " 
 are produced. They usually disappear by the third day. Noth- 
 ing should be done for them, indeed they should be welcomed, 
 for their presence means good involution (contraction) of the 
 uterus. 
 
96 THE MOTHER AND HER CHILD 
 
 THE TEMPERATURE 
 
 Careful notations of the temperature should be made during 
 the first week. A temperature chart should be accurately kept 
 and if the temperature should rise above ioo° the physician 
 should be notified at once. The third day temperature is 
 watched with expectancy, for if an accidental infection occurred 
 at the time of labor, it is usually announced by a chill and 
 sudden rise of temperature on the third day. This may be as 
 good a place as any to mention the commonly met night sweat- 
 ing. This is due to a marked accentuation of the function of 
 the skin. It is not at all unusual for a sleeping mother in the 
 early puerperium to wake up in a sweat with night gown very 
 nearly drenched. The gown should be changed underneath the 
 bedding, while alcohol is rubbed over the moistened skin sur- 
 face. 
 
 These sweats will disappear as soon as the mother begins to 
 regain her strength. A vinegar rub administered on going to 
 bed may often prevent these sweats. 
 
 THE TOILET OF THE VULVA 
 
 Immediately after the birth of the baby and the expulsion of 
 the afterbirth, the thighs and vulva are cleansed as follows: 
 Into a basin of warm, boiled water are dropped four small 
 antiseptic tablets of bichlorid of mercury; this gives a proper 
 antiseptic wash. Into this solution are placed four pieces of 
 sterile cotton. Two of these are used, one at a time, without being 
 returned to the solution to wash each inside of the thigh, the 
 remaining two to cleanse the vulva. Without drying the vulva, 
 two sterile pads are applied and pinned to the binder. These 
 pads are changed every hour during the first day or two because 
 of the profuse lochial flow. 
 
 After each urination and bowel movement, a lysol solution 
 (prepared by putting one teaspoonful of lysol in a quart of 
 sterile water) is poured from a clean pitcher over the vulva 
 into the bed pan, and fresh pads applied. This toilet continues 
 until the close of the second week or longer, if there is a lochial 
 flow. 
 
THE CONVALESCING MOTHER 97 
 
 These sterile pads not only absorb the lochia but also, among 
 ignorant or thoughtless mothers, prevent contamination by the 
 patient's hands. 
 
 URINATION 
 
 The patient should be encouraged to urinate during the first 
 few hours after labor; catheterization should not take place 
 until every effort has been made to bring about normal urina- 
 tion ; or, until there is a well marked tumor above the bony arch 
 of the pelvis in the lower part of the abdomen. It is far less 
 harmful to the patient for her to sit up on the jar placed on the 
 edge of the bed, than to undergo the risk of inflammation of the 
 bladder which so often follows catheterization. 
 
 THE LOCHIA 
 
 The first few days the lochia is very red because of the large 
 amount of blood which it contains. After the third or fourth 
 day it is paler and after the tenth it assumes a whitish or 
 yellowish color. During the three changes it should always 
 smell like fresh blood. Any foul, putrifying odor should be 
 promptly reported to the physician. 
 
 If on getting up at the close of the second week the lochia 
 should resume its red color, the patient should return to bed and 
 notify her physician. 
 
 THE ABDOMINAL BINDER 
 
 After the tenth day, the abdominal binder may be pinned as 
 tightly as the patient desires, but prior to the tenth day many 
 physicians believe the exceedingly tight binder causes mis- 
 placements of the enlarged, softened, and boggy uterus. It 
 should be pinned snugly ; but not drawn as tight as possible with 
 the idea of keeping the uterus from relaxing, for at best, it 
 does not do it; while tight constriction may produce a serious 
 turning or flexion of the uterus. The breast binder is applied 
 during the first twenty-four hours to support the filling breasts, 
 loosely at first, and as they increase in size, as the glands 
 become engorged, the binder is drawn more tightly. A sterile 
 piece of gauze is placed over the nipples. 
 
98 THE MOTHER AND HER CHILD 
 
 THE BOWELS 
 
 On the morning of the second day a cathartic is usually 
 given — say one ounce of castor oil or one-half bottle of citrate 
 of magnesia. The bowels should move at least once during each 
 twenty- four hours; if they are obstinate, a simple laxative 
 may be nightly administered. Certain constipation biscuits, 
 sterilized dry bran, or agar-agar may be eaten with the break- 
 fast cereal. Prunes and figs should be used abundantly. Bran 
 bread should be substituted for white bread. The enema habit 
 is a bad one and should not be encouraged ; however, the enema 
 is probably less harmful than the laxative-drug habit. Mineral 
 oil is useful as a mild laxative, and does not produce any bad 
 after results. 
 
 CARE OF THE NIPPLES 
 
 Fissures of the nipples should be reported to the physician at 
 once. There are many good remedies which the physician may 
 suggest; in his absence, Balsam Peru may be advantageously 
 applied. Boracic acid solution should be applied before and 
 after each nursing from the very first day; in this way much 
 nipple trouble may be prevented through cleanliness and care. 
 The nipples should be kept thoroughly dry between nursings. 
 Nipple shields should be used where fissures persist. 
 
 THE DIET 
 
 For the first three days a liquid and soft diet is followed 
 such as hot or cold milk, gruels, soups, thin cereals, eggnog 
 (without whiskey), eggs, cocoa, dry toast, dipped toast, or 
 cream toast. There should be three meals with a glass of hot 
 milk at five in the morning (if awake) and late at night; noth- 
 ing between meals except plenty of good cold water. After the 
 third day, if temperature is normal, a semi-solid diet may be 
 taken, such as baked, mashed, or creamed potatoes, soups 
 thickened with rice, barley or flour, vegetables (peas, corn, 
 asparagus, celery, spinach, etc.) ; eggs, light meats, stale breads, 
 toast, bland or subacid fruits (sweet apples, prunes, figs, dates, 
 pears, etc.) ; macaroni, browned rice (parched before steaming), 
 etc.; ice cream, custards, and rice puddings for desserts after 
 
THE CONVALESCING MOTHER 99 
 
 the seventh day. Three good meals a day, at eight and one 
 and six, with a couple of glasses of hot milk or cocoa or an 
 eggnog at five a. m., to be repeated at 9 or 10 p. m., with 
 plenty of cold water between the meals, will abundantly supply 
 the necessary milk for the growing babe. Tea and coffee are 
 not of any special value in encouraging a flow of milk. 
 
 The constant coaxing of the mother with " Do drink this," 
 and " You must drink this, or you won't have any milk," not 
 only saddens her but seriously upsets digestion and thus indi- 
 rectly interferes with normal lactation. 
 
 GETTING UP 
 
 Everybody should stay at home and away from the mother 
 and her new born child until after the seventh day, and then, 
 if our patient is normal, visitors may call, but should not stay 
 longer than five minutes. The convalescing mother will improve 
 faster without the neighborhood gossip, or the tales of woe so 
 often carried by well-meaning, but woefully ignorant acquaint- 
 ances. 
 
 When the hard ball-like mass can no longer be felt in the 
 lower abdomen, when the lochia has passed through the three 
 changes already mentioned, and the flow is whitish or yellowish, 
 scanty and odorless, the patient may sit up in a chair increas- 
 ingly each day. Such conditions are usually found anywhere 
 from the tenth to the fifteenth day. The patient first sits up 
 a little in a chair — she has already been exercising some in 
 bed — and this enables her to sit up with ease for a half-hour 
 the first day, increasing one-half hour each day during the week 
 following. At the end of three weeks, she may be taken down 
 stairs providing there is ample help to carry her back up stairs. 
 After another week (at the close of the fourth), if the lochia 
 is entirely white or yellow, with no blood, she may begin care- 
 fully to go about the house. There should be no lifting, shoving, 
 pulling, wringing, sweeping, washing, ironing, or other heavy 
 exercise for at least another two weeks, better four weeks. 
 Any variance from this program usually means backache, lassi- 
 tude, diminished milk supply, and frequently a general invalid- 
 ism for weeks or months — sometimes years. 
 
ioo THE MOTHER AND HER CHILD 
 
 COMPLICATIONS 
 
 Cystitis, or painful urination, is avoided by tardy " getting 
 up;" quietly, slowly moving about; abundant water drinking; 
 and the avoidance of catheterization. 
 
 Hemorrhage. Notify the physician if it occurs at any time. 
 The treatment is heavy kneading of the abdomen until the uterus 
 again becomes like a hard ball. Cold compresses over the lower 
 abdomen may sometimes help. 
 
 Infection is manifested by chilly sensations or a distinct chill 
 followed by fever, usually on the third day. Take a cathartic; 
 notify the physician at once and follow his directions. 
 
 Mastitis, inflammation or caking of the breasts. Very hot 
 fomentations wrung out of boiling water, alternating with ice- 
 cold compress, should be applied to the breast for an hour 
 or more, three or four times a day. Cathartics should be 
 administered, and eliminative measures instituted such as the 
 hot-blanket pack. 
 
 Pneumonia. Keeping the arms and chest well protected by a 
 long-sleeved coat of warm texture, should help in preventing 
 this serious complication. Pneumonia complicating labor is 
 usually the result of carelessness and exposure. 
 
PART II 
 THE BABY 
 
PART II 
 THE BABY 
 
 CHAPTER XII 
 BABY'S EARLY DAYS 
 
 HAPPY is the mother and fortunate is the home that pos- 
 sesses the intelligent services of a trained attendant during 
 the early days of the baby's career. A century or more ago 
 skilled nurses were unheard of, >and both mothers and babies 
 seemed to thrive on the unskilled but faithful and sympathetic 
 care given by the willing neighbor who " thought I'd just run 
 over and help out." Who of us cannot remember the days 
 when mother was " gone to a neighbor's " to give this same will- 
 ing but unskilled care at the time of " confinement." 
 
 MODERN METHODS 
 
 And why are we so concerned today about asepsis, steriliza- 
 tion, etc., when a generation ago they were not? We used to 
 live more slowly than we do now. Then it took the entire day 
 to do the marketing for the week, now we take a receiver from 
 the hook and a telephone wire transmits the verbal message. 
 Our days are literally congested with events that were almost 
 impossibilities a century ago. The ease and leisure of former 
 days are unknown and unheard of today. The artificial way in 
 which we live exerts more or less of a strain upon the present 
 generation; the average woman's nervous system is keyed up 
 to a high pitch; her general vital resistance is running at a 
 low ebb; while child-bearing brings a certain added stress and 
 strain that requires much planning to avoid and overcome. 
 
 For many days and ofttimes weeks the mother is unfit — 
 physically unable — properly to care for her child, and so 
 
 103 
 
104 THE MOTHER AND HER CHILD 
 
 whether it be the trained assistant in constant attendance or the 
 visiting nurse in her daily calls, or the kind, willing, but unskilled 
 neighbor — each helper must acquaint herself, in varying de- 
 grees, with the physical, nervous, and mental needs of the 
 child, as well as take into account and anticipate the numerous 
 habits and wants of the new born babe, such as urination, bowel 
 movement, pulse, respiration, temperature, etc. 
 
 THE HEAD 
 
 At birth, the head is remarkably large as compared to the 
 rest of the body, for, surprising as it may seem, the distance 
 from the crown to the chin is equal to the length of the baby's 
 trunk; and, too, if birth has been prolonged this large head has 
 also been pressed or squeezed somewhat out of shape. This 
 state of affairs, however, need give no cause for either alarm 
 or anxiety, for the head will shape itself to the beautiful rotund- 
 ity of the normal baby's head within, a few days. 
 
 The general shape of the baby's head, as seen from above is 
 oval. Just back of the forehead is formed a diamond-shaped 
 soft spot known as the anterior fontanelle which should measure 
 a little more than one inch from side to side. On a line just 
 posterior to this soft spot and to the back of the head, is 
 found another soft spot somewhat smaller than the one in front. 
 Gradual closure of these openings in the bones occurs, until at 
 the end of six or eight months, the posterior fontanelle is 
 entirely closed; while eighteen months are required for the 
 closure of the anterior fontanelle. 
 
 These " soft spots " should not be depressed neither should 
 they bulge. The head is usually covered with a growth of soft, 
 silky hair which will soon drop out, to be replaced, however, by 
 a crop of coarser hair in due season. The scalp should always 
 be perfectly smooth. Any rash or crusts or accumulation of 
 any kind on the scalp is due to uncleanliness and neglect, and 
 should be carefully removed by the thorough application of 
 vaseline followed by a soap wash. The vaseline should be 
 applied daily until all signs of the accumulation are entirely 
 removed. The eyes of all babies are generally varying tints 
 of blue, but usually change to a lighter or darker hue by the 
 
BABY'S EARLY DAYS 105 
 
 seventh or eighth week. The whitish fur which often is seen 
 
 on the baby's tongue is the result of a dry condition of the 
 
 mouth which disappears as soon as the saliva becomes more 
 abundant. 
 
 CHEST, ABDOMEN, AND LEGS 
 
 The baby's chest, as compared to the size of the head and 
 abdomen, appears at a disadvantage, while the arms are com- 
 paratively short and the legs particularly so, since they measure 
 about the same as the length of the trunk. They naturally 
 " bow in " at birth so that the soles of the feet turn decidedly 
 toward each other. All these apparent deformities, as a rule, 
 right themselves without any help or attention whatsoever. 
 
 PULSE AND RESPIRATION 
 
 The pulse may be watched at the anterior fontanelle or soft 
 spot on top of the head while the child quietly sleeps and should 
 record, at varying ages, as follows: 
 
 At birth 130 to 150 
 
 First month 120 to 140 
 
 One to six months about 130 
 
 Six months to one year about 120 
 
 One to two years no to 120 
 
 Two to four years 90 to no 
 
 The above table is correct for the inactive normal child. 
 Muscular activity, such as crying and sucking, increases the 
 pulse rate from 10 to 20 beats per minute. 
 
 The respiration of the baby often gives us no small amount 
 of real concern at the first. The baby may be limp and breath- 
 less for some few moments at birth, and this condition calls 
 for quick action on the part of the nurse and doctor. 
 
 The utmost care to avoid the " sucking in " of any liquid 
 or blood during its birth must be exercised, for this often 
 seriously interferes with the breathing. Sometimes this condi- 
 tion is not relieved until a soft rubber catheter is placed in the 
 throat and the mucus is removed by quick suction. When you 
 are reasonably sure that there is no more mucus in the throat, 
 
106 THE MOTHER AND HER CHILD 
 
 then sudden blowing into the baby's lungs (its lips closely in 
 touch with the lips of the nurse or physician) often starts 
 respiration. Slapping it on the back also helps, while the quick 
 dip into first hot then cold water seldom fails to give relief. 
 
 A quiet-sleeping infant breathes as shown below at varying 
 ages. An increase of six to ten breaths per minute may be 
 allowed for the time it is awake or otherwise active. 
 
 At birth and for the first two or three weeks. .30 to 50 
 
 During the rest of the first year 25 to 35 
 
 One to two years about 28 
 
 Two to four years about 25 
 
 THE WEIGHT 
 
 The normal weight of the average baby is seven to seven and 
 one-half pounds. Its length may range anywhere from sixteen 
 to twenty-two inches. 
 
 There is an initial loss of weight during the first few days; 
 however, after the milk has been established the child should 
 make a weekly gain of four to eight ounces until it is six 
 months old, after which time the usual gain is from two to 
 four ounces per week. 
 
 If the weight has been doubled at six months and the weight 
 at one year is three times the birth weight, the child is said to 
 have gained evenly and normally. 
 
 THE SKIN 
 
 At birth the skin of the baby is red and very soft owing to 
 the presence of a coating of fine down. A blue-tinged skin 
 may be occasioned by unnecessary exposure or it may be due 
 to an opening in the middle partition of the heart which should 
 close at birth. As soon as the baby is born, it should be placed 
 on its right side while the cord is being tied, as this position 
 facilitates closure of this embryonic heart opening. With the 
 provision for a little additional heat the blue color should 
 disappear, if it is not due to this heart condition. At the close 
 of the first week the red color of the skin changes to a yellow 
 tint due to the presence of a small amount of bile in the blood. 
 This sort of jaundice is very common and is in no wise evidence 
 
BABY'S EARLY DAYS 107 
 
 of disease. The " down " falls off with the peeling of the skin 
 which takes place during the second week ; by the end of which 
 time, the skin is smooth and assumes that delightful " baby " 
 character so much admired. 
 
 THE CORD DRESSING 
 
 The cut end of the tied umbilical cord is swabbed and 
 squeezed with a sterile sponge saturated with pure alcohol. It 
 is then wrapped in a sterile dressing made as follows : Four or 
 five thicknesses of sterile cheese cloth are cut into a four-inch 
 square with a small hole cut in the center and one side cut to 
 this center. This is slipped about the stump of the cord and 
 wrapped around and about in such a manner as entirely to 
 cover the stump of the cord. The wool binder is then applied 
 and sewed on, thus avoiding both pressure and the prick of 
 pins. If it remains dry this dressing is not disturbed until the 
 seventh or eighth day, when the cord ordinarily drops off. 
 Should it become moistened the dressing is removed and the 
 second dressing is applied exactly like the first. 
 
 THE EYES 
 
 The closed eyes of the newly born child are generally cov- 
 ered with mucus which should be carefully wiped off with a 
 piece of sterile cotton dipped in boracic acid solution, in a 
 manner not to disturb the closed lid. A separate piece of cotton 
 is used for each eye and the swabbing is done from the nose 
 outward. The physician or nurse drops into each opened eye 
 two drops of twenty per cent argyrol, the surplus medicine 
 being carefully wiped off with a separate piece of cotton for 
 each eye. The baby should now be placed in a darkened 
 corner of the room, protected from the cold. 
 
 The eyes are washed daily by dropping saturated solution 
 of boracic acid into each eye with a medicine dropper. Separate 
 pieces of gauze or cotton are used for each eye. 
 
 THE FIRST OIL BATH 
 
 As soon as the cord and the eyes have received the proper 
 attention and the mother has been made comfortable, the baby 
 
108 THE MOTHER AND HER CHILD 
 
 is given its initial bath of oil. This oil may be lard, olive oil, 
 sweet oil, or liquid vaseline. The oil should be warmed and the 
 baby should be well covered with a warm blanket and placed on 
 a table which is covered with a thick pad or pillow. The temper- 
 ature of the room should be at least eighty degrees Fahrenheit. 
 Quickly, thoroughly, and carefully the entire body is swabbed 
 with the warmed oil ■ — the head, neck, behind the ears, under 
 the arms, the groin, the folds of the elbow and knee — no part 
 of the body is left untouched, save the cord with its dressing. 
 This oil is then all gently rubbed off with an old soft linen 
 towel. 
 
 THE FIRST CLOTHING 
 
 After the oil bath, the silk and wool shirt (size No. 2), the 
 diaper and stockings are quickly put on to avoid the least 
 danger of chilling. The band having been applied at the time 
 of the dressing of the cord, our baby is now ready for the 
 flannel skirt. This should hang from the shoulders by a yoke 
 of material adapted to the season, cotton yoke without sleeves 
 if a summer baby, and a woolen yoke with woolen sleeves if 
 a winter baby. The outing-flannel night dress completes the 
 outfit and should be the only style of dress worn for the first 
 two weeks. Loosely wrapped in a warm shawl, the baby is 
 about ready for its first nap, save for a drink of cooled, boiled 
 water. 
 
 This cooled, boiled, unsweetened water should be given in 
 increasing amounts every two hours until the child is two or 
 three years of age. It is usually given the child in a nursing 
 bottle. In this way it is taken comfortably, slowly, can be kept 
 clean and warm, and should the babe be robbed of its natural 
 food and transferred to the bottle as a substitute for mother's 
 milk, it will already be acquainted with the bottle and thus 
 one-half of a hard battle has already been fought and won. 
 
 baby's first nap 
 
 The baby's bed should be separate and apart from the 
 mother's. It may be a well-padded box, a dresser drawer, a 
 clothes basket, or a large market basket. A folded comfortable 
 
BABY'S EARLY DAYS 109 
 
 slipped in a pillow slip makes a good mattress. A most ideal 
 bed may be made out of a clothes basket; the mattress or pad 
 should come up to within two or three inches of the top, so the 
 baby may breathe good fresh air and not the stale air that is 
 always found in a deeply made bed. Into this individual bed 
 the baby is placed as soon as it is dressed, and a good sleep of 
 four to six hours usually follows. 
 
 Frequent observations of the cord dressing should be made 
 as occasionally hemorrhage does take place, much to the detri- 
 ment of the babe. If bleeding is at any time discovered the cord 
 is retied just below the original tying. By the time baby has 
 finished a six- or eight-hour nap the mother is wondrously 
 refreshed and is ready to receive it to her breast. 
 
 PUTTING TO THE BREAST 
 
 During the first two days the baby draws from the breasts 
 little more than a sweetened watery fluid known as the colos- 
 trum; but its intake is essential to the child in that it acts as 
 a good laxative which causes the emptying of the alimentary 
 tract of the dark, tarry appearing stools known as the meconium. 
 On the third day this form of stool disappears and there fol- 
 lows a soft, yellow stool two or three times a day. 
 
 The child should be put to the breast regularly every four 
 hours; two things being thus encouraged: an abundant supply 
 of milk on the third day and the early shrinking of the uterus. 
 More than once a mother has missed the blessed privilege of 
 suckling her child because some thoughtless person told her 
 " why trouble yourself with nursing the baby every four hours, 
 there's nothing there, wait until the third day;" and so when 
 the third day came, there was little more than a mere sugges- 
 tion of a scanty flow of milk, which steadily grew less and less. 
 
 THE URINE 
 
 The urine of the very young child should be clear, free from 
 odor and should not stain the diaper, nor should it irritate the 
 skin of the babe. Often urination does not take place for sev- 
 eral hours, sometimes not at all during the first twenty-four 
 hours. If the infant does not show signs of distress, there is 
 
no THE MOTHER AND HER CHILD 
 
 no cause for alarm; the urine should pass, however, within 
 thirty hours. As a rule there are usually between ten and 
 twenty wet diapers during each twenty-four hours. The fol- 
 lowing table shows about the amounts of urine at different ages : 
 
 Birth to two years 8 to 12 ounces 
 
 Two to five years 15 to 25 ounces 
 
 Five to ten years 25 to 35 ounces 
 
 GENITALS OF THE MALE CHILD 
 
 The foreskin of the male child is often long, tight, and 
 adherent, and is often the direct cause of irritability, nervous- 
 ness, crying, and too frequent urination. It should be closely 
 examined by both physician and nurse and when the foreskin 
 does not readily slip back over the acorn-like head of the 
 organ, circumcision is advised early in the second week. This 
 simple operation will start the child out on his career with 
 at least one moral handicap removed and one desirable pos- 
 sibility established — that of being able to keep himself clean. 
 
 POST-OPERATIVE CARE OF CIRCUMCISION 
 
 The dressings that are loosely applied at the time of the 
 operation should remain untouched (especially those next to 
 the skin), unless otherwise directed by the physician, until the 
 seventh or eighth day when the babe is placed in a warm soap 
 bath, at which time the dressings all come off together. Clean 
 sterile gauze is so placed as entirely to protect the inflamed 
 skin from the diaper at all times before this bath, and these 
 same dressings should be continued for at least another week. 
 Sterile vaseline (from a tube) should be applied twice a day 
 after the original dressings are removed in the bath at the end 
 of the first week. There should be little or no bleeding follow- 
 ing the operation, neither should the penis swell markedly; if 
 either complication should occur, the physician should be 
 promptly notified. 
 
 CARE OF THE FEMALE GENITALS 
 
 The girl baby is often neglected in respect to the proper care 
 of the genitals. The lips of the vulva should be separated and 
 
Fig. 6. How to Hold the Baby 
 
BABY'S EARLY DAYS ill 
 
 thorough but careful cleaning should be the daily routine. The 
 foreskin or covering of the clitoris should not be adherent; 
 while the presence of mucus, pus, or blood in the vulva should 
 be at once reported to the physician; in his absence, the appli- 
 cation of twenty per cent argyrol should be made daily. 
 
 HANDLING THE BABY 
 
 Let us thoroughly come to understand the very first day 
 the little one's life, that it was not sent to us because the family 
 needed something to play with; it is not a ball to toss up, 
 neither is it a variety show. It is a tiny individual, and your 
 responsibilities as parents and caretakers are very great. The 
 child was sent to be fed, clothed, kept warm, dry, and other- 
 wise cared for by you, until such a time as it will become able to 
 care for itself. Remember, what we sow, that shall we also reap. 
 If we sow indulgence we shall reap anger, selfishness, irri- 
 tability, " unbecomingness " — the spoiled child. At two or 
 three days the baby learns that when it opens its mouth and 
 emits a holler, someone immediately comes. If we do it on the 
 second and third day, why should we object to run, bow, and 
 indulge on the one hundredth and second day? 
 
 Handle the baby as little as possible. Turn occasionally from 
 side to side, feed it, change it, keep it warm, and let it alone; 
 crying is absolutely essential to the development of good strong 
 lungs. A baby should cry vigorously several times each day. 
 If the baby is to be handled, support the back carefully (Fig. 6). 
 
 THE EARLY BATHS 
 
 During the first week the baby is oiled daily over his entire 
 body, with the exception that the cord dressing remains un- 
 touched. The face, hands, and buttocks are washed in warm 
 water. After the third week the bathroom is thoroughly 
 warmed and the small tub is filled with water at temperature of 
 ioo F. The baby having been stripped and wrapped in a warm 
 turkish towel, is placed on a table protected by a pillow, while 
 the caretaker stands by and vaselines the creases of the neck, 
 armpits, folds of the elbows, knees, thighs, wrists, and genitals ; 
 and then, with her own hands, she applies soap suds all over 
 
H2 THE MOTHER AND HER CHILD 
 
 the body — every portion of which is more quickly and readily 
 reached — than by the use of a wash cloth. And now, with 
 the bath at ioo F., with a folded towel on the bottom of the 
 small tub, the soapy child is placed into the water and after 
 a thorough rinsing is lifted out again to a warm fresh towel 
 on the table and the careful drying is quickly begun. After 
 the bath all the folds and creases are given a light dusting with 
 a good talcum. 
 
 During hot weather the bath should be given daily, soap 
 being used twice a week. On the other days there should be the 
 simple dipping of the child into the tub. During the cold 
 weather the full bath is given but twice a week, while on the 
 other days a sponge bath or an oil rub may be administered. 
 
 A weak, delicate child should not be exposed to the daily 
 full bath, but rather the semi-weekly sponge bath and the daily 
 oil rub should be administered. We have found the late after- 
 noon hour to be better than the early morning hour for baby's 
 bath. It requires too much vital resistance to react to an early 
 morning bath, especially when the house is cool. 
 
 REGARDING SOAP 
 
 The use of soap is very much abused with young babies. 
 I recall one mother who came into the office with her poor 
 little baby which was constantly crying and fretting because of 
 a greatly inflamed body — all a result of the too frequent use 
 of soap. I said, " I am afraid you do not keep your baby clean." 
 " O Doctor ! " she replied, " I wash him with soap every time 
 I change him; I am sure he is clean." And come to find out, 
 the poor little fellow's tender skin had been subjected to soap 
 several times a day. We ordered the use of all soap discon- 
 tinued, vaseline and talcum powder to be used instead, and the 
 child's skin got well in a very short time. 
 
 CARE OF THE UMBILICUS 
 
 Tight bands should not be placed about the babe. If the 
 umbilicus protrudes, do not endeavor to hold it in by a tight 
 band, but consult your physician about the use of a bit of folded 
 cotton and adhesive plaster, and then allow the child the free- 
 
BABY'S EARLY DAYS 113 
 
 dom of the knitted bands, with skirts suspended from yokes. 
 The day of tight bands and pinning blankets with their 
 additional and traditional windings is over. After the complete 
 healing of the cord, the need for a snug binder to hold the 
 dressings in place is over. Should the baby cry violently, 
 the umbilicus should be protected in the manner described above 
 — the fold of cotton and the adhesive plaster. 
 
 The diaper, stockings, shirt, skirt, and dress with an addi- 
 tional wrapper for cold days completes the outfit at this age. 
 
 BIRTH REGISTRATION 
 
 " One of the most important services to render the newborn 
 baby is to have his birth promptly and properly registered." 
 
 In most states the attending physician or midwife is required 
 by law to report the birth to the proper authority, who will see 
 that the child's name, the date of his birth, and other particulars 
 are made a matter of public record. Birth registration may be 
 of the greatest importance when the child is older, and parents 
 should make sure this duty is not neglected. 
 
 A public health official some time ago epitomized some of the 
 uses of birth registration as follows: 
 
 There is hardly a relation in life from the cradle to the grave in 
 which such a record may not prove to be of the greatest value. For 
 example, in the matter of descent ; in the relations of wards and 
 guardians; in the disabilities of minors; in the administration of 
 estates ; the settlement of insurance and pensions ; the requirements 
 of foreign countries in matters of residence, marriage, and legacies; 
 in marriage in our own country; in voting and in jury and militia 
 service; in the right to admission and practice in the professions 
 and many public offices; in the enforcement of laws relating to 
 education and to child labor, as well as to various matters in the 
 criminal code; the irresponsibility of children under ten for crime 
 or misdemeanor; the determination of the age of consent, etc., etc. 
 
CHAPTER XIII 
 THE NURSERY 
 
 WE wish it were possible for every mother who reads this 
 book to have a special baby's room or nursery. Some of 
 our readers have a separate nursery-room for the little folks, 
 and so we will devote a portion of this chapter to the description 
 of what seems to us a model arrangement for such a room; 
 but, realizing that ninety-five per cent of our readers can only 
 devote a corner of their own bedroom to the oncoming citizen, 
 we have also carefully sought to meet their needs and help 
 them to take what they have and make it just as near like the 
 ideal nursery as possible. 
 
 THE SEPARATE NURSERY 
 
 The nursery should be a quiet room with a south or south- 
 westerly exposure. The bathroom should adjoin or at least be 
 near. A screened-in porch is very desirable. 
 
 Draperies that cannot be washed, and upholstered furniture, 
 do not belong in the baby's room. A hardwood floor is better 
 than a carpet or matting; while a few light-weight rugs, easily 
 cleaned, are advisable. Enameled walls are easily washed and 
 are, therefore, preferable to wall paper or other dressings. 
 
 The windows should be well screened, for by far the greatest 
 dangers to which the baby is exposed, are flies and mosquitoes 
 — carriers of filth and disease. Flies, mosquitoes, cockroaches, 
 bed bugs, cats, dogs, lice, and mice are all disease carriers and 
 must therefore be kept out of baby's room. 
 
 NURSERY EQUIPMENT 
 
 At each window should be found dark shades, and if curtains 
 are desired they should be of an easily washable material, such 
 
 114 
 
THE NURSERY 115 
 
 as mull, swiss, lawn, voile, or scrim. The hardwood floor may 
 be covered where necessary with easily handled rugs which 
 should be aired daily. The other necessary articles of furniture 
 are a crib of enameled iron whose bedding will be described 
 elsewhere in this chapter, a chest for baby's clothes and other 
 necessary supplies, a screen or two, a low table and a low- 
 rocker, a small clothes rack on which to air the clothes at 
 night, a pair of scales, and a medicine chest placed high on the 
 wall. 
 
 If the room will conveniently admit it, a couch will add 
 greatly to the mother's comfort; and, if possible, it should be 
 of leather upholstery; otherwise, it should possess a washable 
 cover, for all articles that promote the accumulation of dust are 
 not to be allowed in the nursery. In these early weeks and 
 months baby will not benefit from pictures or other wall decora- 
 tions, and so let him have clean walls that are easily washed 
 and quickly dusted. 
 
 The necessities for baby's personal care are: 
 
 Talcum powder. Sterile cotton balls in covered 
 
 Castile soap. glass jar. 
 
 Soft wash cloths. Safety pins of different sizes. 
 
 Soft linen towels. Hot water bag with flannel 
 
 Bottle of plain vaseline. cover. 
 
 Boracic acid, oz. iv (Saturated Baby scales. 
 
 Solution). Drying frames for shirt and 
 
 Olive oil. stockings. 
 
 baby's bed 
 
 Since the days of Solomon, accidents have occurred where 
 mother and babe have occupied the same bed. Not only is there 
 the ever-present danger of smothering the babe, but there are 
 also many other reasons why a baby should have its own bed. 
 The constant tendency to nurse it too often and the possibility 
 of the bed clothing shutting off the fresh air supply, are in and 
 of themselves sufficient reasons for having a separate bed for 
 baby. 
 
 The first bed is usually a basinet — a wicker basket with high 
 sides — with or without a hood. A suitable washable lining 
 
n6 THE MOTHER AND HER CHILD 
 
 and outside drape present a neat as well as sanitary appearance. 
 The mattress of the basinet is usually a folded clean comfort 
 slipped into a pillow slip; this is to be preferred to a feather 
 pillow, as it is cooler and in every way better for the babe. 
 
 Drapes about the head of the basinet are not only often in 
 the way, shutting out air, etc., but they also gather dust and 
 are unsanitary. Screens are movable — they may be used or 
 put away at will — and are, therefore, very convenient about 
 the nursery. 
 
 The basinet may be dispensed with entirely if the sides of the 
 enameled crib are lined to cut off draughts and the babe is 
 properly supported by pillows. After the baby is four to six 
 months of age it is transferred to the crib. The basinet has an 
 advantage over the crib during those early weeks in that its 
 high sides protect the babe from draughts, and the comforts and 
 blankets can be more easily tucked about the little fellow to 
 keep him warm. The sides should not extend more than four 
 inches above the lying position of the child. 
 
 THE CRIB 
 
 The enameled iron crib should be provided with a woven-wire 
 mattress, over which is placed a mattress; hair is best as a 
 filling for the mattress, wool next, and cotton last. Over the 
 mattress should be placed a rubber sheet, and over all a folded 
 sheet. 
 
 A pillow of hair or down is not to be discarded; for recent 
 investigation has shown that the pillow favors nasal drainage, 
 while lying flat encourages the retaining of mucus in the nose 
 and nasal chambers — the sinuses. The pillow slip should be of 
 linen texture. 
 
 During the winter a folded soft blanket over the rubber 
 sheet increases both softness and warmth. No top sheet is used 
 during the first months, particularly if the first months are the 
 winter months. The baby is wrapped loosely in a light weight 
 clean blanket or shawl, and other blankets — as many as the 
 season demands are tucked about the child. These blankets 
 should be aired daily, and the one next to the baby changed, 
 aired, or washed very often. 
 
THE NURSERY 
 
 117 
 
 Fig. 7. Making the Sleeping Blanket 
 
n8 THE MOTHER AND HER CHILD 
 
 THE SLEEPING BLANKET 
 
 To prevent baby from becoming uncovered the sleeping 
 blanket has been devised. The blanket is folded and stitched 
 in such a way as completely to envelop the sleeping babe, and 
 at the same time afford the utmost freedom (Fig. 7). The 
 babe may turn as often as he desires, but cannot possibly 
 uncover himself. Bed clothes fasteners are also used — an 
 elastic tape being securely fastened to the head posts and 
 then by means of clamps or safety pins attachment is made to 
 the blankets on either side. The elasticity allows considerable 
 freedom to the child in turning (See Fig. 8). 
 
 NURSERY HEATING AND VENTILATION 
 
 The subject of ventilation has been so fully discussed by the 
 authors in another work that we refer the reader to The Science 
 of Living, or the Art of Keeping Well. 
 
 For the first two or three weeks the nursery temperature 
 should be maintained at seventy degrees Fahrenheit by day 
 and from sixty degrees to sixty-five degrees by night. In the 
 third week the day temperature should be sixty-eight degrees 
 Fahrenheit measured by a thermometer hanging three feet 
 from the floor. After three months the night temperature may 
 go as low as fifty-five degrees Fahrenheit, and after the first 
 year it may go as low as forty-five degrees. 
 
 The heating of the nursery is usually controlled by the gen- 
 eral heating plant, and no matter what system of heating is 
 maintained, humidifiers must be used, the necessity for which 
 is doubled when the system is that of the hot-air furnace. 
 
 These shallow pans of water with large wick evaporating 
 surfaces will evaporate from three to four quarts during the 
 twenty-four hours. The humidity should be fifty throughout 
 the seasons of artificial heating. 
 
 Many colds may be entirely avoided by the use of humidifiers 
 or evaporators. The open grate is one of the very best means 
 of nursery heating. Gas and oil heaters should not be depended 
 upon for nursery heat. Only in an emergency should they be 
 used at all, and the electric heater is by far the best device 
 for such occasions. 
 
Fig. 8. In the Sleeping Blanket 
 
THE NURSERY 119 
 
 baby's corner in mother's room 
 It is probably a conservative estimate to say that ninety-five 
 per cent of all the babies occupy a corner of mother's and 
 father's bedroom for the first two or three years. And believ- 
 ing this estimate to be correct, it is advisable to give the matter 
 some consideration. To begin with, a lot of the non-essentials, 
 ruffles and fluffles of the average bedroom, must go. The good 
 father's chiffonier may have to be put in the bath room; heavy 
 floor coverings must be discarded, to be replaced by one or two 
 small, light-weight rugs; wall decorations and the usual bric-a- 
 brac of dressers, tables, etc., should be carefully packed away. 
 In fact, there should be nothing in the room save the parents' 
 bed, dresser (several drawers of which must be devoted to 
 baby's necessities), table, low rocker, a stool, baby's bed and a 
 good big generous screen, made out of a large clothes horse 
 enameled white and filled with washable Swiss. 
 
 Window draperies must be taken down and packed away, while 
 they are replaced with simple muslin which can go to the 
 laundry twice a month. If it be within the means of the family 
 purse, it is well to renovate the walls just prior to the advent 
 of the little stranger. 
 
 And now the baby's bed is placed in the corner most pro- 
 tected from draughts and the glare of the sunlight. If it can 
 be so arranged that baby looks away from the light, and not at 
 it, we are guarding it from defective vision in the future. 
 
 crib substitutes 
 
 Many a beautiful artistic creation so much admired in this 
 world is found to be, on closer inspection, a very ordinary thing 
 whicfi has received an artistic touch; and so, many convenient, 
 sanitary, and beautiful cribs are fashioned from market baskets 
 fastened to tops of small tables whose legs are sawed off a 
 bit; from soap boxes fastened to a frame, and from clothes 
 baskets. A can of white enamel, a paint brush and the deft 
 hand of a merry, cheery-hearted expectant mother can work 
 almost miracles. Remember, please, that all draperies must be 
 washable and attached with thumb tacks so as to admit of 
 easy and frequent visits to the laundry. 
 
120 THE MOTHER AND HER CHILD 
 
 A medium-sized clothes basket will take care of our baby 
 for four or five months. The same general plan for the mat- 
 tress and bedding is followed as before described. 
 
 EXTRA HEAT TO THE CRIB 
 
 If necessary — and it usually is, especially during the winter 
 months — a hot-water bottle may be placed underneath the 
 bedding on top of the mattress. This insures a steady, mild, 
 uniform warmth and it not only saves the baby from the danger 
 of being burned, but it also obviates the temporary overheating 
 of the child which usually occurs when the bottle is placed 
 inside the bed, next to the baby. If the bed is properly made 
 — the blankets coming from under the babe up and over — 
 there is little or no need for extra heat for well babies after 
 the first month. 
 
 LIGHTING BABY'S ROOM 
 
 If electric lighting is not an equipment of the home neither 
 gas or oil lamps should be allowed to burn in the room for 
 long periods. For emergency night lighting a well-protected 
 wax candle should be used. However, don't go to sleep and 
 allow a candle to burn unprotected as did one tired, exhausted 
 mother. The father, suddenly aroused from his sleep, saw a 
 large flame caused by the overturning of a wax candle into 
 a box of candles, while the lace drapery of the basinet was within 
 a few inches of the flame and the baby just beyond. Grabbing a 
 pillow he smothered the flames and saved baby and all. 
 
 FRESH AIR 
 
 Plenty of fresh air and lots of sunshine should enter baby's 
 room. The large screen amply shields from draughts, and when 
 thus protected there need be no unnecessary concern about 
 cool fresh air, especially after two or three months, as it is 
 invigorating and prevents " catching cold." Warm, stuffy air 
 is devitalizing and even during the early weeks when the 
 fresh air must be warm, an electric fan should be advantageously 
 placed so that many times each day the warm fresh air may 
 be put in motion without creating a harmful draught. 
 
THE NURSERY 121 
 
 Warm stuffy air makes babies liable to catch cold when taken 
 out into the open. 
 
 Throw open the windows several times each day and com- 
 pletely change the air of baby's room. In the absence of the 
 large screen, a wooden board five or six inches high is fitted 
 into the opening made by raising the lower window sash. Then 
 as the upper sash is lowered the impure air readily escapes while 
 fresh air is admitted. 
 
 THE BATH EQUIPMENT 
 
 Make early preparations for bathing the baby in the easiest 
 possible manner ; in fact, the young mother should seek to attend 
 to all her duties — the family, the home, and the baby — in the 
 easiest way. For the administration of a bath during the 
 early months, a table is needed, protected by oilcloth on which 
 is placed a roomy bathtub with a folded turkish towel on the 
 bottom for baby to sit on. In addition to the tub, have : 
 
 An enameled pitcher for extra A medicine dropper for washing 
 
 supply of warm water. baby's eyes. 
 
 A small cup for boracic acid Talcum powder. 
 
 solution. Oil or vaseline. 
 
 Castile soap. Sterile cotton. 
 
 A soft wash cloth. Tooth picks. 
 
 Several warmed soft towels. A needle and thread for sewing 
 
 A bath thermometer. on the band. 
 
 All of the clean clothing needed. 
 
 See that the bathtub is clean and enamel unbroken, and if 
 it has been used by another babe, freshen it with a coat of 
 special enamel sold for that purpose. 
 
 BATH TEMPERATURES 
 
 During the first eight weeks Temperature 100 F. 
 
 From two to six months Temperature 98 F. 
 
 From six to twenty-four months 
 
 Temperature 90 — 97 F. 
 
 A bath at ninety-eight degrees is a neutral bath, and after the 
 baby is six months and over, the bath may be given at this tem- 
 perature, and at the close quickly cooled to ninety degrees. 
 
122 THE MOTHER AND HER CHILD 
 
 NURSERY CLEANLINESS 
 
 The nursery should furnish the baby's first protection from 
 contagious diseases. It must be a veritable haven of safety. There- 
 fore, no house work of any kind should be done in the room, such 
 as washing or drying the baby's clothes. The floors and the fur- 
 niture should be wiped daily with damp cloths. A dry cloth or 
 feather duster should never be used to scatter dust around the room. 
 
 All bedding and rugs should receive their daily shaking and 
 airing out of doors, remembering that particles of dust are 
 veritable airships for the transportation of germs. In every 
 way possible avoid raising a dust. So much of the lint which 
 commonly comes from blankets may be avoided with the 
 daily shaking out of doors. 
 
 Soiled diapers should not accumulate in a corner or on the 
 radiator; their removal should be immediate, and if they must 
 await a more opportune time, soak them in a receptacle filled 
 with cold water. Even those diapers slightly wetted should 
 never be merely dried and used again, but should be properly 
 washed and dried. No washing soda should be used in the 
 cleansing of diapers — just an ordinary white soap, a good boil, 
 and plenty of rinse water, with drying in the sun if possible. 
 They require no ironing. Hands that come in contact with 
 soiled or wet diapers must be thoroughly cleansed before caring 
 for the baby or preparing his food. 
 
 As before mentioned, and it will bear repetition often, all 
 windows and doors must be well screened, for flies and mos- 
 quitoes are dreaded foes in any community and in babyland in 
 particular. All used bottles and nipples as well as used cups, 
 pitchers, bits of used cotton, should be removed at once. The 
 washcloth is a splendid harbinger of germs. There should be 
 one for the face, and one for the body and bath, and both 
 should receive tri-weekly boiling. Bath towels should not be 
 used more than twice, better only once. 
 
 The technic of bathing, together with the location, furnish- 
 ings, and cleanliness of the baby's sick room, will be taken up 
 in later chapters. 
 
CHAPTER XIV 
 WHY BABIES CRY 
 
 IT is surprising how soon even a young and inexperienced 
 mother will learn to distinguish between the pain cry and 
 the plain cry of her baby; for most crying can easily be traced 
 to some physical discomfort which can be relieved, or to some 
 phase of spoiling and indulgence which can be stopped. 
 
 NORMAL HEALTHY CRYING 
 
 The young baby can neither walk, talk nor engage in gym- 
 nastics, except to indulge in those splendid physical exercises 
 connected with a good hearty cry. To be good and healthy, 
 an aggregate of an hour a day should be spent in loud and 
 lusty crying. He should be allowed to kick, throw his arms 
 in the air and get red in the face; for such gymnastics expand 
 the lungs, increase general circulation and promote the general 
 well-being of the normal child. As the child grows older and 
 is able to engage in muscular efforts of various sorts, these 
 " crying exercises " should naturally decrease in frequency 
 and severity. When baby cries, see that the abdominal band 
 is properly applied, that rupture need not be feared. 
 
 THE BIRTH CRY 
 
 The sound most welcomed by both doctor and nurse is the 
 cry of the newly born child, for it shows that the inactive lungs 
 have opened up and the baby has begun to use them, for all 
 the time baby was living in the uterine room he did not 
 breathe once, the lungs having been in a constant state of 
 collapse; and not until now, the very moment the air comes 
 in contact with his skin, do the lungs begin to functionate as 
 he emits his first lusty holler. 
 
 123 
 
124 THE MOTHER AND HER CHILD 
 
 ABNORMAL CRYING 
 
 The cry is said to be abnormal when it continues too long 
 or occurs too often. It may be strong and continuous, quieting- 
 down when he is approached or taken up ; or it may be a worry- 
 ing, fretful cry, a low moan or a feeble whine. And now as 
 we take up the several cries, their description, cause, and 
 treatment, we desire to say to the young mother: Do not 
 yourself begin to fret and worry about deciding just which 
 class your baby's cry belongs to ; for help, knowledge, and wis- 
 dom come to every anxious mother who desires to learn and 
 who is willing to be taught by observation and experience. 
 
 THE HUNGER CRY 
 
 The continuous, fretful cry, accompanied by vigorous suck- 
 ing of the fists, both of which stop when hunger has been 
 satisfied, is without question the hunger cry. 
 
 If this cry is constant with regular feedings, then the quan- 
 tity of the food must be increased, or the quality improved. 
 The tired, fretful hunger cry must not be neglected; the cause 
 must be removed, for it points to malnutrition. 
 
 THE CRY OF THIRST 
 
 One day when lecturing at an Iowa chautauqua, I remained 
 in the beautiful park for the noonday meal. It was a warm 
 day and the tables in the well-screened dining tent were filled 
 with mothers who, like myself, preferred the cool shade of 
 the park to the hot ride through the city to the home or hotel 
 dinner. At my table a baby was pitifully crying. The mother 
 had offered the little child seated in a small uncomfortable 
 go-cart, milk, bread, and a piece of cake — all of which were 
 ruthlessly pushed aside. My little son, then only four and a 
 half, said " Mamma, maybe the baby's thirsty," and up he 
 jumped, hurried to the mother's side with his glass of water, 
 saying, " I haven't touched it, maybe the baby's thirsty." The 
 mother brushed the boy aside, saying, " No, I never give the 
 baby water." In spite of the mother's remonstrance, the baby 
 cried on and on, and finally on " trying " the water, the child 
 drank fully one-half the glass and the crying was hushed. 
 
WHY BABIES CRY 125 
 
 Babies should be given water regularly — many times every 
 day — from birth, in varying amounts from two teaspoons 
 to one-half cup, according to the age of the child. The water 
 should be boiled for the first few months, and longer if there is 
 any suspicion of impurities. 
 
 Milk to the nursing infant is like beefsteak and potatoes to 
 the adult; and many times the milk bottle or the breast is just 
 as nauseating to the thirsty babe, as meat would be to the very 
 thirsty adult whose hunger has previously been fully satisfied. 
 
 THE FRETFUL CRY 
 
 The babe who is wet, soiled, too hot, or is wrapped too 
 tightly, or who has on a tight, uncomfortable belly band, or 
 whose clothing is full of wrinkles, has only one way to tell 
 us of his discomfort, and that is to cry. It is a fretful cry and 
 should command an immediate investigation as to the possible 
 cause. It takes but a moment to discover a wet diaper; to run 
 the hand up the back under the clothes ; to sprinkle with talcum 
 if perspiring; to straighten out the wrinkled clothing; to find 
 the unfastened pin that pricks; or to loosen the tight band. 
 Acquire the art of learning to perform these simple tasks easily, 
 and any or all of these services should be rendered without 
 taking the child from its bed. 
 
 Let the child early learn to rest happily and quietly in his 
 own bed. The pillow or mattress may be turned or perhaps 
 the mattress be raised nearer the edge of the basinet. One 
 poor youngster instantly stopped his fretful cry when his mat- 
 tress was raised four or five inches so he could get the air, at 
 the same time taking him out of his hot room to a cooler room 
 with raised windows. Babies like cold air. They cry when the 
 air is hot, or even warm and close. Every day — rain or 
 shine, wind or sleet — ■ babies should nap out of doors on the 
 porch, in a well-sheltered corner. A screen or a blanket protects 
 from the wind, sleet, or rain; and if the baby's finger tips are 
 warm, you can rest assured the feet and body are warm. Scores 
 of babies will sleep out on the porch, on the protected fire escape, 
 or in a room with opened windows, from one bottle or feeding 
 to another; being aroused at the end of the three or four hour 
 
126 THE MOTHER AND HER CHILD 
 
 interval just enough to nurse, when back they go to their 
 delightful, warm nest in the cool, fresh air to sleep for another 
 period. Babies should never sleep in a room with closed 
 windows. 
 
 One of the incidents that surprised me most in my early 
 work with dispensary babies was the utter misconception of the 
 purpose of the belly band. Invariably it was put on so tightly 
 that I could not slip a finger between it and the babe. It is 
 not a surgical instrument, neither is it a truss. These tight 
 belly bands are a source of much fretting and crying. 
 
 THE PAIN CRY 
 
 The little pinched look about the face, the drawing up of the 
 legs, the jerking of the head, arms, or legs, associated with a 
 strong, sharp, unceasing or intermittent cry, demands imme- 
 diate attention. Our first work should be to go about quietly, 
 painstakingly, and systematically to locate the cause of this 
 " cry of pain." 
 
 There are often some accompanying symptoms to the cry 
 of pain which demand skilled medical advice and attention, 
 such as the arching of the body backward, the drawing of the 
 head strongly to one side, the inability to use one side of the 
 body, or the presence of fever. There may be an earache, an 
 abdominal complication, or a sore throat, any one of which will 
 be detected by the skilled doctor. 
 
 Earache frequently occurs in young babies who have been 
 taken out of doors without proper protection to the ears; or, 
 it may be associated with a cold in the head, which is not 
 detected until the mischief has already been done, while the 
 resulting running ear tells the tale of woeful suffering. Ear- 
 ache must always be thought of as a possible cause when the 
 cry of pain accompanies a cold in the head, and if medical aid 
 is secured early, the abscess may be aborted and the deafness 
 of later years entirely avoided. There is only one home remedy 
 for earache, and that is the application of external heat, either 
 by a hot-water bottle or hot-salt bag. Medical advice should 
 be sought before anything whatsoever is dropped into the baby's 
 ear. 
 
WHY BABIES CRY 127 
 
 In this connection should be mentioned the wild cry at night 
 which so often accompanies tuberculosis of the bone. A care- 
 ful X-Ray examination will reveal the disease, and proper 
 medical measures should be instituted at once. Other fretful 
 night crying will be mentioned further on. 
 
 HABIT CRYING 
 
 By the frequent repetition of actions, habits are formed. 
 When the baby is two or three days old, he is so new to us 
 and we have waited for him so long, and it is such a great 
 big world that he has come into, that we jump, dance, and 
 scramble to attend to his every need and adequately to provide 
 for his every want. At this very early, tender age whenever 
 he opens his mouth to cry or even murmur — some fond auntie 
 or some overly indulgent caretaker flies to his side as if she 
 had been shot out of a gun, grabs him up and ootsey tootsey's 
 him about as she endeavors to entertain and quiet him. The 
 next time and the next time and the succeeding time he whim- 
 pers — like a flash someone dashes to the side of the basket, 
 and baby soon learns that when he opens his mouth and yells, 
 somebody comes. In less than a week the mischief has been 
 done and baby is badly spoiled. No other factor enters so 
 largely into the sure " spoiled " harvest as picking a new baby 
 up every time he cries. Often in the early days some indulgent 
 parent will say, " Oh, don't turn out the light, something might 
 happen to the dear little thing" — and old Mother Nature sees 
 to it that a constant repetition of " leaving the light on " brings 
 its sure harvest of " he just won't go to sleep without the light." 
 And then, " just once " he had the pacifier — perhaps to prevent 
 his crying disturbing some sick member of the family — and so 
 we go on and on. If a thing is bad, it is bad, and a supposedly 
 good excuse will not lessen the evil when the habit has been thus 
 started and acquired. 
 
 The rocking of babies to sleep may be a beautiful portrayal 
 of mother love, but we all pity the child who has to be rocked 
 to sleep as much as we do the mother who sits and rocks, want- 
 ing, Oh, so much ! to do some work or go for a walk — but 
 she must wait till baby goes to sleep. 
 
128 THE MOTHER AND HER CHILD 
 
 THE TEMPER CRY 
 
 And so now we come to the temper cry — that lusty, strong 
 outburst of the cry of disappointment when he finds that all of 
 a sudden people have stopped jumping and dancing for his 
 every whim. The baby is not to blame. We began something 
 we could not keep up. and he — the innocent recipient of all 
 our indulgences — is in no sense at fault. It is most cruel to 
 encourage these habits of petty indulgence, which must cause 
 so much future disappointment and suffering on the part of the 
 little fellow as he begins to grow up. 
 
 Nobody is particularly attracted to the spoiled baby. After 
 the over-indulgent parent and caretaker have completed their 
 thoughtless work, they themselves are ashamed of it and not 
 infrequently begin to criticise the product of their own making 
 — the formation of these unpleasant bad habits. More than 
 anything else, the spoiled child needs a new environment, new 
 parents, and a new life. 
 
 THE SPOILED BABY 
 
 Seek to find out if possible — and it usually is possible — just 
 what he is crying for. It may be for the pacifier, for the light, 
 or to be rocked, jolted, carried, taken up and rocked at night, 
 or a host of other trifles; and if he is immediately hushed on 
 getting his soul's desire — then we know he is " spoiled." 
 
 The unfortunate thing about it all is that the one who has 
 indulged and spoiled the baby usually does not possess the 
 requisite nerve, grit, and will power to carry out the necessary 
 program for baby's cure. And the pity of it all is that over- 
 indulgence in babyhood so often means wrecked nerves and 
 shattered happiness in later life. So, fond, indulgent parents, 
 do your offspring the very great kindness to fight it out with 
 them while they are young, even if it takes all summer, and 
 thus spare them neurasthenia, hysteria, and a host of other 
 evils in later life. 
 
 This sort of " spoiled baby crying " can be stopped only 
 through stern discipline — simply let the baby " cry it out." 
 The first lesson may require anywhere from thirty minutes to 
 an hour and thirty minutes. The second lesson requires a much 
 
WHY BABIES CRY 129 
 
 shorter time, and, in normal babies with a balanced nervous 
 system, a third or fourth lesson is not usually required. 
 
 THE CRY OF SERIOUS ILLNESS 
 
 The cry of the severely sick child is the saddest cry of all. 
 The low wail or moan strikes terror to the saddened mother- 
 heart. It is often moaned out when the child is ill with " sum- 
 mer complaint " or other intestinal disturbances. Instant help 
 must be secured, and, if medical help is not obtainable, remem- 
 ber, with but one or two exceptions, you are safe in carefully 
 washing out the bowels, in applying external heat and giving 
 warmed, boiled water to drink. 
 
 Another cry which demands immediate attention, and the 
 faithful carrying out of the doctor's orders, is the hoarse, 
 " throaty " cry indicative of croup or bronchitis. 
 
 THE COLICKY CRY 
 
 Perhaps the greatest cause of the most crying during infancy, 
 next to that of over-indulgence, is ordinary colic which — 
 
 . . . manifests itself in every degree of disturbance from mere 
 peevishness and fretfulness to severe and intensely painful attacks 
 in which restlessness passes into grunting, writhing, and kicking; 
 the forehead becomes puckered and the face has an agonized 
 expression ; the baby tends to scream violently and draws his 
 thighs up against his belly, which will usually be found to be hard 
 and more or less distended. 
 
 A colicky baby completely upsets the household and greatly 
 disturbs the mother, who requires both quiet and rest that she 
 may the better produce the life-sustaining stream so much 
 needed for the upbuilding and development of the growing 
 child. 
 
 COLIC IN THE BREAST-FED 
 
 While colic is so often seen in the bottle-fed babe, it often 
 occurs in the breast-fed child, and is usually traceable to some 
 error in the mother's diet or to some other maternal nutritional 
 disturbance. One mother who was sure she had eaten nothing 
 outside the diet suggestions she had received, was requested to 
 
130 THE MOTHER AND HER CHILD 
 
 bring to the office a fresh voiding of her own urine which was 
 found to be highly acid. The administration of an alkaline 
 such as simple baking soda or calcined magnesia to the mother, 
 corrected this acidity, and the colic in the baby entirely dis- 
 appeared. I recall the case of one mother who ate her dinner 
 in the middle of the day, with a light meal in the evening and 
 thereby stopped the colic in her babe. 
 
 Another source of colic in the breast-fed baby is the unclean 
 nipple. The nipples should be washed with soap and water 
 and rinsed in boracic acid solution before each nursing. If 
 the mother worries greatly, or thoughtlessly " gets very angry " 
 just before the nursing hour, there is a substance known as 
 " epinephrin " secreted by the glands located just above the 
 kidneys which is thrown into the blood stream and which raises 
 the blood pressure of the mother and often produces not only 
 colic in the babe, but many times throws him into severe con- 
 vulsions. 
 
 COLIC IN BOTTLE-FED BABIES 
 
 There are many opportunities for colic in the bottle-fed baby ; 
 for instance, dirty bottles, dirty nipples, careless cleansing of 
 utensils used in the preparation of baby's food, improper mix- 
 tures, too much flour, the wrong kind of sugar, too much cream 
 or too little water — all these things help to produce wind under 
 pressure in the intestine, which is commonly known as colic. 
 Underfeeding or overfeeding, too rapid feeding or too frequent 
 feeding also contribute their mite in producing colic. 
 
 As a rule, the bottle-fed child is fed too often. In the new 
 born, the interval between feeds should be three hours from 
 the start; after six months the interval may be lengthened to 
 four hours. 
 
 COLIC AND CHILLINESS 
 
 Hiccough — a spasm of the diaphragm — often accompanies 
 colic, and, in the case of infants, is usually due to the swallow- 
 ing of air or over-filling the stomach ; gentle massage, external 
 heat, and a few sips of very warm water usually corrects the 
 condition. 
 
WHY BABIES CRY 131 
 
 The chilling of the skin very often produces a temporary 
 intestinal congestion with colic as the result. Cold feet, wet 
 diapers, and loitering at bath are all very likely to produce colic; 
 and when it is thus caused by chilling, quickly prepare a bath 
 at 100 R, and after immersing the child for five minutes, wrap 
 up well in warm blankets. 
 
 THE TREATMENT OF COLIC 
 
 Those of my mother readers who have electric lights in their 
 home, will find the photophore to be a source of great comfort 
 and convenience; for this simple contrivance is usually able 
 to banish colic in a few moments. The photophore is simply 
 radiant heat — heat plus light (See Fig. 3) — and as this heat is 
 applied to legs and buttocks of the crying child the diaper is 
 warmed, the abdomen relaxes, gas is expelled, intestinal con- 
 tractions relieved, and the baby is soon fast asleep. 
 
 Occasionally with the aid of the photophore, and even without 
 it, the warm two-ounce enema containing a level teaspoon 
 of baking soda and a level teaspoon of salt to a pint of water 
 when allowed to flow into the bowel, will soon bring down 
 both gas and feces to the great relief of the baby. Warm water 
 to drink is also very helpful. Putting the feet in very warm 
 water is also quieting to the crying colicky babe. 
 
 It is often necessary in cases of repeated and persistent colic, 
 to give a full dose of castor oil to clear out the bowel tract. 
 Do not jolt or bounce the baby, do not carry him about, and 
 don't walk the floor with him. 
 
 Heat him up inside and outside, warm his clothing and his 
 bedding, and thus bring about relief without sowing seeds for 
 future trouble — the sorrow of a spoiled child. 
 
 One very quiet little baby was one day brought to the dis- 
 pensary whose mother said : " Doctor, I didn't bring him 'cause 
 he's sick, but 'cause he looks so pale ; he's as quiet as a mouse ; 
 he never cries any more since I got to giving him medicine." 
 On examination of the baby and on inquiring about the medicine, 
 we found that the baby was dead drunk all the time. Some 
 " neighbor friend " had told the tired out mother, " Give him a 
 teaspoon of whiskey at each feeding and that'll fix him all 
 
132 
 
 THE MOTHER AND HER CHILD 
 
 right." If a few more states go dry maybe it will not be so 
 easy for the ignorant mother to dope and drug her helpless 
 baby. 
 
 And neither is paregoric to be administered wholesale for 
 colic. It contains an opiate, and should not be given without 
 definite orders from a physician. And so as a parting word on 
 " Why Babies Cry," we ask each mother to run over the follow- 
 ing summary of the chapter, and thus seek to find out why 
 her baby cries. 
 
 BABY CRIES BECAUSE I 
 
 He is hungry. 
 
 He is thirsty. 
 
 He has been given a dirty bottle. 
 
 His mother has failed properly 
 
 to cleanse the nipples. 
 His food is not prepared right. 
 His food is too cold. 
 His bowels are constipated. 
 His band is too tight. 
 His clothes are wrinkled. 
 His diaper is wet. 
 He is too hot. 
 He wants fresh air. 
 
 He is too cold. 
 
 He is in pain. 
 
 He is very sick. 
 
 His throat is sore. 
 
 His ear aches. 
 
 He has been rocked, carried, or 
 bounced. 
 
 He has been given a pacifier. 
 
 He has had too much excite- 
 ment. 
 
 His mother has eaten the wrong 
 food. 
 
CHAPTER XV 
 THE NURSING MOTHER AND HER BABE 
 
 HAPPY is the mother, and thrice blessed is the babe when 
 he is able to enjoy the supreme benefits of maternal nurs- 
 ing. The benefits to the child are far reaching; he stands a better 
 chance of escaping many infantile diseases; the whole outlook 
 for health — and even life itself — is greatly improved in the 
 case of the nursing babe, as compared with the prospect of the 
 bottle-fed child. Maternal nursing lays the foundation for 
 sturdy manhood and womanhood. 
 
 Out of every one hundred bottle-fed babies, an average of 
 thirty die during the first year, while of the breast-fed babies, 
 only about seven out of every one hundred die the first year. 
 At the same time, nursing the babe delivers the mother from all 
 the work and anxiety connected with the preparation of the 
 artificial food, the dangers and risks of unclean milk, and the 
 ever-present fear of disease attendant upon this unnatural feed- 
 ing. The mother who nurses her child can look forward to a 
 year of joy and happiness; whereas, if the babe is weaned, she 
 is compelled to view this first year with many fears and fore- 
 bodings. Mother's milk contains every element necessary for 
 the growth and development of the child, and contains them 
 in just the proportions required to adapt it as the ideal food 
 for that particular child. 
 
 A dirty baby, properly fed, will thrive. A baby deprived of 
 fresh air, but wisely fed, will survive and even develop into a strong 
 healthy man or woman. But the baby raised according to the latest 
 and most approved rules of sanitation and hygiene, if improperly 
 fed, will languish and die. 
 
 133 
 
134 THE MOTHER AND HER CHILD 
 
 HYGIENE OF NURSING MOTHERS 
 
 Outings and Exercise. It is most highly important that the 
 nursing mother should be able thoroughly to digest her food; 
 otherwise the flow of milk is likely to contain irritants that 
 will disturb the baby's digestion, even to the point of making 
 him really sick. In order to avoid these complications, exercise 
 and outings are absolutely essential for the mother. A vigorous 
 walk, gardening, light housework or other light athletics, 
 greatly facilitate digestion and increase the bodily circulation, 
 as well as promote deep breathing, all of which are of paramount 
 importance to a good appetite and good digestion. 
 
 The Bowels. The bowels should move regularly and normally 
 once or twice during the twenty-four hours. Unfortunately, 
 this is not usually the case; and in this connection we would 
 refer our reader to the chapter on " The Hygiene of Preg- 
 nancy," particularly those sections relative to the care of the 
 bowels, recipes for bran bread, lists of laxative foods and other 
 suggestions pertaining to the hygiene of the nursing mother. 
 
 Sleep. Nothing less than eight hours sleep will suffice for 
 the nursing mother, and during the day she should take at least 
 one nap with the baby. 
 
 Care of the Skin. Salt-rub baths are very beneficial taken 
 once a week. The daily cold-friction rub described elsewhere, 
 will tone up the system and increase digestion and improve the 
 general well being. The soap wash may be taken once a week. 
 The thorough cleansing of the breasts, and the frequent chang- 
 ing of the undergarments, will help to keep the baby happy; 
 for oftentimes it is the odor of perspiration as well as the smell 
 of soiled clothing that spoils the appetite of the baby, causing 
 it to refuse food. 
 
 Recreation. Pleasant diversion is very essential for the 
 mother, and should be indulged in at least once a week. The 
 bedtime hours, however, should not be interfered with and the 
 recreation should be selected with a view to amuse, refresh 
 and create a harmless diversion for the mother's mind. Under 
 no circumstances should the mother settle down to the thought : 
 " No, I can't go out any more. I can't leave my baby." You 
 
THE NURSING MOTHER AND HER BABE 135 
 
 should get away from the baby a short time each day, and 
 go out among your former friends and acquaintances. Many 
 a wrecked home — a shattered domestic heaven — dates its 
 beginnings back to the days when the over-anxious young 
 mother turned her back on her husband and looked only into 
 the face of her (their) child. Nothing should come in between 
 the filial friendship of husband and wife, not even their child. 
 So, dear mother, if you can, go out occasionally, away from the 
 baby, and enjoy the association of your husband and keep in 
 touch not only with his interests, but with the outside world. 
 You will come back refreshed and wonderfully repaid, and the 
 face of the adored infant will appear more beautiful than ever. 
 
 DIET OF THE NURSING MOTHER 
 
 The general suggestions on diet which we made to the ex- 
 pectant mother are also valuable for the nursing mother. The 
 food should be appetizing, nutritious, and of a laxative nature. 
 Three meals should be eaten : one at seven a. m., one at one p. m. 
 and one about six-thirty at night, with the heaviest meal usually 
 at one p. m. As the mother usually wakens at five o'clock, or 
 possibly earlier, she should be given a glass of milk, cocoa, or 
 eggnog. If she awakens at six, nothing should be taken until 
 the breakfast, which should consist of a good nourishing meal, 
 such as baked potatoes with white sauce, poached eggs, cereal, 
 milk or cocoa, prunes, figs, or a baked sweet apple, with bread 
 and butter, etc. 
 
 From that hour until one p. m. only water is taken, and several 
 glasses are urged during this interval. With nothing between 
 meals but water and a little outdoor exercise, a good appetite 
 is created for the one p. m. meal which should abundantly 
 supply and satisfy the hungry mother; and then again, nothing 
 is to be taken between dinner and supper but water. And after 
 the supper hour, a walk out into the cool night air should be 
 enjoyed with the husband and on going to bed about ten p. m., 
 an eggnog or glass of milk may be taken. At the close of the 
 other meals a cup of oatmeal gruel or milk or any other nourish- 
 ing liquid may be enjoyed. 
 
 The eating of food or the drinking of nourishing drinks 
 
136 THE MOTHER AND HER CHILD 
 
 between the meals not only interferes with digestion and dis- 
 turbs the mother, but it also upsets the baby; and it is often 
 the reason why the appetite of the mother is so deranged at 
 the meal time, her spirits depressed, and her milk diminished. 
 Plenty of good nourishing food, taken three times a day with an 
 abundance of water drinking between the meals, together with 
 ? free happy frame of mind occasioned by the recreation before 
 mentioned, usually produces good milk and plenty of it. A nap 
 between meals will probably produce more milk than eating 
 between meals. 
 
 OBJECTIONABLE FOODS 
 
 All foods that cause indigestion in the mother or babe should 
 be avoided. 
 
 Some mothers continue to eat tomatoes, peaches, sour salads, 
 acid fruits, and it appears in no way to interfere with baby's 
 comfort; but they are the exception rather than the rule. 
 Usually tomatoes, acid salad dressings, and mixed desserts must 
 be avoided. Each mother is a law unto herself. Certainly 
 none of our readers will selfishly continue any food she feels 
 will make her baby cry. All acid fruits, rich desserts, certain 
 coarse vegetables, concoctions of all descriptions such as rare- 
 bit, condiments, highly seasoned sauce, etc., should be avoided. 
 
 Acid fruitades, such as lemonade, limeade and orangeade, can 
 be taken by a small per cent of nursing mothers ; and, since 
 fruit acids are neutralized and alkalized in the process of diges- 
 tion and assimilation, and since they are the very fruit-drinks 
 we prescribe for patients suffering with an increased acidity, 
 it would appear that they were in every way wholesome for the 
 mother — if they in no way interfere with the baby. Prac- 
 tically, they do as a rule disturb the baby's digestion and should 
 be avoided by those mothers who have found this to be the 
 case. 
 
 CAKED BREASTS 
 
 During the first week of lactation the milk tubes of the 
 breasts very often become blocked and the breasts become en- 
 gored with milk, this condition being known as " caked 
 
THE NURSING MOTHER AND HER BABE 137 
 
 breasts." At this particular time of the baby's life, he takes 
 little more than an ounce of milk at a feed; so, beside the in- 
 coming engorgement of milk, an additional burden is thrown 
 upon the milk tubes of the breasts in that they are not entirely 
 emptied each nursing time by the young infant. When the 
 breasts threaten to " cake," immediate steps must be taken to 
 relieve the condition — to empty the breasts — and this is 
 usually accomplished in the following manner: with hands well 
 lubricated with sweet oil or olive oil the nurse begins gentle 
 manipulation of the breasts toward the nipple in circular strokes, 
 with the result that the milk soon begins to ooze out. This 
 massage should be continued until relief is obtained; or the 
 breast pump may be applied. Hard nodules should not be 
 allowed to form or to remain in the breasts. Hot compresses 
 (wrung from boiling water by means of a "potato ricer") 
 may be applied to the caked breast which is protected from the 
 immediate heat by one thickness of a dry blanket flannel. These 
 hot compresses should be removed every three minutes until 
 three have been applied, then an ice water compress is quickly 
 applied, to be followed by more hot ones and then a cold; 
 and so on, until as many as four sets each have been admin- 
 istered. 
 
 Gentle massage may again be administered and it will be found 
 that they empty now with greater ease because of the preceding 
 heat. After the breasts have been emptied, and thoroughly 
 washed with soap suds and carefully dried, they should be 
 thickly covered with cotton batting and firmly compressed 
 against the chest wall by a snug-fitted breast binder, which 
 serves the double purpose of relieving pain by not allowing the 
 breasts to sag downward, at the same time preventing an over- 
 abundant secretion of milk by diminishing the blood supply to 
 the glands of the breast. In case the persistent manipulation 
 of the breast and the use of the breast pump do not relieve the 
 condition, and if the repeated effort day after day seems to 
 avail nothing; then, as a rule, we must look for a breast abscess 
 to follow if the breasts are not immediately " dried up." In all 
 such cases of engorgement, the attending physician should be 
 notified at once. 
 
138 THE MOTHER AND HER CHILD 
 
 SORE NIPPLES 
 
 The nipple must be kept dry between nursings, which should 
 be limited to twenty minutes. Regularity should be main- 
 tained. The nipples should never be touched or handled by 
 hands that have not been scrubbed with soap and a nail brush. 
 During the early nursing days they are wet much of the time 
 and are subject to much stress and strain in the " pulling effort " 
 of the baby, as a result of which they become very tender, 
 chapped, cracked, and often bleed. Allowing the baby to go to 
 sleep with the nipple in his mouth also exposes the nipple to 
 unnecessary moisture which increases the possibility of painful 
 cracking. The pain occasioned by nursing at this time is truly 
 indescribable, and is most often the cause of absolute refusal 
 on the part of the mother to nurse her babe — with the result 
 that it is put on the bottle. Again, the fear and dread of being 
 hurt so often tends to diminish the flow of milk. It is entirely 
 possible so to prepare the nipple for this exposure, during the 
 last months of pregnancy, that all this discomfort and pain may 
 be entirely avoided (See chapter, "The Hygiene of Preg- 
 nancy "). 
 
 Before the mother is put to rest after the birth of the baby 
 the breasts are prepared as follows : A thorough cleansing 
 with soap and water is followed by a careful disinfection with 
 alcohol which leaves the nipple perfectly dry. A soft sterile 
 pad is then applied and held in place by a breast binder. Before 
 and after each nursing the nipple and surrounding area is 
 swabbed with boracic acid (saturated solution) and carefully 
 dried by applying a clean, dry, sterile pad. 
 
 Painful cracks and fissures are nearly always due to lack of 
 the care described above, and are almost wholly preventable. 
 When the first crack appears and nursing becomes painful, the 
 baby's mouth should not touch the nipple again until healing 
 has taken place. A thorough cleansing with boiled water should 
 be made and then the sterile nipple shield should be applied 
 through which baby will get abundant satisfaction, while the 
 mother is spared the pain, and the nipple has an opportunity to 
 get well. 
 
THE NURSING MOTHER AND HER BABE 139 
 
 In the case of sore and cracked nipples, thorough cleansing 
 with boiled water and boracic acid solution follows each nurs- 
 ing seance; and, after careful drying, balsam peru — equal 
 parts with glycerine — may be applied with a tiny piece of 
 sterile gauze or cotton; a sterile cotton pad is then applied to 
 each breast which is held in place by a breast binder. 
 
 The nipple shield, when employed, is boiled after each nurs- 
 ing and washed in boracic acid solution just before each 
 nursing. The strictest cleanliness must be observed, and then 
 we hope to bring relief and comfort to the mother, and effect 
 the saving of nature's best food for the baby. 
 
 CONSTITUENTS OF MOTHER' S MILK 
 
 Mother's milk — that wonderfully adaptable, ever-changing 
 food, so accurately and scientifically suited to the hourly and 
 daily needs of the growing child — is composed of five different 
 parts, totally unlike in every particular, and each part exactly 
 suited to the needs which it supplies. The cream of the milk, 
 as well as the lactose or sugar, builds up the fatty tissues of the 
 body as well as helps provide the energy for crying, nursing, 
 kicking, etc. The proteins (the curd of the milk) are exceed- 
 ingly important; they are especially devoted to building up the 
 cells and tissues of the body of the growing child. The salts 
 form a very small part of the baby's food, but an important one, 
 for they are needed chiefly for the bones and the blood. The 
 fats, sugars, proteins, and salts, taken together, form the solids 
 of mother's milk, and are held in solution in the proportion of 
 thirteen parts of solids to eighty-seven parts of water; which 
 so holds these solids in solution that the baby can digest and 
 assimilate these necessary food elements. The mother's milk 
 increases in strength day by day and month by month as the 
 baby grows, and is the only perfect infant food on earth. 
 
 THE TIME OF THE FIRST FEEDING 
 
 Soon after the birth of the baby the wearied mother seeks 
 rest — she usually falls into a quiet, restful slumber ; the baby 
 likewise goes to sleep and usually does not awaken for several 
 hours. After six or eight hours the child is put to the breast 
 
140 THE MOTHER AND HER CHILD 
 
 and he begins to nurse at once, without any special help. This 
 first nursing should be discontinued after four or five minutes, 
 while he is put to the other breast for the same length of time. 
 
 If there is difficulty in sucking, a bit of milk may be made 
 to ooze out on the clean nipple, while the baby's lips are pressed 
 to it, after which the nurse gently presses and rubs the breasts 
 toward the nipple. After the nursing, the nipples should be 
 elongated, if necessary, by rubbing, shaping, or breast pump. 
 
 The baby gets but little nourishment during the first two days, 
 but that which he does get is essential ; for the colostrum — 
 the first milk — is highly laxative in nature and serves the 
 important purpose of cleaning out the intestinal tract of that 
 first tarry, fecal residue, the meconium. This early sucking 
 of the child accomplishes another purpose besides the obtaining 
 of this important laxative — it also reflexly increases the con- 
 tractibility of the muscles of the womb, which is an exceed- 
 ingty important service just at this time. 
 
 Should the mother or caretaker feel that baby will starve 
 before the milk comes, or that it is necessary to provide " sweet- 
 ened water ; " let us assure them that nothing is needed except 
 what nature provides. Nature makes the babe intensely hungry 
 during these first two days, so that he will suck well, and if he 
 is fed sweetened water, gruel, or anything else, he will not 
 suck forcefully; and so nature's plan for securing extra or 
 increased uterine contractions and the stimulation of the breast 
 glands will be seriously interfered with. 
 
 WATER DRINKING 
 
 As soon as the new born babe is washed and dressed he is 
 given two teaspoons of warmed, boiled water; and this prac- 
 tice is continued every two hours during the day, until as much 
 as two to four ounces of unsweetened water is taken by the tiny 
 babe during the twenty-four hours. Inanition fever — the fever 
 that sometimes follows a failure to give water to the new born 
 infant — is thus avoided. The bottle from which the water 
 is given should be scalded out each time, the nipple u oiled, and 
 just before the "water nursing" the nipple should be swabbed 
 with boracic acid solution. 
 
THE NURSING MOTHER AND HER BABE 141 
 
 REGULARITY IN FEEDING 
 
 From earliest infancy the baby should be nursed by the 
 " clock," and not by the " squawk." Until he reaches his sixth- 
 month birthday, he is fed with unerring regularity every three 
 hours during the day. Asleep or awake he is put to the breast, 
 while during the night he is allowed to sleep as long over the 
 three-hour period as he will. Babies are usually nursed at 
 night: during the early weeks, at nine o'clock in the evening, 
 at midnight, and at six o'clock in the morning. After four 
 months all nursing after ten p. m. may be omitted. 
 
 The baby is ordinarily allowed to remain at the breast for 
 about twenty minutes. He may often be satisfied with one 
 breast if the milk is plentiful; if not, he is given both breasts; 
 and may we add the following injunction? insist that nothing 
 shall go into your baby's mouth but your own breast milk and 
 warm or cool-boiled water; no sugar, whiskey, paregoric, or 
 soothing syrup should be given, no matter how he cries. Never 
 give a baby food merely to pacify him or to stop his crying; it 
 will damage him in the end. More than likely he is thirsty, 
 and milk to him is what bread and meat are to you, neither 
 of which you want when you are thirsty. 
 
 POSITION OF MOTHER DURING THE NURSING 
 
 A perfectly comfortable position during nursing for both 
 mother and babe is necessary for satisfactory results. During 
 the lying-in period the mother should rest well over on her side 
 with her arm up and her hand under her head, the other hand 
 supports the breast and assists in keeping the nipple in the baby's 
 mouth, as well as preventing the breast from in any way inter- 
 fering with baby's breathing. A rolled pillow is placed at the 
 mother's back for support. 
 
 After the mother leaves the bed, she will find a low chair 
 most convenient when nursing the baby, and if an ordinary 
 chair be used, she will find that a footstool adds greatly to her 
 comfort. Once during the forenoon and once during the after- 
 noon the nursing mother will find it a wonderful source of rest 
 and relaxation if she removes all tight clothing, dons a com- 
 fortable wrapper, and lies down on the bed to nurse her babe; 
 
142 THE MOTHER AND HER CHILD 
 
 and as the babe naps after the feed, she likewise should doze 
 and allow mother nature to restore, refresh, and fit her for 
 restful and happy motherhood. 
 
 Worry, grief, fatigue, household cares, loss of sleep, social 
 debauches, emotional sprawls — all debilitate the mother, and 
 usually decrease the flow of milk. 
 
 NURSING WHEN ANGRY AND OVERHEATED 
 
 Overheating, irritability, and sudden anger, almost invariably 
 tend to raise the blood-pressure, which means the entry into 
 the blood stream of an increased amount of epinephrin, which 
 disturbs the baby greatly, often throwing him into convulsions 
 or other sudden, acute illness. 
 
 Menstruation often interferes with the nursing mother, 
 the milk becoming weaker at this time; however, if the infant 
 continues to gain and the mother feels comparatively well, no 
 attention need be paid to this fact. 
 
 Another pregnancy demands a drying up of the breast at 
 once, as the tax is too great on the mother. 
 
 THE STOOLS 
 
 The stools of the breast-fed baby do not require as much 
 attention as those of the bottle-fed child. In cases of con- 
 stipation, after four months, from one teaspoon up to one-half 
 cup of unsweetened prune juice may be given one hour before 
 the afternoon feed. 
 
 In instances of colic with signs of fermentation in the stool, 
 the mother may take several doses (under her physician's 
 orders) of common baking soda; or, if she is constipated, cal- 
 cined magnesia will usually right the condition. Nature's 
 mother milk is so beautifully adapted to the baby's needs that it 
 is the rule for baby to have perfectly normal stools. 
 
 SYMPTOMS OF SUCCESSFUL NURSING 
 
 A happy baby is a satisfied baby. He lies quietly in a sleepy, 
 relaxed condition if he has enough to eat, provided he is other- 
 wise comfortable and dry. He awakens at the end of two hours 
 and perhaps cries; but plain, unsweetened, warm, boiled water 
 
THE NURSING MOTHER AND HER BABE 143 
 
 quenches his thirst, and he lies content for another hour, when 
 he is regularly nursed. He gains on an average of about one 
 ounce a day. 
 
 EARMARKS OF UNSUCCESSFUL NURSING 
 
 Constant discomfort, vomiting, fretful crying, passing and 
 belching of gas, colicky pain, disturbed sleep, greenish stools 
 with mucus, are among the more prominent earmarks of unsuc- 
 cessful nursing. These symptoms appearing in a pale, flabby, 
 listless, indifferent or cross baby, with steady loss of weight 
 continued over a period of three or four weeks, point to " nurs- 
 ing trouble ; " which, if not corrected, will lead to that much 
 dreaded infantile condition — malnutrition. 
 
 Bolting of food or overeating results in vomiting and gas, 
 and thus interferes with normal nursing, as also may tongue- 
 tie. A condition in the mouth, medically known as " stomatitis," 
 and commonly known as " thrush," often gives rise to a fretful 
 cry when nursing is attempted. In the first place, the baby can- 
 not " hold on " to the nipple ; while, in the second place, it hurts 
 his inflamed mouth when he makes an effort to nurse. 
 
 Long continued nursing covering three-fourths of an hour 
 or more, seizing of the nipple for a moment and then discard- 
 ing it, apparently in utter disgust, are the earmarks of very 
 scanty milk supply and should receive immediate attention. 
 
 AIDS TO THE MILK SUPPLY 
 
 Believing that many more mothers than do so should nurse 
 their babies, we have carefully tabulated a number of aids to 
 the milk supply, which we hope will be most earnestly tried 
 before the baby is taken from the breast — for so many, many 
 more bottle-fed babies die during the first year than the breast 
 fed. The dangers of infection, the worry of the food prepara- 
 tion, the uncertainty of results, all call for a most untiring 
 effort on the part of every doctor, nurse, and mother, in their 
 endeavors to secure maternal nursing. The following is a 
 summary of " aids to the milk supply : " 
 
 1. Regular periodical sucking of the breasts from the day of 
 baby's birth. 
 
144 THE MOTHER AND HER CHILD 
 
 2. Systematic applications of alternate hot and cold com- 
 presses, followed by massage to the breasts. 
 
 3. Three good nourishing meals each day, eaten with merri- 
 ment and gladness of heart. 
 
 4. A glass of " cream gruel," milk, cocoa, or eggnog at the 
 close of each meal, with a glass just before retiring. 
 
 5. Three outings each day in the open air. 
 
 6. Nurse the baby regularly and then turn its care over to 
 another, you seek the out of doors and engage in walking, row- 
 ing, riding and other pleasurable exercise. 
 
 7. Take a daily nap. 
 
 8. You can bank on fretting and stewing over the hot cook 
 stove to decrease your milk. It seldom fails to spoil it. 
 
 9. Regular body bathing, with cold friction rubs to the skin. 
 
 10. A happy, carefree mental state. Nothing dries up milk 
 so rapidly as worry, grief, or nagging. 
 
 11. The administration, preferably in the early days, of 
 desiccated bovine placenta ; although it may be given at any time 
 during the period of nursing. 
 
 WHEN THE BABY SHOULD NOT BE NURSED 
 
 As much as we desire maternal nursing for the babe, there 
 do occur instances and conditions which demand a change to 
 artificial feeding, such as the following: 
 
 1. A new pregnancy. 
 
 2. Mothers with uncontrollable tempers. 
 
 3. Cases of breast abscess. 
 
 4. Prolonged illness of the mother with high fever. 
 
 5. Wasting diseases such as tuberculosis, Bright's disease, 
 heart disease, etc. 
 
 6. Maternal syphilis. 
 
 7. When maternal milk utterly fails, or is wholly inadequate. 
 
 When a maternal anesthetic is to be administered, or in case 
 of inflammation of the breast or during a very short illness not 
 covering more than two or three days, then the breast pump 
 may be used regularly every three hours to both breasts; the 
 
THE NURSING MOTHER AND HER BABE 145 
 
 baby may be artificially fed and then returned to the breast after 
 the effects of the anesthetic has worn off or the temperature 
 has been normal for twenty-four hours. 
 
 There may also appear definite indications in certain children 
 which make it imperative that the nursing child should early be 
 weaned. These manifestations of disordered nutrition and 
 failing health admonish us to put the baby on properly modified 
 milk, or to transfer it to a wet nurse. 
 
 These conditions are: 
 
 1. Progressive loss in weight. 
 
 2. A bad diarrhea of long standing; one which does not 
 yield to the usual remedies, at least not as long as the baby 
 continues to feed from the breast. These diarrheas are espe- 
 cially serious when accompanied by a steady loss in weight. 
 
 3. Excessive vomiting accompanied by progressive loss in 
 weight. 
 
 THE WET NURSE 
 
 Because of the rarity of good, healthy wet nurses, it is always 
 better to attempt to feed the baby with scientifically modified 
 milk (not proprietary foods), good, clean, cow's milk properly 
 modified to suit the weight and age of the child. We put weight 
 first, for we prepare food for so many pounds of baby rather 
 than for the number of months old he is. 
 
 If modified food has failed and the best specialist within 
 your reach orders a wet nurse; she must have the following 
 qualifications : 
 
 1. She must be free from tuberculosis and syphilis. 
 
 2. She should be between twenty and thirty years of age. 
 
 3. She should abstain from all stimulants. 
 
 4. She should be amiable, temperate, and should sense her 
 responsibility. 
 
 If an unmarried mother of her first child is engaged as a 
 wet nurse, she should not be " stuffed " or allowed to overeat, 
 which is commonly the result of moving her from her lower 
 life into more comfortable surroundings, or given ale or beer 
 to increase her milk. She should continue her normal eating, 
 take light exercise, which does not mean the scrubbing of 
 
146 THE MOTHER AND HER CHILD 
 
 floors or doing the family washing, and live under the same 
 hygienic regime outlined for the nursing mother. Should she 
 be the mother of the second or third illegitimate child, then 
 she is quite likely to be mentally deficient and she should not 
 be engaged. Her own babe will have to be fed artificially as 
 very few mothers can endure the strain of two suckling chil- 
 dren. 
 
 The baby's own mother should keep general supervision and 
 not turn her babe entirely over to the care of the wet nurse. 
 Remember always that no one in the wide world will ever 
 take the same mother interest in your offspring that can spring 
 from your own mother heart. 
 
CHAPTER XVI 
 THE BOTTLE-FED BABY 
 
 IN taking up the subject of the bottle-fed baby, we must 
 repeat that the only perfect baby food on earth is the milk 
 that comes from the breast of a healthy mother. 
 
 But sudden illness, accident, chronic maladies, or possibly 
 the death of the mother, often throw the helpless babes out into 
 a world of many sorts and kinds of artificial foods — foods 
 that are prepared by modifying cow's, ass', or goat's milk ; foods 
 arranged by the addition to the milk of various specially pre- 
 pared cereals, albumens or malted preparations, otherwise known 
 as " proprietary foods." We shall endeavor, then, in this chap- 
 ter and in that on " the feeding problem," to lay down certain 
 general suggestions to both the nurse and the mother, which 
 may assist them in their effort to select the food which will 
 more nearly simulate nature's wondrous mother-food, and which 
 will, at the same time, be best suited to some one particular 
 baby. 
 
 THE HOURLY SCHEDULE 
 
 The normal baby, from birth to six months, should receive 
 properly prepared nourishment every three hours, beginning 
 the day usually at six a. m. , the last feeding being at nine p. m. 
 During the early weeks an additional bottle is given at midnight, 
 but this is usually discarded at four months, at which time the 
 last feeding should be given at about ten instead of at nine at 
 night. 
 
 Should the baby continue to awaken during the night before 
 six in the morning, unless he is under weight, a bottle of warm, 
 boiled, unsweetened water should be given. 
 
 147 
 
148 THE MOTHER AND HER CHILD 
 
 QUANTITY OF FOOD 
 
 The quantity of food to be given is always determined by 
 the size of the baby's stomach, which, of course, depends some- 
 what upon the age of the child; for instance, the stomach of 
 the average baby one week old holds about one ounce, while at 
 the age of three months the stomach holds five ounces; so it 
 would not only be folly to give two ounces at one week and 
 seven ounces at three months, but it would also be very detri- 
 mental to the babe, causing severe symptoms due to the over- 
 loading of the stomach. 
 
 Careful study of the size of the stomach at different ages in 
 infancy, together with the quantity of milk drawn from the 
 breast by a nursing baby, has led to the following conclusions 
 regarding the capacity of the baby's stomach : 
 
 AGE QUANTITY 
 
 I — 4 weeks i — 2 ounces 
 
 4 weeks — 3 months 2 l / 2 — 4 ounces 
 
 3 months — 6 months 4 — 6 ounces 
 
 6 months — 1 year 6 — 8 ounces 
 
 REFRIGERATOR NECESSITY 
 
 It is highly important that the day's feedings be kept in a 
 cold place, free from the odors of other foods as well as free 
 from dust, flies, and filth. In order that this may be accom- 
 plished, the well-protected bottles, each containing its baby- 
 meal, are placed in a covered pail containing ice and water. 
 This covered receptacle is now put in an ice box; and, in order 
 that our most economical reader — one who may feel that she 
 cannot afford to keep up the daily expense of the family refrig- 
 erator — may herself prepare a simple home refrigerator, the 
 following directions are given (Fig. 9). 
 
 HOMEMADE ICE BOX 
 
 Procure a wooden box about eighteen inches square and six- 
 teen or eighteen inches deep and put four inches of sawdust 
 into the bottom.; now fill in the space between a ten-quart pail, 
 which is set in the middle of the box with more sawdust. A 
 cover for the box is now lined with two or three inches of 
 
THE BOTTLE-FED BABY 
 
 149 
 
 Fig. 9. Homemade Ice Box 
 
150 THE MOTHER AND HER CHILD 
 
 newspaper, well tacked on, and is fastened to the box by hinges. 
 We are now ready for the inside pail of ice, into which is 
 carefully placed the well-protected bottles of milk, all of which 
 is then set into the ten-quart pail in the box. Five cents worth 
 of ice each day will keep baby's food cool, clean, and provide 
 protection against the undue growth of germs. 
 
 PREPARING THE BOTTLE 
 
 At each feeding hour, one of baby's bottled meals is taken 
 from the ice box and carefully dipped in and out of a deep cup 
 of hot water. A very convenient receptacle is a deep, quart 
 aluminum cup, which may be readily carried about. The hot 
 water in the cup should amply cover the milk in the bottle 
 (Fig. 10). 
 
 To test the warmth allow a few drops to fall on the inner 
 side of the arm, where it should feel quite warm, never hot. 
 A baby's clean woolen stocking is now drawn over the bottle, 
 which keeps it warm during the feeding. No matter how great 
 the danger of offending a fond grandparent or a much adored 
 friend never allow anyone to put the nipple in her mouth to make 
 the test for warmth of baby's food. 
 
 There are many contrivances, both electrical and alcoholic, 
 for heating baby's bottle, many of which are both convenient 
 and inexpensive. 
 
 POSITION DURING FEEDING 
 
 And now we realize that we are about to advise against the 
 time-honored injunction which has been handed down from 
 " Grandma This " and " Mother That " to all young mothers who 
 have lived in their neighborhoods : " My dear young mother, 
 if you can't nurse your precious infant, you can at least 
 ' mother it ' at the nursing time by holding it in your arms and 
 gently rocking it to and fro as you hold the bottle to its lips." 
 This so-called " mothering " has resulted in regurgitation, 
 belching, and numerous other troubles, as well as the formation 
 of the " rocking habit." 
 
 A young mother came running into my office one day saying : 
 "Doctor, it won't work, the food's all wrong; my baby is not 
 
THE BOTTLE-FED BABY 
 
 151 
 
 going to live, for he throws up his food nearly all the time." 
 We arranged to be present when the next feeding time came 
 and watched the proceedings. A dear old friend had told her 
 " she must ' mother ' her baby at the nursing time," and so she 
 had held the child in a semi-upright position as she endeavored 
 to hold the bottle as near her own breast as was possible. The 
 hole in the nipple was a bit large, which occasioned the subse- 
 quent bolting of the food, and then to continue the " mothering " 
 
 Fig. 10. Heating the Bottle 
 
 she swayed him to and fro, all of which was interrupted sud- 
 denly by the vomiting of a deluge of milk. 
 
 I drew the shade in an adjoining room, opened the windows, 
 and into a comfortable carriage-bed I placed the baby on his 
 side. Seating myself beside him I held the warm, bottled meal 
 as he nursed. Several times I took it from his mouth, or so 
 tipped it that " bolting " was impossible. Gradually, carefully, 
 and slowly, I took the empty bottle away from the sleepy 
 babe, and as I closed the door the mother said in anxious 
 amazement : " He won't forget I'm his mother if I don't hold 
 
152 THE MOTHER AND HER CHILD 
 
 him while he nurses ? " You smile as I smiled at this girl- 
 mother's thought ; but, nevertheless there are many like her — 
 anxious, well-meaning, but ignorant. 
 
 The infant stomach is little more than a tube, easily emptied 
 if the baby's position is not carefully guarded after nursing. 
 No bouncing, jolting, patting, rocking, or throwing should take 
 place either just before, during, or immediately after meals. 
 
 TIME ALLOWANCE FOR ONE FEEDING 
 
 From twelve to twenty minutes is long enough time to spend 
 at a bottle meal. The nipple hole may have to be made larger, 
 or a new nipple with a smaller hole may have to be purchased. 
 When new, you should be able to just see a glimmer of light 
 through the hole, and if the infant is too weak to nurse hard, 
 or the hole too small, it may be made larger by a heated hatpin 
 run from the inside of the nipple out ; great care must be taken, 
 else you will do it too well. If the nipple hole is too large, bolting 
 is the sure result; while too small a hole results in crying and 
 anger on the part of the hungry child, because he has to work 
 too hard to get his meal. 
 
 AFTER THE FEED 
 
 We have seen some mothers, in their anxiety to prevent the 
 sucking in of air from the emptied bottle, rush in and jerk 
 the nipple from the going-to-sleep babe so forcibly that all 
 thoughts of sleep vanished and a crying spell was initiated. 
 The tactful mother is the quiet one who slowly, quietly, draws 
 the empty bottle with its " much loved nipple " from the lips. 
 If you observe that the babe is going to sleep, with an occa- 
 sional superficial draw at the nipple, wait a moment; he will 
 drop it himself, and you can pick it up as you quietly leave 
 the room. In all instances, whether it be indoors or out of doors, 
 arrange the babe in a comfortable sleeping position, remem- 
 bering that nursing is warm exercise and the babe gets uncom- 
 fortably sweaty if overbundled, especially about the head and 
 neck. No one should unnecessarily touch the babe immediately 
 after feeding; even his diaper may be changed without awaken- 
 ing him while he is thus lying quietly in his bed. 
 
THE BOTTLE-FED BABY 153 
 
 INTERVALS BETWEEN MEALS 
 
 The three-hour interval is reckoned from the beginning of 
 the meal, and not from its close. More than two hours is 
 spent in the stomach digestion, and any food or sweetened 
 water which may enter between meals only tends to cause 
 indigestion and other disturbances. And that this important 
 organ may have a bit of rest, we fix the interval at three hours, 
 which in our experience and that of many other physicians, has 
 yielded good results. As a rule we have no regurgitation and 
 no sour babies on the three-hour schedule. Sick babies, very 
 weak babies, and their feeding time, will be discussed in a 
 later chapter. 
 
 ADDITIONAL FOODS 
 
 At six months, and often as early as four, in cases of con- 
 stipation, unsweetened, well-strained prune juice may be given, 
 beginning with one-half teaspoon one hour before the after- 
 noon feed and increasing it daily until two tablespoons are 
 taken. At six months, both orange juice and vegetable broths 
 are given, whose vegetable salts add a very important food 
 element to the baby's diet — an element which our grandmothers 
 thought could only be obtained through the time-honored " bacon 
 rind " of by-gone days. 
 
 Orange juice is also unsweetened and well strained, and is 
 administered in increasing amounts, beginning with one-half 
 teaspoon one hour before the afternoon feeding, until the 
 juice of a whole orange is greedily enjoyed by the time of the 
 first birthday. The vegetable juices are obtained from cut-up 
 spinach, carrots, tomatoes, and potatoes, strained, with a flavor 
 of salt and onion — really a bouillon — and is given just before 
 the bottle at the six p. m. feeding. They are also begun in 
 teaspoon amounts. 
 
 FOOD FOR THE TRAVELING BABE 
 
 Baby travel should be reduced to a sheer necessity; never 
 should the babe be subjected to the exposure of disease germs, the 
 change of food, the possibilities of draughts and chilling, for 
 
154 THE MOTHER AND HER CHILD 
 
 merely a pleasure trip — the risks are too great and the pos- 
 sibilities of future trouble too far reaching. 
 
 If you are in touch with the milk laboratory of a large city, 
 you will find that they make a specialty of preparing feedings 
 which are good for a number of days for the traveling baby, 
 and we strongly advise that their preparations be accepted; but 
 in the event of not being in touch with such a laboratory we 
 suggest the making of a carrying ice-box covered with wicker, 
 which must be kept replenished with ice. Food kept in such 
 a device may be kept fresh for twenty-four to forty-eight hours. 
 Plans other than the laboratory preparations or the ice-box 
 are risky, and should not be depended upon. 
 
 Many of our railway dining cars now pick up fresh, certified 
 milk at stations along the line for use on their tables, and 
 where such is the case fresh preparations of milk may be made 
 on a trans-continental trip by the aid of an alcohol stove. 
 Malted milk may also be used, provided you have accustomed 
 the baby to its use a week before leaving home, by the gradual 
 substitution of a fourth to a half ounce each day in the daily 
 food; all of which, of course, should be done under your 
 physician's direction. 
 
 If possible, leave baby at home in his familiar, comfortable 
 environment in the care of a trained nurse and a trusted relative, 
 and under the supervision of the baby's own physician. He 
 is much better off, much more contented, and we are all aware 
 of the fact that contentment and familiarity of sights and 
 people promote good appetite, good digestion, and happiness — 
 the very essentials of success in baby feeding. We speak 
 touchingly and sympathetically to the mother who must leave 
 her babe ; and likewise we wish to cheer her as we remind her 
 that by wireless messages and night letters it is possible to 
 keep in touch with loved ones though a thousand miles away. 
 
 The sanitation and modification of cow's milk, as well as 
 stools, etc., are taken up in later chapters. 
 
 RULES FOR THE BOTTLE-FED 
 
 1. Never play with a baby during or right after a meal. 
 
 2. Lay the baby on his side when nursing the bottle. 
 
THE BOTTLE-FED BABY 155 
 
 3. Three full hours should intervene between feedings. 
 
 4. Don't give the food too hot — it should just be warm. 
 
 5. Make the test for warmth on the inner side of your arm. 
 
 6. Give a drink of water between each meal if awake. 
 
 7. Never save the left-overs for baby. 
 
 8. If possible, give three feedings each day in the cool air, 
 with baby comfortably warm. 
 
 9. Do not jump, bounce, pat, or rock baby during or after 
 meals. 
 
 10. Never coax baby to take more than he wants, or needs. 
 
 11. No solid foods are given the first year. 
 
 12. Orange juice may be given at six months; while, after 
 four months, unsweetened prune juice is better than medicine 
 for the bowels. 
 
CHAPTER XVII 
 MILK SANITATION 
 
 COWS milk, like mother's milk, is made up of solids and 
 water. In a previous chapter Ave learned that in one- 
 hundred parts of mother's milk, eighty-seven parts were water 
 and thirteen parts were solid. These thirteen parts of solids 
 consist of sugar, proteins, and salts ; this is likewise the case 
 with cow's milk, except that in the case of the cow's milk, the 
 sugar is decreased while the proteins are increased as will be 
 noted by the accompanying comparative analysis: 
 
 mother's milk 
 
 Fat % 4.00 
 
 Sugar 7.00 
 
 Proteins 1.50 
 
 Salts 0.20 
 
 Water 87.30 
 
 % 100.00 
 
 COW'S MILK 
 
 Fat % 4.00 
 
 Sugar 4.50 
 
 Proteins 3.50 
 
 Salts 0.75 
 
 Water 87.25 
 
 % 100.00 
 
 Mother's milk is absolutely sterile, that is, free from the 
 presence o£ germs; on the other hand, cow's milk is anything 
 but sterile — the moment it leaves the udder it begins to accumu- 
 late numerous bacteria, all of which multiply very rapidly. 
 
 156 
 
MILK SANITATION 157 
 
 Cow's milk is generally twenty-four to forty-eight hours old 
 before it can possibly reach the baby. It is just as important 
 to keep in mind these facts of milk contamination — dirt, filth, 
 flies, and bacteria — as it is to plan for the modification of cow's 
 milk for the purpose of making it more nearly resemble 
 mother's milk. While mother's milk has about the same per- 
 centage of fat as cow's milk, it is almost twice as rich in sugar, 
 and has only one-fourth to one-third as much protein. This 
 protein is vastly different from that found in cow's milk, which 
 you recall has a tough curd, as seen in cottage cheese. While 
 mother's milk contains a small amount of casein similar to that 
 found in the cheese of the cow's milk, the principal protein 
 constituent is of another kind (lactalbumin), and is much more 
 easy of digestion than the casein of cow's milk. 
 
 This is a most important point to remember, because the 
 baby's stomach is not at first adapted to the digestion of the 
 heavier and tougher protein curds of cow's milk. It requires 
 time to accustom the infant stomach to perform this heavier 
 work of digestion. There are a number of factors which must 
 be borne in mind in the modification of milk, whether it be 
 cow's milk, or goat's milk (for many European physicians use 
 goat's milk entirely in the artificial feeding of infants) : namely, 
 the cleanliness of the milk, the acidity of milk, the difference 
 in the curd, the percentage of sugar, and the presence of 
 bacteria. 
 
 SUGAR 
 
 In the modification of cow's milk, sugar must be added to 
 make up for the sugar which is decreased when the water was 
 added to reduce the protein. There are several sorts of sugar 
 used in the modification of milk. These sugars are not added 
 to sweeten the milk alone, but to furnish a very important 
 element needed for the growth of the baby. Sugar is the one 
 element which the infant requires in the largest amount. 
 
 Milk sugar is probably most universally used in the modifica- 
 tion of milk, but a good grade of milk sugar is somewhat 
 expensive, costing from thirty to sixty cents a pound, and this 
 places it beyond the reach of many mothers. It is added to 
 
158 THE MOTHER AND HER CHILD 
 
 the food mixtures in the proportion of one ounce to every 
 twenty ounces of food. Cane sugar (table sugar) may also 
 be used, but it must be clean and of good quality. It is used 
 in rather less quantity than that of milk sugar, usually from 
 one-half to one-third of an ounce by measure to each twenty 
 ounces of food. Dextri-maltose (malt sugar) is very easy of 
 digestion and may be used in the modification of milk. Maltose 
 seems to help the children to gain more rapidly in weight than 
 when only milk or cane sugar is used. It is also exceedingly 
 useful in constipation, as its action is more laxative than any 
 of the other sugars ; but it should not be given to children who 
 vomit habitually or have loose stools. 
 
 ACIDITY 
 
 Like mother's milk, the cow's milk is neutral as it comes 
 from the udder; but, on standing, it quickly changes, soon 
 becoming slightly acid, as shown by testing with blue litmus 
 paper. In fact, what is known as ordinarily fresh milk, if sub- 
 jected to the litmus paper test, always gives an acid reaction. 
 This acidity is neutralized by adding lime water to the formula 
 in the proportion of one ounce to each twenty-ounce mixture. 
 Ordinary baking soda is sometimes prescribed by physicians in 
 place of the lime water. In the event of obstinate constipa- 
 tion, milk of magnesia is sometimes added to the day's feedings. 
 
 CREAM 
 
 There may be procured in any large city an instrument called 
 the cream gauge, which registers approximately (not accur- 
 ately) the richness of milk. Some milk, even though rich, 
 parts with its cream very slowly; while some poor milk allows 
 nearly all the cream quickly to rise to the surface. We know 
 of no way for the mother to determine the amount of cream 
 (without the cream gauge) except by the color and richness of 
 the milk. In cities it is very convenient to send a specimen 
 of the milk to the laboratories to be examined by experts, who 
 will gladly render a report to both physician and mother. 
 
 The lactometer is a little instrument used to estimate the 
 specific gravity of milk. An ordinary urinometer such as used 
 
Courtesy of Lakewood Farm 
 
 Courtesy of Lakewood Far 
 
 Fig. ii. A Sanitary Dairy 
 
MILK SANITATION 159 
 
 by physicians in estimating the specific gravity of urine may 
 also be used. The specific gravity of cow's milk should not 
 register below 1028 or above 1033. 
 
 HERD MILK 
 
 Milk from a single cow is not to be desired for baby's food 
 because of its liability to vary from day to day, not to mention 
 the danger of the cow's becoming sick. Authorities have 
 agreed that herd milk of Holstein or ordinary grade cows is 
 best for infant feeding. This mixed-herd milk contains just 
 about the proper percentage of fat; whereas, if Jersey milk 
 must be used, some of the cream should be taken away. Our 
 milk should come from healthy cows which have been tested 
 for tuberculosis at least every three months. 
 
 Annatto is sometimes added to milk to increase its richness 
 of color. To test for annatto proceed as follows: To a couple 
 of tablespoons of milk add a pinch of ordinary baking soda. 
 Insert one-half of a strip of filter paper in the milk and allow 
 it to remain over night. Annatto will give a distinct orange 
 tint to the paper. The commonly used milk preservatives are 
 boracic acid, salicylic acid, and formaldehyde, any of which 
 may be readily detected by your health officials. 
 
 SANITARY DAIRIES 
 
 In close proximity to most large cities there is usually to be 
 found one or more sanitary dairies. It is a joy indeed to visit 
 a farm of this kind with its airy stables and concrete floors, 
 which are washed with water coming from a hose. The drain- 
 age is perfect — all filth is immediately carried off (Fig. 11). 
 The cows are known to be free from tuberculosis, actinomycosis 
 (lumpy jaw), and foot and mouth disease. The milkmen on 
 this farm wear washable clothes at the milking time, and their 
 hands are painstakingly cleansed just before the milking hour. 
 Previous to the milking the cattle have been curried outside 
 the milking room and their udders have received a careful 
 washing. The milkman grasps the teat with clean hands, while 
 the milk is allowed to flow through several thicknesses of 
 sterilized gauze into the sanitary milking pail. This milk is 
 
160 THE MOTHER AND HER CHILD 
 
 at once poured into sterile bottles, is quickly cooled and shipped 
 in ice to the substations where the delivery wagon is waiting. 
 In the ideal delivery wagon there are shallow vats of ice in 
 which the bottles are placed, thus permitting the milk to reach 
 the baby's home having all the while been kept at a temperature 
 just above the freezing point. 
 
 And why all this trouble ? Why all this worry over temperature 
 and cleanliness? Babies were not so cared for in the days 
 of our grandmothers. The old-fashioned way of milking the 
 cows with dirty clothes and soiled hands, while cattle were more 
 or less covered with manure, with their tails switching millions 
 of manure germs into the milking pail, produced a milk laden 
 not only with manure germs — the one great cause of infantile 
 diarrhea — but also swarming with numerous other mischief 
 making microbes. Even tuberculosis, that much dreaded disease 
 germ of early infancy, may come from the dairy hands as well 
 as from infected cows. 
 
 There used to be many dairymen like the old farmer who, 
 when interrogated by the health commissioner concerning the 
 cleanliness of his milk, laughed as he reached down into the 
 bottom of a pail of yellow milk and grabbing up a handful of 
 manure and straw, said : " That's what makes the youngsters 
 grow." But it does not make them grow; it often causes them 
 to die, and even if they do live, they live in spite of such con- 
 taminated food, for the germ which is always found in the 
 colon of the cow (coli communis), probably kills more babies 
 every year than any other single thing. 
 
 It is possible to reduce the growth of these germs by keeping 
 the milk at a very low temperature from the time it leaves the 
 cow until the moment it gets to the home refrigerator. Those 
 which survive this process of refrigeration may be quickly 
 rendered harmless by pasteurizing or sterilizing at the time 
 of preparing baby's food. 
 
 In the absence of the modern sanitary dairy, we would suggest 
 that the milk supply be improved by giving attention to the 
 following: 
 
 The cattle should be tested for tuberculosis every three 
 months. The walls of the cowhouse should be whitewashed 
 
MILK SANITATION 161 
 
 three times a year. The manure should be stored outside the 
 barn. The floor of the cowhouse should be sprinkled and swept 
 each day. The cattle should be kept clean — curried each day, 
 and rubbed off with a damp cloth before milking. The udders 
 should be washed before each milking. The milker can wear 
 a clean white gown or linen duster which should be washed 
 every two days, while his hands should be washed just before 
 the milking. The milking pail should be of the covered sanitary 
 order. The barn should be screened. 
 
 CERTIFIED MILK 
 
 Immediately after leaving the cow, the milk should be cooled 
 to at least 45 F. It should at once be put into bottles that have 
 been previously sterilized and then be tightly covered, and 
 should be kept in ice water until ready for consumption. No 
 matter how carefully the milk is handled, it is infected with 
 many bacteria, but if it is quickly cooled, the increase of the 
 bacteria is greatly retarded. Under no circumstances buy milk 
 from a grocery store out of a large can. Go to your health 
 officer and encourage him in his campaign for sanitary dairies 
 and certified milk. 
 
 Such milk as we have described under the head of sanitary 
 dairies, when it has been tested by the board of health and has 
 received the approval of the medical profession, is known as 
 " certified milk;" and, although the price is usually fifteen to 
 twenty cents a quart, when compared with the cost of baby's 
 illness it will prove to be cheaper than the dirty milk which 
 sickens and kills the little folks. 
 
 There is no doubt that the increased use of " certified milk " 
 has been a great factor in the reduction of deaths from infant 
 diarrhea in recent years. 
 
 BOILING THE MILK 
 
 When certified milk cannot be had, it is absolutely dangerous 
 to give raw, unboiled, or unpasteurized milk to the baby, par- 
 ticularly in warm weather ; for the countless millions of manure 
 germs found in each teaspoon of ordinary milk not only dis- 
 turbs the baby's digestion, but actually makes him sick, causing 
 
1 62 THE MOTHER AND HER CHILD 
 
 colic, diarrhea, and cholera infantum. The only way this milk 
 can be rendered safe is by cooking it — actually killing the 
 bacteria. This process of boiling, however, does not make good 
 milk out of bad milk nor clean milk out of that which is dirty, 
 it simply renders the milk less dangerous. 
 
 There are two methods of killing bacteria — sterilization and 
 pasteurization. By sterilization is meant the process of render- 
 ing the milk germ free by heating, by boiling. Many of the 
 germs found in milk are comparatively harmless, merely causing 
 the souring of milk ; but other microbes are occasionally present 
 which cause serious diseases, such as measles, typhoid and 
 scarlet fever, diphtheria, tuberculosis, and diarrhea. It is always 
 necessary to heat the milk before using in warm weather, and 
 during the winter it is also important when infectious or con- 
 tagious diseases are prevalent. 
 
 Milk should be sterilized when intended for use on a long 
 journey, and may be eaten as late as two or three days after- 
 ward. 
 
 To sterilize milk, place it in a well-protected kettle and allow 
 to boil for one hour and then rapidly cool. This process renders 
 it more constipating, and for some children many of its nutritive 
 properties seem to be destroyed, as scurvy is often the result 
 of its prolonged use. When a child must subsist upon boiled 
 milk for a long period, he should be given the juice of an 
 orange each day. Children are not usually strong and normal 
 when fed upon milk of this character for indefinite periods. 
 All living bacteria (except the spores or eggs) may be destroyed 
 by boiling milk for one or two minutes. 
 
 PASTEURIZATION 
 
 When baby is to use the milk within twenty-four hours, 
 " pasteurization " is better than boiling as a method of destroy- 
 ing microbes. 
 
 There are many pasteurizers on the market which may be 
 depended upon, among which are the Walker-Gordon Pasteur- 
 izer, and Freeman's Pasteurizer; but in the absence of either 
 of these pasteurization may be successfully accomplished by the 
 following method: 
 
MILK SANITATION 163 
 
 On the bottom of a large kettle filled with cold water, place 
 an ordinary flatiron stand upon which is put a folded towel. 
 On this place the bottle of milk as it comes from the dairyman, 
 with the cap of the bottle loosened. The cold water in the 
 kettle should come up to within an inch of the top of the bottle 
 of milk. Heat this water quickly up to just the boiling point — 
 until you see the bubbles beginning to rise to the top. The gas 
 is then turned down or the kettle is placed on the back of the 
 range and held at this near-boiling point for thirty minutes, 
 after which it is taken to the sink and cold water is turned 
 into the water in the kettle, until the bottle of milk is thoroughly 
 cooled. It is now ready to be made up into the modified food 
 for baby. 
 
 Never let pasteurized milk stand in the room, nor put it near 
 the ice when warm. It must be cooled rapidly, as described 
 above; that is, within fifteen or twenty minutes. 
 
 The " spores " of the milk are not killed by pasteurization 
 and they hatch out rapidly unless the milk is kept very cold, 
 and, as already stated, it should be used within twenty-four 
 hours after pasteurization. 
 
 THE CARE OF BOTTLED MILK 
 
 The certified milk or the ordinary milk that has been delivered 
 to your home and is to be used without pasteurization or steril- 
 ization, should receive the following care: 
 
 1. It should be placed at once in a portion of the ice box that 
 is not used to store such foods as radishes, cabbage, meats or 
 any other open dishes of food whose odors would quickly be 
 absorbed by the milk. The milk should never be left standing 
 on the doorsteps in the sun, for many reasons : the sun heats 
 the milk, encourages the growth of bacteria, and a passing cat 
 or dog, whose mouth often contains the germs of scarlet fever, 
 tonsilitis, and diphtheria, should it be hungry, laps the tops of 
 the bottles, particularly in the winter when the cream has 
 frozen and is bulging over the edge. 
 
 2. It should never be kept in the warm kitchen, as when 
 visiting her sick baby we discovered one young mother doing. 
 In answer to my question, she explained ; " Doctor, we do not 
 
164 THE MOTHER AND HER CHILD 
 
 take ice in the winter time, everything is ice outdoors, so I 
 just set the bottle outside the window bringing it in whenever 
 I need to give the baby some food. I forget to put it out some- 
 times, but really now, does it matter ? " It really matters much, 
 for you see, reader, the milk is first freezing then thawing 
 and it is rendered entirely unfit for the baby. 
 
 3. Milk should be kept covered and protected from dust and 
 flies; it should be kept in glass jars which have been sterilized 
 by boiling before being filled, and then placed in the refriger- 
 ator. If the milk is sour, or if there is any sediment in the 
 bottle, it is unfit for baby's use. 
 
CHAPTER XVIII 
 HOME MODIFICATION OF MILK 
 
 IN a previous chapter it was found from comparing the 
 analysis of mother's milk with that of cow's milk, that 
 they widely differed in the proteins and sugar. The art of so 
 changing cow's milk that it conforms as nearly as is possible 
 to mother's milk is known as " modification." Where protein, 
 sugar, and fat are given in proper amounts, healthy infants get 
 along well; but when either the fats or proteins are given in 
 excess, or when the digestion of the child is deranged, there is 
 often no end of mischief. 
 
 There are two groups of milk formulas that are useful. First, 
 those in which the fats and proteins are about the same, known 
 as " whole milk," , or " straight " milk mixtures ; second, those 
 in which the, -fats are used in larger proportions than proteins, 
 and known as " top milk " — milk taken from the upper part 
 of the bottle after the cream has risen. And since the larger 
 proportion of babies take the lower fats or " whole milk " 
 formulas, and seem to get along better than the babies who 
 have the " top milk " formulas, we will first take up the con- 
 sideration of the modification of whole milk. 
 
 PREPARATION FOR MODIFICATION 
 
 To begin with, everything that comes in contact with the 
 preparation of baby's food must be absolutely clean. The table 
 on which the articles are placed, and any towel that comes in 
 contact with the articles or the mother's hands, or those of the 
 nurse, must be thoroughly scrubbed. 
 
 There is only one way to prepare the utensils that are to be 
 used in making the baby's food, and that is to put them in a 
 large kettle and allow them to boil hard for fifteen minutes 
 
 165 
 
1 66 THE MOTHER AND HER CHILD 
 
 just before they are to be used. The articles needed are (Fig. 
 12): 
 
 i. As many bottles as there are 10. A bottle of lime water. 
 
 feedings in one day. n. A fine-mesh, aluminum 
 
 2. A nipple for each bottle. strainer. 
 
 3. Waxed paper for each bottle 12. A square of sterile gauze for 
 
 top. straining the food (should 
 
 4. Rubber bands for each be boiled for fifteen min- 
 
 bottle. utes with the utensils). 
 
 5. A two-quart pitcher. 13. One plate, and later a 
 
 6. A long-handled spoon for double boiler (14). 
 
 stirring the food. 15. The sugar. 
 
 7. A tablespoon. 16. The milk. 
 
 8. A fork. 17. Ready for the ice box. 
 
 9. An eight-ounce, graduated 18. Refrigeration. 
 
 measuring glass. 
 
 BOTTLES AND NIPPLES 
 
 There is but one bottle which can be thoroughly washed 
 and cleaned, and that is the wide-mouthed bottle. It should 
 hold eight ounces and should have the scale in ounces blown 
 in the side (Fig. 10). The nipple for this bottle is a large, 
 round breast from which projects a short, conical nipple, which 
 more nearly resembles the normal breast than do the old-fash- 
 ioned nipples so frequently seen on the small-necked nursing 
 bottles. There is a great advantage in this, in that the baby 
 cannot grasp the nipple full length and thus cause gagging. 
 These bottles and nipples are known as the " Hygeia/' and 
 have proven to be a great source of comfort to the baby as 
 well as to the mother or nurse whose duty it is to keep them 
 clean. There are a number of other nursing bottles on the 
 market, which, if they are used, must be thoroughly cleansed 
 with a special bottle brush each day. The neck is small and 
 the nipple is small and great care must be taken in the cleansing 
 of both of them. 
 
 CARE OF BOTTLES AND NIPPLES 
 
 When there is a bottle for each individual feeding in the day, 
 immediately after each nursing both bottle and nipple should 
 
HOME MODIFICATION OF MILK 
 
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168 THE MOTHER AND HER CHILD 
 
 be rinsed in cold water and left standing, filled with water, 
 until the. bottles for one day's feeding have all been used. The 
 nipples should be scrubbed, rinsed, and wiped dry and kept by 
 themselves until their boiling preparation for the following 
 day's feeding. 
 
 If the same bottle is to be used for the successive feed- 
 ings during the day, it should be rinsed, washed with soap and 
 water, and both bottle and nipple placed in cold water and 
 brought quickly to the boiling point and allowed to boil for 
 fifteen minutes. No bottles or nipples must ever be used after 
 a mere rinsing; boiling, preceded by a thorough washing in 
 soap and water, must take place before they are used a second 
 time. 
 
 New nipples are often hard and need to be softened, which is 
 readily done by either prolonged boiling or rubbing them in 
 the hands. 
 
 All new bottles should be annealed by placing them on the 
 stove in a dishpan of cold water and allowing them to boil 
 for twenty minutes, and then allowing them to remain in the 
 water until they are cold. When bottles are treated in this 
 manner they do not break so readily when being filled with 
 boiling water or hot food. 
 
 PREPARING THE FOOD 
 
 In a large preserving kettle place all the utensils needed in 
 the preparation of the food — pitcher, spoon, fork, measuring 
 glass, bottles, nipples, cheesecloth for straining, agate cup, wire 
 strainer, in fact everything that is to be used in the preparation 
 of the food. Now fill the kettle with cold water and place over 
 the gas and allow to boil for fifteen minutes. On a well- 
 scrubbed worktable place a clean dish towel, and on this put the 
 utensils and the bottles right side up. The nipples on being 
 taken out of the boiling water will dry of themselves; they 
 should be placed in a glass-covered jar until they are needed 
 for each individual feeding, the nipples not being placed on the 
 bottles as they go to the ice box. 
 
 Having been given your formula by your physician, proceed 
 in the following way. Suppose we were preparing the food 
 
HOME MODIFICATION OF MILK 169 
 
 for a normal two-months old baby that weighed ten pounds, 
 with the prescription as follows: 
 
 Baby Smith. 
 $ 
 
 Whole Milk ounces 11 
 
 Cane Sugar level tablespoons 2 
 
 Boiled Water ounces 12^2 
 
 Lime Water ounces 1 
 
 Amount at Each Feeding ounces 3^ 
 
 Number of Bottles 7 
 
 Interval Between Feedings hours 3 
 
 DETAILS OF PREPARATION 
 
 Two level tablespoons of cane sugar are placed in the agate 
 cup and dissolved in a small amount of boiling water. The 
 solution should be perfectly clear, and if it does not clear up 
 put it over the heat for a few moments. 
 
 This is now turned into the eight-ounce measuring glass 
 which is then filled with boiling water and emptied into the 
 two-quart pitcher. We need four and one-half more ounces of 
 boiling water to complete the prescription requirement of twelve 
 and one-half ounces. 
 
 The bottle of milk, if properly certified, need not be pasteur- 
 ized; but if it is not, it should have been previously pasteurized 
 while the utensils were boiling according to the suggestions 
 found in the chapter on " milk sanitation." The top of the 
 milk bottle should be thoroughly rinsed and wiped dry, and 
 after a thorough shaking of the milk, the cover is removed with 
 the sterile fork and eleven ounces are measured out by measur- 
 ing glass and poured into the pitcher. All is now stirred 
 together with an ounce of lime water, which should never look 
 murky, but should be as clear as the clearest water and should 
 always be kept in the ice box when not in use. 
 
 The sterile cheesecloth which has been boiled for fifteen 
 minutes is now put over the nose of the pitcher, the contents 
 of which is accurately measured into the seven clean, empty 
 bottles, each containing three and one-half ounces. Over the 
 
 top of each of the nursing bottles is placed a generous piece of 
 
170 THE MOTHER AND HER CHILD 
 
 waxed paper which is held down by a rubber band. Each meal 
 for the day is now contained in a separate bottle, and all are 
 placed in a covered pail of water containing ice, and put in the 
 ice box. 
 
 If the prescription for the baby's food contains gruel, it is pre- 
 pared in the following manner: 
 
 Suppose the baby is eight months old and the prescription 
 called for two level tablespoons of flour and eight ounces of 
 boiled water. The two level tablespoons of flour, whether it 
 be wheat (ordinary bread flour), or barley flour, are put into 
 a cup and stirred up with cold water, just as you would stir up 
 a thickening for gravy; now measure out eight ounces of water 
 and allow it to come to a boil in the inner pan of the double 
 boiler, into which the thin paste is stirred until it comes to a 
 boil. After boiling for twenty minutes, remeasure in the measur- 
 ing glass and what water has been lost by evaporation must be 
 added to complete accurately the prescription requirement of 
 eight ounces; this is now added to the other ingredients of the 
 prescription. 
 
 TABLE FOR INFANT FEEDING 
 
 We now offer a monthly schedule — a table which is the 
 result of our experience in feeding hundreds of babies in vari- 
 ous sections of Chicago. It is not a schedule for the sick baby, 
 but it is a carefully tabulated outline for the normal, healthy, 
 average child ranging from one week to one year in age. In 
 offering this table we remind the mother, if the baby is six 
 months old and not doing well on the food it is getting and a 
 change is desired by both mother and physician, that it is far 
 better to begin with the second or third month's prescription 
 and quickly work up to the sixth month's. This change may 
 often be accomplished in two or three days. 
 
 In all large cities there are to be found milk laboratories 
 which make it their business to fill prescriptions for the modi- 
 fication of milk under the direction of baby specialists. This 
 milk can be absolutely relied upon. In specialized diet kitchens 
 in many large hospitals, these feeding prescriptions also may 
 be filled. 
 
HOME MODIFICATION OF MILK 
 
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172 THE MOTHER AND HER CHILD 
 
 TOP-MILK FORMULA 
 
 Top milk is the upper layer of milk which has been removed 
 after standing a certain number of hours in a milk bottle or any- 
 other tall vessel with straight sides. It contains most of the 
 cream and varying amounts of milk. It may be removed by a 
 small cream dipper which holds one ounce, or it may be taken 
 off with a siphon, but it should never be poured off. To obtain 
 seven per cent top milk which is the one most ordinarily used in 
 the preparation of top milk formulas, we take off varying 
 amounts — according to the quality of the milk — which Doctor 
 Holt describes as follows: 
 
 From a rather poor milk, by removing the upper eleven ounces 
 from a quart, or about one-third the bottle. 
 
 From a good average milk, by removing the upper sixteen ounces, 
 or one-half the bottle. 
 
 From a rich Jersey milk, by removing the upper twenty-two 
 ounces, or about two-thirds the bottle. 
 
 Cream is often spoken of as if it were the fat in milk. It 
 is really the part of the milk which contains most of the fat 
 and is obtained by skimming, after the milk has stood usually 
 for twenty- four hours; this is known as "gravity cream." It 
 is also obtained by an apparatus called a separator; this is 
 known as " centrifugal cream," most of the cream now sold 
 in cities being of this kind. The richness of any cream is indi- 
 cated by the amount of fat it contains. 
 
 The usual gravity cream sold has from sixteen to twenty 
 per cent fat. The cream removed from the upper part (one- 
 fifth) of a bottle of milk has about sixteen per cent fat. The 
 usual centrifugal cream has eighteen to twenty per cent fat. 
 The heavy centrifugal cream has thirty-five to forty per cent 
 fat. 
 
 The digestibility of cream depends much upon circumstances. 
 Many serious disturbances of digestion are caused by cream. 
 
 It is convenient in calculation to make up twenty ounces of 
 food at a time. The first step is to obtain the seven per cent 
 milk, then to take the number of ounces that are called for 
 in the formula desired. 
 
HOME MODIFICATION OF MILK 173 
 
 One should not make the mistake of taking from the top of 
 the bottle only the number of ounces needed in the formula, as 
 this may be quite a different per cent of cream and give quite a 
 different result. 
 
 There will be required in addition, one ounce of milk sugar 
 and one ounce of lime water in each twenty ounces. The rest 
 of the food will be made up of boiled water. 
 
 These formulas written out would be as follows: 
 
 FORMULA FROM SEVEN PER CENT MILK 
 
 I II III IV V VI VII VIII IX 
 
 Oz. Oz. Oz. Oz. Oz. Oz. Oz. Oz. Oz. 
 
 7 per cent milk 2 3 456789 10 
 
 Milk sugar 1 1 1 1 1 % % % % 
 
 Lime water 1 1 1 1 1 1 1 1 1 
 
 Boiled water 17 16 15 14 13 12 11 10 9 
 
 ~20 "20 ~20 ""20 ~20 ~20 ~20 ~~20 ~20 
 
 The approximate composition of these formulas expressed in 
 percentages are as follows: 
 
 Formula Fat Sugar Proteins 
 
 I 0.70 5.00 0.35 
 
 II 1.00 6.00 0.50 
 
 III 1.40 6.00 0.70 
 
 IV 1.75 6.00 0.87 
 
 V 2.00 6.00 1.00 
 
 VI 2.40 6.00 1.20 
 
 VII 2.80 6.00 1.40 
 
 VIII 3.10 6.00 1.55 
 
 IX 3.50 6.00 1.75 
 
 It is necessary to make the food weak at first because the infant's 
 stomach is intended to digest breast milk, not cow's milk; but if we 
 begin with a very weak cow's milk the stomach can be gradually 
 trained to digest it. If we began with a strong milk the digestion 
 might be seriously upset. 
 
 Usually we begin with number one on the second day; num- 
 ber two on the fourth day; number three at seven to ten days; 
 but after that make the increase more slowly. A large infant 
 with a strong digestion will bear a rather rapid increase and 
 may be able to take number five by the time it is three or four 
 weeks old. A child with a feeble digestion must go much 
 
174 THE MOTHER AND HER CHILD 
 
 slower and may not reach number five before it is three or 
 four months old. 
 
 It is important with all children that the increase in the food be 
 made very gradually. It may be best with many infants to increase 
 the milk by only half an ounce in twenty ounces of food, instead of 
 one ounce at a time, as indicated in the tables. Thus, from three 
 ounces the increase would be to three and one-half ounces; from 
 four ounces to four and one-half ounces, etc. At least two or three 
 days should be allowed between each increase in the strength of 
 the food. 
 
 PEPTONIZED MILK 
 
 Another modification which at times may be ordered by your 
 physician is peptonized milk. Since it is infrequent for the 
 proteins of milk to be the cause of indigestion, peptonized milk 
 has only a limited use, chiefly in cases of acute illness. The milk 
 is peptonized in the following manner : 
 
 Place the peptonizing powder (it is procurable in tubes or 
 tablets from the drug store) in a small amount of milk, and 
 after being well dissolved, put into the bottle or pitcher with the 
 plain or modified milk, after which the whole is shaken up 
 together. The bottle is then put into a large pitcher containing 
 water heated to about no° F. or as warm as would bear the 
 hand comfortably, and left for ten or twenty minutes (if the 
 milk is to be partially peptonized). To completely peptonize the 
 milk, two hours are required. Either of these formulas is only 
 used on the advice of a physician. 
 
 BUTTERMILK 
 
 In many cases of chronic intestinal indigestion, buttermilk 
 is used in place of the milk. It is prepared as follows: After 
 the cream has been taken from the milk and it has been allowed 
 to come to a boil, it is cooled to just blood heat. A buttermilk 
 tablet, having first been dissolved in a teaspoonful of sterile 
 water, is now stirred into the quart of warmed, skimmed milk 
 and allowed to stand at room temperature for twenty-four hours 
 at which time it should look like a smooth custard. With a 
 sterile whip this is now beaten and is ready for the sugar and 
 
HOME MODIFICATION OF MILK 175 
 
 the boiled water which is added according to the written pre- 
 scription from the doctor. 
 
 CONDENSED MILK 
 
 Under no circumstances should condensed milk be used as 
 the sole food of the baby for more than one month. Children 
 often gain upon it, but as a rule they have little resistance, and 
 they are very prone to develop rickets and oftentimes scurvy; 
 and, as noted elsewhere, orange juice should always be adminis- 
 tered at least once during the twenty-four hours as long as 
 condensed milk is used. 
 
 Of all the brands of condensed milk, those only should be 
 selected which contain little or no cane sugar. Perhaps the 
 " Peerless Brand " of evaporated milk is the most reliable and 
 in the preparation of food from this evaporated milk the same 
 amount of sugar, etc., should be added as we do in the prepara- 
 tion of " whole milk " or " top milk." 
 
 We do not in any way advise the use of condensed milk. 
 Fresh milk should always be used where it is obtainable, but 
 in traveling it sometimes has to be used. Holt says, " It should 
 be diluted twelve times for an infant under one month and six 
 to ten times for those who are older." 
 
 Malted milk is a preparation suitable in some cases where 
 fresh cow's milk is not obtainable. Even better than condensed 
 milk, this food will be found serviceable in traveling, or in 
 instances where only very bad cow's milk is within reach. 
 
 SPECIAL FOODS 
 
 Most patent foods are made up of starches and various kinds 
 of sugars, and some of them have dried milk or dried egg 
 albumin added. Many flours under fanciful names are sold on 
 the market today. For instance, one flour with a very fanciful 
 name is simply the old fashioned " flour ball " that our great, 
 great grandmothers made; and, by the way, perhaps there is 
 no flour for which we are more grateful in the preparation of 
 infant food than the flour ball which is prepared as follows : 
 A pound of flour is tied tightly in a cheesecloth and is put into 
 a kettle of boiling water which continues to boil for five or six 
 
176 THE MOTHER AND HER CHILD 
 
 hours, at the end of which time the cheesecloth is removed and 
 the hard ball, possibly the size of an orange, is placed on a pie 
 pan and allowed slowly to dry out in a low temperatured oven. 
 At the end of two or three hours, the ball, having sufficiently 
 dried, has formed itself into a thick outer peel which is removed, 
 while the heart which is very hard and thoroughly dry, is now 
 grated on a clean grater, and this flour has perhaps helped more 
 specialists to serve more sick babies than any other form of 
 starch known. It is used just as any other flour is used — wet 
 up into a paste, made into a gruel, which is boiled for twenty 
 minutes before it is added to the milk. 
 
 Whey is sometimes used in the preparation of sick babies' 
 food and is prepared as follows: 
 
 To a pint of fresh lukewarm cow's milk are added two tea- 
 spoons of essence of pepsin, liquid rennet or a junket tablet. It is 
 stirred for a moment, then allowed to stand until firmly coagulated, 
 which is then broken up and the whey strained off through a 
 muslin. 
 
 The heavy proteins remain in the curd, and the protein that 
 goes through with the whey is chiefly the lactalbumin. 
 
 h 
 
 1 
 
CHAPTER XIX 
 THE FEEDING PROBLEM 
 
 A FRIEND of ours who presides over a court of domestic 
 relations in a large city, recently told us that he believed 
 much trouble was caused in families — many divorces, occa- 
 sioned, and many desertions provoked — because improperly fed 
 babies were cross and irritable and so completely occupied the 
 time of the mother, who, herself, knew nothing about mother- 
 craft or the art of infant feeding. Consequently, the home was 
 neglected and unhappy, quarreling abounded and failure, utter 
 failure, resulted. The children were constantly cross, and so 
 much of the mother's time was consumed in caring for these 
 irritable, half-fed babies, that the home was disheveled, the 
 meals never ready, the husband's home-coming was a dreaded 
 occurrence, and he, endeavoring to ;seek rest and relaxation, 
 usually sought for it in the poolroom or the saloon, with the 
 usual climax which never fails to bring the time-honored results 
 of debauch — despair and desertion. 
 
 In the beginning of this book we paid our respects to the 
 present-day educational system which does not provide an 
 adequate compulsory course in which all women could be given 
 at least a working knowledge of home-making and the care 
 and feeding of the babies; so that statement need not be 
 repeated in this chapter. But we wish to add, in passing, that 
 ignorance is the basis and the foundation of more unhappy 
 homes, broken promises, panicky divorces, and shattered hopes, 
 as well as of more deaths during the first year of infancy, than 
 any other cause. And in speaking of its relationship to baby- 
 craft, we believe that ignorance concerning normal stools, how 
 many times a day the bowels should move; how much a baby's 
 stomach holds ; how often he should be fed, etc. — I say it is 
 
 177 
 
178 THE MOTHER AND HER CHILD 
 
 ignorance of these essential details that lies at the bottom of 
 many problems which come up during the first year, par- 
 ticularly the " feeding problem." 
 
 INFANT WELFARE 
 
 In the city of Chicago at the time of this writing, the Infant 
 Welfare Association maintains over twenty separate stations 
 where meetings are held for mothers, where lectures are deliv- 
 ered on the care and feeding of babies. Babies are brought 
 to these stations week in and week out; they are weighed and 
 measured and, if bottle-fed, nurses are sent to the homes to 
 teach the mother how properly to modify the milk in accord- 
 ance with the physician's orders. The health authorities of our 
 city also maintain several such stations where mothers and 
 babies may have this efficient help. A corps of nurses are 
 employed to carry out the instructions and to follow up the 
 mothers and the babies in their homes, and thus the death rate 
 has been greatly reduced, not only in our city but in all such 
 cities where baby stations have been instituted. In a certain 
 ward in Philadelphia the death rate was reduced forty-four 
 per cent in one year after the baby stations were established. 
 
 CHOOSING A FORMULA 
 
 There are three classes of infants who require weak-milk 
 mixtures to begin with : namely, the baby who has been previ- 
 ously nursed and whose mother's milk has utterly failed; the 
 baby just weaned; and the infant whose power to digest is low. 
 If these children were six months old, and the formula best 
 suited to them is unknown, we must begin with a formula 
 suited to a two- or three-month-old child and quickly work up 
 to the six-month formula, which may often be accomplished 
 within two or three days. 
 
 THE BOTTLE-FED BABY 
 
 When a baby is getting on well with his food, he should 
 show the following characteristics : He should have a good 
 appetite; should have no vomiting or gas; he should cry but 
 little; and he should sleep quietly and restfully. His bowels 
 
THE FEEDING PROBLEM 179 
 
 .should move once or twice in twenty-four hours. His stool 
 should be a pasty homogeneous mass. He should possess a clear 
 skin and good color. He should show some gain each week — 
 from four to eight ounces — and he should also show mental 
 development. 
 
 As long as a baby appears happy and gains from four to 
 eight ounces a week and seems comfortable and well satisfied, 
 the feeding mixture should not be changed or increased. 
 
 MAKE CHANGES GRADUALLY 
 
 In our experience with the artificial feeding of infants, we 
 have come to look upon the practice of gradually changing the 
 food formula as the most important element in successful baby 
 feeding. 
 
 We recall one mother in the suburbs who came to us with 
 her baby who had been feeding on a certain proprietary food. 
 She declared that it " just couldn't take cow's milk." She 
 admitted " it was not doing well/' and so she would like to 
 have help. The baby was old enough, had it been normal, to 
 have been taking whole milk for some time. We recall our 
 having the mother prepare the proprietary food just as she had 
 been used to preparing it, and each day we had her throw 
 away one-half ounce and put in one-half ounce of whole milk, 
 this mixture she fed the baby for two days. 
 
 The next time, we had her take out one ounce of the mixture 
 and put in one ounce of whole milk, which we fed the baby 
 for three successive days; and then one and one-half ounces 
 were substituted which was fed to the baby for four days; and 
 thus we carefully, slowly, and gradually withdrew the proprie- 
 tary food and substituted fresh, certified cow's milk. It took 
 us a month to complete the change, but we are glad to add that 
 it was done without in the least disturbing the child. 
 
 Now, had the change been made abruptly — in a day or two, 
 or three days — the baby would probably have been completely 
 upset, while both the mother and the doctor would have been 
 greatly discouraged. Many mothers and even some physicians 
 have jumped from one baby food to another baby food; they 
 have tried this and they have tried that, until the poor child. 
 
180 THE MOTHER AND HER CHILD 
 
 having been the victim of a number of such dietetic experi- 
 ments, finally succumbed. 
 
 We cannot urge too strongly the fact that, as a rule, when- 
 ever a change is made from one food to another, it should be 
 done gradually, unless it be the change of a single element 
 such as that of a very high per cent of cream found in top 
 milk mixtures, when it seems to be a troublesome element in 
 the milk. No bad effects will follow the quick change to 
 skimmed milk with added sugar, starches, etc.; but in changing 
 from a proprietary food to a milk mixture, the change should 
 always be made gradually, the quantity of the new food being 
 increased gradually. Milk should be increased by quarter (34 ) 
 ounce additions, and it should not be increased more than one 
 ounce in one week; while the mixture should not be increased 
 as long as the baby is gaining satisfactorily. A wise mother 
 and an experienced physician can usually see at a glance when 
 a child is doing well — by the color and consistency of the stools, 
 the child's appetite, his sleep, and his general disposition. 
 
 COMMON MISTAKES IN FORMULAS 
 
 First and foremost, we believe a great mistake is often made 
 in using too heavy cream mixtures; babies as a rule do not 
 stand the use of too high a percentage of cream. Formulas 
 that call for whole milk should contain four per cent fat or 
 cream; and while babies often gain rapidly on the higher per- 
 centage of cream found in a rich Jersey milk, nevertheless, 
 sooner or later serious disturbances of digestion usually occur. 
 Herd milk is, therefore, better for the babies because in the 
 " whole milk " of the herd of Holsteins we have only about 
 four per cent fat. 
 
 Another common mistake is too heavy feeding at the time of 
 an attack of indigestion ; even, the usual feeding may be too 
 heavy during this time of indisposition. It is not at all uncom- 
 mon for us to dilute baby's food to one-third its strength at 
 the time of an acute illness. 
 
 Still another trouble maker is dirt — dirt on the dish-towel, 
 dirt on the nipple, dirt in the milk, dirt on the mother's hands. 
 Dirt is an ever present evil and an endless trouble maker, as 
 
THE FEEDING PROBLEM 181 
 
 evidenced by stool disturbances, indigestion, fretful days, and 
 sleepless nights. A dirty refrigerator is another factor which 
 has been responsible for much illness and distress. 
 
 Indigestion is often brought on because a nurse, caretaker, 
 or possibly the mother, not wishing to go down to the refriger- 
 ator in the middle of the night, brings up the food early in 
 the evening and allows it to become warm — to remain in a 
 thermos bottle — and we are sure that had they been able to 
 see the enormous multiplication of germs because of this warm 
 temperature, they would never have given occasion for such 
 an increase in bacteria just to save themselves a trifle of incon- 
 venience. 
 
 Still another common mistake is to use one formula too long; 
 a feeding mixture which was good for four or possibly six 
 weeks, must be changed as the child grows older and his 
 requirements become greater. Let the weight, stools, general 
 disposition and sleep of the child be your guides, and with 
 these in mind errors in feeding can be quickly detected and 
 minor mistakes speedily rectified. 
 
 SYMPTOMS OF DISSATISFACTION 
 
 Some of the pointed questions which are put to a young 
 mother who brings her child into the office of the baby specialist, 
 are the following: 
 
 Does the baby seem satisfied after his feeding? 
 
 Does he suck his fist? 
 
 How much does he gain each week in weight? 
 
 Does he sleep well? 
 
 Does the baby vomit? 
 
 What do his bowel movements look like? 
 
 Will you please send a stool to the office? 
 
 With the intelligent answers to these questions — after know- 
 ing the birth weight and the age of the child and its general 
 nervous disposition — the physician can formulate some con- 
 clusion as to the babe's general condition and can usually 
 find a feeding formula that will make him grow. 
 
 Vomiting, restlessness, sleeplessness and the condition of the 
 
182 THE MOTHER AND HER CHILD 
 
 bowels, are the telltales which indicate whether or not the food 
 is being assimilated; and the stools may vary all the way from 
 hard bullet-like lumps to a green diarrhea. 
 
 Babies do not thrive well in large institutions where the 
 food is so often made up in a wholesale manner, for the simple 
 reason that the food elements are not suited to the need of 
 each individual baby. Some infants are unable to digest raw 
 milk, and for them sterilized or boiled milk should be tried; 
 others require a fat-free mixture such as skimmed milk, while 
 still others may need buttermilk for a short time. Babies 
 require individual care, particularly in their food, and the good 
 or bad results are plainly shown in the stools, weight, sleep, etc. 
 
 FLATULENCE 
 
 Flatulence is an excessive formation of gas in the stomach 
 and bowels leading to distension of the abdomen and the belch- 
 ing of gas, and often the bringing up of a sour, pungent, watery 
 fluid. 
 
 Flatulence is seen in infants suffering from intestinal indi- 
 gestion and the food is nearly always at fault. This condition 
 is the result of the faulty digestion of the sugar and starches 
 — particularly the starch — which should be immediately 
 reduced. In such conditions the addition of a slight amount 
 of some alkaline (such as soda, magnesia or lime water) to 
 the food often produces good results. Great patience must be 
 exercised with a child that suffers from flatulence, for immediate 
 improvement can hardly be expected; time is required for the 
 restoration of good digestion. 
 
 VOMITING 
 
 Vomiting is perhaps more often the result of over feeding or 
 too frequent feeding than anything else. A healthy, breast-fed 
 baby may now and then regurgitate a bit, but it simply spills 
 over because it is too full. We do not refer to this as vomiting, 
 we refer to the belching up or vomiting of very sour or acrid 
 milk which leaves a sour odor on the clothing. This can all 
 usually be rectified by lengthening the intervals from two to 
 three hours and preventing bolting of food by getting a nipple 
 
THE FEEDING PROBLEM 183 
 
 whose hole is not so large. Too much cream in the food will 
 also sometimes cause vomiting. 
 
 Too frequent feeding at night is another cause of vomiting. 
 When the stomach is full, the failure to lay the baby down 
 quietly, as is so often seen in those homes where bouncing and 
 jolting are practiced, may also result in vomiting. 
 
 Vomiting may be the first sign of many acute illnesses such 
 as scarlet fever, measles, pneumonia, whooping cough, etc. 
 
 The treatment for acute vomiting is simple. All foods should 
 be withheld — nothing but plain, sweetened water should be 
 administered, while it is often advisable to give a dose of 
 castor oil. A physician should be called at once if the vomit- 
 ing continues, and not until the vomiting has entirely ceased 
 for a number of hours and water is easily retained, should food 
 be given, and even then it should be begun on very weak 
 mixtures. 
 
 OVER-FEEDING 
 
 The size of the child's stomach should be the guide to the 
 quantity of food given, and attention is called to the table 
 given in a previous chapter. All food taken in excess of his 
 needs lies in his stomach and intestines only to ferment and 
 cause wind and colic. The symptoms of over-feeding are rest- 
 lessness, sleeplessness, stationary weight (or loss in weight), 
 and oftentimes these very symptoms are interpreted by the 
 mother as sufficient evidence that the baby needs more food; 
 and so the reader can see the terrible havoc which is soon 
 wrought where such ignorance reigns. 
 
 WEIGHT 
 
 The weighing time should immediately follow a bowel move- 
 ment and just before a feeding time; then, and only then, 
 we have the real weight of baby, as a retained bowel movement 
 may often add from four to five ounces to the child's weight. 
 There should be a careful record of each weighing, for there 
 may develop a great difference if different members of the 
 family endeavor to keep the weight in their minds. The normal 
 baby should gain four to eight ounces a week up to six months, 
 
184 THE MOTHER AND HER CHILD 
 
 and from then on the weekly gain is from two to four ounces; 
 in other words, by six months the baby should double his birth 
 weight and at the end of a year his weight should be three 
 times the birth weight. A stationary or diminishing weight 
 demands careful attention; a good doctor should be called at 
 once. Likewise, a very rapid increase in weight is not to be 
 desired, as we do not want a fat baby, but we do desire a well- 
 proportioned and alert baby, and, as someone has said, it is 
 better to have little or no gain during the excessive heat than 
 to upset the digestion by over-feeding, designed to keep the 
 baby gaining. 
 
 In weighing, usually the outside garments are removed, 
 leaving on a shirt, band, diaper, and stockings with the neces- 
 sary pins; the little fellow thus protected is placed into the 
 weighing basket and at each successive weighing, these same 
 clothes or others just like them are always included in the 
 weight, and it should be so reported to the physician. 
 
 THE STOOLS 
 
 In the chapter " Baby's Early Care," the first stools were 
 described in detail, and there we learned that the dark, tarry, 
 meconium stools are quickly changed within a week to the 
 normal canary-yellow stool, having the odor of sour milk. 
 
 The bottle-fed babies' stools differ somewhat in appearance; 
 they are thicker and a lighter color, but should always be 
 homogeneous if the food is well digested. They do not have 
 nearly the number of bowel movements each day that the 
 breast-fed baby does. If a bottle-fed baby's bowels move once 
 a day and he seems perfectly well otherwise, we are satisfied. 
 And curds (white lumps), or mucus (sedimentary, slimy 
 phlegm), indicate that the food is not well digested. 
 
 BOTTLE FEEDING AND CONSTIPATION 
 
 A bottle baby may be constipated because the proteins are 
 too high, the fat too high, the food of an insufficient quantity 
 or quality, or the milk have been boiled, while weak babies 
 really may lack the muscular power to produce a bowel move- 
 ment. With the help of your physician endeavor to arrive 
 
THE FEEDING PROBLEM 185 
 
 at the cause of the constipation, and, if the baby is two or 
 three months old, from one to two teaspoons of unsweetened 
 prune juice may be administered. Milk of magnesia may be 
 added to the food (leaving out the lime water), or a gluten 
 suppository may be used. 
 
 The change from milk sugar to malt sugar has helped many 
 infants; while the giving of orange juice (after six months) is 
 very beneficial in many cases. A small amount of sweet oil may 
 be injected into the rectum which will lubricate the hard lumps 
 and thus favor comfortable evacuation. The periodicity of the 
 bowel movement (at definite times each day) is a matter of 
 great importance. Immediately after a meal, if the child is 
 old enough, he should be placed on the toilet chair. A bit of 
 cotton, well anointed with vaseline and inserted into the rectum 
 just before meals, will often aid in producing a bowel move- 
 ment shortly after the meal has been taken. 
 
 Abdominal massage should be administered in all instances 
 of constipation, beginning with light movements and gradually 
 increasing, with well-oiled hands. 
 
 DIARRHOEA 
 
 Diarrhoea usually accompanies acute intestinal indigestion and 
 is so often associated with the common disorders of infancy 
 that we refer the reader to the chapter " Common Disorders 
 of Infancy." Dark stools should always be saved for the 
 physician to observe, as they frequently contain blood. Stools 
 full of air bubbles with pungent sour odor show fermentation ; 
 in which cases the starches should be reduced, if not entirely 
 taken away from the food mixtures. Green stools mean putre- 
 faction from filth-germs; a thorough cleansing of the bowel 
 should be immediately followed by a reduction in the strength 
 of the food and the boiling of the milk. 
 
 REGULATION OF THE STOOLS 
 
 At a certain time each day the napkin should be removed 
 and the child should be held out over a small jar. It is sur- 
 prising to note how quickly and readily the little fellow co- 
 operates. Diaper experiences may be limited to much less than 
 
186 THE MOTHER AND HER CHILD 
 
 a year if the mother has patience enough and the baby has the 
 normal intelligence to enter into this regulation regime. We 
 recall one caretaker who complained bitterly because the child 
 under her care constantly wet his diaper; so the caretaker 
 was instructed to keep a daily schedule of the baby's actions 
 for five days ; and, to her surprise, she discovered that the 
 baby urinated about the same time each day. A regularity 
 was also noted concerning the bowel movements. 
 
 The variations in the time of the urinations were only 
 fifteen or twenty minutes, so nearly did the kidneys act at 
 the same time each day. The caretaker was instructed to remove 
 the diaper and hold the baby out at the earliest occurrence on 
 the daily schedule, and, to the astonishment of the entire 
 family, no further accidents occurred, and the child soon ac- 
 quired the habit of letting them understand when he was about 
 to wet his diaper. Bowel movements may be regulated more 
 easily than the urination. After the child is about a year old, 
 very few accidents should occur. 
 
 MIXED FEEDING 
 
 In many instances, and particularly if the infant is under 
 six months of age, and where he has had to have additional 
 feeding from the bottle — under such circumstances the breast 
 milk may be continued as " partial feeding," at least until the 
 baby has reached his ninth or tenth month, at which time it 
 may be wholly discontinued. 
 
 At each nursing time the baby empties both breasts, and 
 the amount he draws may readily be estimated by carefully 
 weighing him before and after each nursing. By referring 
 to the directions in a previous chapter, the quantity of food 
 needed for his size and age may be determined ; while the deficit 
 is made up from a bottle of milk containing properly modified 
 cow's milk. 
 
 If the mother's health admits, or if the breasts continue to 
 secrete a partial meal for the babe, mixed feeding should be 
 continued until after the ninth or tenth month, when it can 
 gradually be reduced from four or five times each day to once 
 or twice a day, until it is finally omitted altogether. In the 
 
THE FEEDING PROBLEM 187 
 
 meantime, the baby is gradually getting stronger food and at 
 eleven or twelve months the little fellow is able to subsist and 
 thrive upon whole milk. 
 
 INFANT FEEDING PUZZLES 
 
 It is very difficult to explain how some babies thrive on some 
 certain food while others grow thin and speedily go into a decline 
 on the same regime. The hereditary tendencies and predisposi- 
 tions undoubtedly have a great deal to do with such puzzling 
 cases. 
 
 Again, sometimes a slight variation in technic or some other 
 trifling error in connection with the preparation of the 
 baby's food, may be more or less responsible for the varia- 
 tion in the results obtained. No two mothers will prepare food 
 exactly alike even when both are following the same printed 
 directions and these slight discrepancies are enough to upset 
 some delicately balanced baby. 
 
 On the other hand, some babies are born with such strong 
 digestive powers and such a powerful constitution that they are 
 easily able to survive almost any and all blunders as regards 
 artificial feeding, while at the same time they also manifest the 
 ability to surmount a score of other obstacles which the com- 
 bined ignorance and carelessness of their parents or caretakers 
 unknowingly place in the pathway of early life which these little 
 folks must tread. 
 
 The fact that so many babies do so well on such unscientific 
 feeding only serves to demonstrate the old law of " the survival 
 of the fittest " — they are born in the world with an enormous 
 endowment of " survival qualities " — and in many cases the 
 little fellows thrive and grow no matter how atrociously they 
 are fed. 
 
 There may be other factors in the explanation of why some 
 babies do so well on such poor care, but heredity is the chief 
 explanation, while adaptation is the other. If the little fellows 
 can survive for a few weeks or a few months, the human 
 machine possesses marvelous powers of adaptation, and we 
 find here the explanation why many a neglected baby pulls 
 through. 
 
188 THE MOTHER AND HER CHILD 
 
 INFANT FOODS 
 
 Rickets and scurvy have so often followed the prolonged use 
 of the so-called " infant foods " which have flooded the market 
 for the past decade, that intelligent physicians unanimously 
 agree that they are injurious and quite unfit for continued use in 
 the feeding of infants. If they are prescribed to replace milk 
 during an acute illness, or at other times when the fats and 
 proteins should be withheld for a short period, both the 
 physician and the mother should be in the possession of definite 
 and exact knowledge as to just what they do and do not con- 
 tain. To provide such knowledge, we present the analysis 
 (Holt) of some of the more commonly used infant foods. 
 
 1. The Milk Foods. Nestle's Food is perhaps the most widely 
 known. The others closely resembling it in composition are 
 the Anglo-Swiss, the Franco-Swiss, the American-Swiss, and 
 Gerber's Food. These foods are essentially sweetened, con- 
 densed milk evaporated to dryness, with the addition of some 
 form of flour which has been dextrinized; they all contain a 
 large proportion of unchanged starch. 
 
 2. The Liebig or Malted Foods. Mellin's Food may be taken 
 as a type of the class. Others which resemble it more or less 
 closely are Liebig's, Horlick's Food, Hawley's Food, malted 
 milk, and cereal milk. Mellin's food is composed principally 
 (eighty per cent) of soluble carbohydrates. They are derived 
 from malted wheat and barley flour, and are composed chiefly 
 of a mixture of dextrins, dextrose, and maltose. 
 
 3. The Farinaceous Foods. These are Imperial Granum, 
 Ridge's Food, Hubbell's Prepared Wheat, and Robinson's Patent 
 Barley. The first consists of wheat flour previously prepared 
 by baking, by which a small proportion of the starch — from 
 one to six per cent — has been converted into sugar. 
 
 In chemical composition these four foods are very similar to 
 each other, consisting mainly of unchanged starch which forms 
 from seventy-five to eighty per cent of their solid constituents. 
 
 4. Miscellaneous Foods. Under this head may be mentioned 
 Carnrick's Soluble Food and Eskay's Food. 
 
 The composition of the foods mentioned is given in the accom- 
 panying table. 
 
THE FEEDING PROBLEM 
 
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CHAPTER XX 
 BABY'S BATH AND TOILET 
 
 FROM earliest girlhood, women have loved their dolls, and 
 one of the greatest joys connected with the adored expe- 
 rience was the make-believe bath and the dressing of the make- 
 believe baby ; so now, when we are the happy possessors of real 
 live dolls, we should go about the task with the same light- 
 headedness of a score of years ago when we hugged, kissed, 
 bathed, and dressed our dolls. There is one big advantage now, 
 the doll won't break; but, we sigh as we stop to think, we can't 
 stick pins into it as we all did into the sawdust bodies of our 
 dolls those years and years ago. 
 
 THE FIRST WEEK 
 
 In the chapter on " Baby's Early Care," this subject was 
 fully discussed and we only wish to repeat, in passing, that 
 before baby's bath or toilet is undertaken the hands of the 
 mother, nurse, or caretaker must be scrupulously clean. And 
 while the first day's bath usually consists of sweet oil, albolene, 
 or benzoated lard, if the new baby happens to come during the 
 very warm days of July or August and the oil seems to irritate 
 the soft downy skin, as it often does during those hot days, a 
 simple sponge bath may be substituted. The cord dressing 
 remains as the doctor left it, and if there be any interference, 
 let it be subject to his orders. 
 
 The cord usually drops off, and the abdomen is entirely healed 
 by the seventh to the tenth day, after which time baby is daily 
 sponged for another week. And now we will describe in detail 
 the simplest, easiest manner of administering an oil bath or a 
 sponge bath. 
 
 190 
 
BABY'S BATH AND TOILET 191 
 
 GIVING THE BATH 
 
 A large pillow or a folded soft comfort is placed on a table 
 in a warm room — temperature not below 75 F. On baby's 
 tray near by, and within reaching distance, are the boracic acid 
 solution in a small cup, a medicine dropper, the warm saucer 
 of oil, the toothpick applicators (made by twisting cotton about 
 one end, making sure the sharp end of the pick is well pro- 
 tected), a glass jar of small cotton balls made from sterile 
 absorbent cotton, the castile soap, talcum powder, needle and 
 thread. A vessel of warm water, several old, soft, warmed 
 towels and the clean garments required, complete the layout. 
 
 Into the warm, soft blanket on the pillow or comfort we 
 place the partially undressed baby, for the binder, diaper, and 
 socks are not removed until the head-and-face toilet is com- 
 pleted. 
 
 The top of the head, behind the ears, the folds of the neck, 
 and the armpits are now gently but thoroughly rubbed with 
 oil, which is then all rubbed off with a soft linen towel. The 
 eyes next receive two or three drops of the boracic acid solu- 
 tion, put in by the aid of the medicine dropper, while, with a 
 separate piece of cotton, the surplus solution is wiped off each 
 eye, rubbing from the nose outward. 
 
 Then with the applicator made by wrapping cotton about the 
 end of a toothpick, oil is put into each nostril, all the time exer- 
 cising the utmost care not to harm the tender mucous membrane. 
 The ears are also carefully cleansed with a squeezed-out dip of 
 boracic acid on the applicator. 
 
 Unless there is an inflammation present in the mouth, and 
 the physician in attendance has ordered mouth swabbing, do not 
 touch it; for much harm is done the mucous membrane of the 
 baby's mouth by the forceful manner in which much of the 
 swabbing is done. The face and head are then washed with 
 warm water; very little soap is needed and, when used, must 
 be most thoroughly rinsed off. 
 
 THE SECOND WEEK 
 
 And now during the second week, we proceed to sponge the 
 baby's body; the hands are washed with soap and rinsed, and, 
 
192 THE MOTHER AND HER CHILD 
 
 only those who have performed this feat know just how tightly 
 they hold shut their little fists. These hands must be relaxed, and 
 all the lint, dirt, and perspiration be thoroughly washed away. 
 The arms, shoulders, chest, and back are then sponged. All the 
 time the nurse or caretaker is standing while carrying out this 
 most pleasant task. At any time she may quickly cover the 
 babe and stop for this or that with no inconvenience to herself 
 or the child. 
 
 After the thorough drying of baby's upper body, a bit of 
 talcum is put under the arms, in the folds of neck, etc., and the 
 shirt is slipped on. Next the band, diaper, and stockings are 
 removed and after first oiling the groin and the folds of the 
 thighs and the buttocks, the same sponging, drying, and powder- 
 ing is done here as on the upper body. 
 
 The band is now applied, and sewed on. The diaper, stock- 
 ings, booties, and — if a winter baby — the skirt and outing 
 flannel gown (for babies should wear only night dresses for the 
 first two or three weeks) are now slipped over the feet and 
 drawn upward, and baby is ready for nursing or for his nap. 
 
 TEMPERATURE OF BATHS 
 
 First few weeks, ioo F. ; early infancy, 98 F. ; after six months, 
 97 F., cooling down to 90 F. 
 
 A wooden bath thermometer may be purchased for twenty- 
 five cents and it should be in every home where babies are 
 bathed. In the absence of a thermometer do not depend upon 
 the hand to determine temperature. Thrust the bared elbow 
 into the water and if it is just comfortable — neither hot or 
 cool — it is probably about the correct temperature for baby. 
 Do not shock the baby by dashes of cold water, for, while it 
 may amuse an onlooker, it unnecessarily frightens your child, 
 and, subconsciously, he learns to dread his bath. 
 
 THE BATHING PLACE 
 
 If the bathroom is warm — temperature 75 F. — that is the 
 most logical place for the bath, provided baby has his own tub. 
 Place a couple of strong slats several inches wide across the 
 big tub, six inches apart, and on this place the baby's tub. Of 
 
BABY'S BATH AND TOILET 193 
 
 course, care must be exercised to prevent slipping by means of 
 properly fitted cleats on the under surface of the slats. The 
 mother should always stand to bathe her baby and the small 
 tub should be placed at such a height that she neither has to 
 stoop nor bend. Thus the bathing of the baby becomes a 
 pleasure instead of a "job" or an "irksome task." 
 
 If the bathroom is not warm then the kitchen table or a small 
 table pulled up near the stove is a place par excellence for the 
 dip. 
 
 Many boils seen on young baby's tender skin have been traced 
 to the careless use of the family tub to bathe the baby in. Not 
 until the child is two or three years of age, when his skin has 
 become more toughened, should he be allowed to use the 
 family tub. 
 
 FREQUENCY OF BATHS 
 
 To begin with, we never bathe either a baby or an adult 
 immediately after a full meal. From one hour to one and one 
 half hours should intervene. 
 
 The frequency of baths depends somewhat upon the season 
 of the year, the vitality of the child, and the warmth of the 
 home. 
 
 We have seen many infants who were bathed too often. The 
 vitality expended upon the necessary reaction following a tub 
 bath was too much for the little fellow; the daily bath was 
 stopped and a semi-weekly bath substituted, much to the gain 
 of the child. Of course in this instance the hands, face, and 
 buttocks received a daily sponging. 
 
 The oil bath may be administered daily. In robust children 
 the tub bath may be a daily affair; while in pale, anemic little 
 folks, the tub bath is perhaps better given twice a week. In 
 hot summer days a sponge bath may be given many times a 
 day. 
 
 BEST HOUR FOR BATHING 
 
 Again this depends upon several factors; the warmth of 
 the house or apartment, the vitality of the child, and the kind 
 of bath to be administered. 
 
194 THE MOTHER AND HER CHILD 
 
 An oil bath may be given any time — often it may be admin- 
 istered entirely under the bed clothes, only care must be taken 
 to keep oil from the blankets. 
 
 Many of our mothers prefer to give the tub bath at five 
 o'clock in the afternoon, when the house is thoroughly warm, 
 and the child is thereby prepared for the long night's sleep. 
 Before dressing in the morning an oil bath or rub may be 
 given in such cases. 
 
 If the forenoon is selected as the time for bathing the child, 
 then an hour just before the mid forenoon meal is the best. 
 In either event, be regular about it — do it at the same time 
 every day. Let the caretaker attend to her many duties, and, 
 as far as possible, mothers, bathe your baby yourself. The 
 folds of the skin, the creases in the neck, the clenched fists, 
 must all receive particular care, and no one in all the world will 
 ever care as you — the mother — cares. 
 
 SOAP AND WATER 
 
 Select a soap free from irritants and excess of alkalis. There 
 are few kinds that equal the old-fashioned, white castile soap 
 our grandmothers used. 
 
 Very hard water which makes the skin rough and sore may 
 be improved by boiling, but if possible substitute rain water for 
 it. A flannel bag tied over the faucet and changed each day 
 will help to clarify muddy water, provided the stream flows 
 gently through it. 
 
 ROUTINE OF THE TUB BATH 
 
 Just as we directed the nurse or caretaker to stand while the 
 oil rub or sponge bath was given, so we admonish the mother 
 to stand while the tub bath is given. First, get everything in 
 readiness for the bath as directed for the oil bath, and then 
 the baby's tub setting on the securely cleated slats placed across 
 the top of the family tub may be filled with water by means of 
 a hose attached to the faucet. The temperature should be 
 ioo F. when baby is dipped in to be rinsed. 
 
 The head and face toilet are identical with that described 
 before, and with the baby undressed and wrapped in a warm 
 
Fig. 13. Supporting the Baby for the Bath 
 
BABY'S BATH AND TOILET 195 
 
 towel placed inside the warm blanket on the pillow or comfort 
 as before mentioned, we proceed with a good lather of castile 
 soap and water to lather the baby's body all over — under the 
 arms, the neck, chest, groins, thighs, buttocks, legs, feet, and 
 between the toes, while the genitals also receive their share of 
 attention. The foreskin of the boy baby is gently pushed back 
 and cleansed thoroughly; while the vulva of the little girl baby, 
 having first been swabbed with boracic acid, is now gently 
 lathered and cleansed. Now grasp the ankles and legs with the 
 right hand and support the upper back and neck and shoulders 
 with the left and gently lower the baby into the water in a semi- 
 reclining position (See Fig. 13). The water should cover the 
 shoulders. Keep a good firm supporting left hand under the 
 head, neck, and shoulders, and with the right, rinse all soap from 
 the body. 
 
 After this is thoroughly done, lift the baby out onto a fresh 
 warm towel inside the warm blanket on the pillow, and remain 
 standing, while you gently pat (never rub) the baby dry. All 
 the little folds, creases, and places between fingers and toes, 
 are carefully patted dry, and where any two skin surfaces rub 
 together put on a bit of talcum. 
 
 The dressing takes place in the manner already described — 
 first the shirt, then the band (sewed on), the diaper, stockings, 
 skirt, and gown. 
 
 Please note that the soap bath is contra-indicated (should not 
 be given) in case of eczema. 
 
 baby's daily rub 
 
 This soap bath should be administered for cleanliness only, 
 and should be given twice a week. If a tub bath is to be given 
 on other days, after the routine head and face toilet, the baby 
 is simply dipped into the water and the soft skin gently rubbed. 
 
 If the sponge or tub bath is given in the afternoon just 
 before the long sleep at night, then the oil rub should take 
 place before the mid- forenoon meal; and likewise, if the sponge 
 or tub bath is given during the mid forenoon, then the oil rub 
 or dry hand rub is given before the going-to-bed time. The 
 rub should be a daily procedure for the first two years. Nothing 
 
196 THE MOTHER AND HER CHILD 
 
 rougher than the soft palm of the hand should be rubbed on 
 baby's soft skin. 
 
 USE AND ABUSE OF TALCUM 
 
 Babies have come to my clinic with cakes of talcum under 
 their arms, and particularly between their thighs and in the 
 crease of the buttocks. Here the well-meaning but thoughtless 
 mother had reasoned, "a little is good; more is better" which 
 is not always the case. 
 
 Talcum is not used to replace careful drying, and it should 
 never be found in quantities on the baby's skin any more than 
 you would expect to find quantities of face powder caked in the 
 creases of the neck or behind the ears of an adult. The skin 
 is first cleaned, then patted entirely dry, and, as a finishing touch, 
 a bit of talcum is put on by means of a puff. 
 
 TONIC AND MEDICATED BATHS 
 
 Tonic baths are usually given to older children when they 
 are able to enter into the sport and frolic of a cool bath. Baths 
 are called tonic because they call forth from the body a reac- 
 tion — a sort of circulatory rebound. This rebound or reaction 
 brings the blood to the skin, increases the circulation, and tones 
 up the nerves. The room should be properly warmed and, if 
 necessary, some form of exercise be continued after the bath 
 to prevent the chill that sometimes follows a poorly administered 
 bath. 
 
 In the case of the anemic child, after six months of age, 
 the mother's hand dipped in cold water may briskly rub the chest 
 and back until it glows or becomes red. The child should enjoy 
 this bath. Never frighten a child by throwing cold water on 
 it or by giving it a too sudden cold plunge; great harm may be 
 permanently done by these efforts to " toughen the baby." 
 
 The simple medicated baths may be administered according 
 to the following directions: 
 
 Salt. Use half a teacup of common salt or sea salt to each 
 gallon of water. The salt should first be dissolved in a cup 
 of warm water to prevent the sharp particles from pricking 
 the skin. The doctor sometimes orders a salt bath. 
 
BABY'S BATH AND TOILET 197 
 
 Starch. Add a cup of ordinary, cooked laundry starch for 
 every gallon of water in the bath. 
 
 Soda. A soda bath requires two tablespoons of ordinary bak- 
 ing soda to a gallon of water, dissolving it in a little water 
 before adding it to the bath. 
 
 Bran. Make a cotton bag of cheesecloth or other thin mate- 
 rial, six inches square. Fill loosely with bran. Soak the bag 
 in the bath water, squeezing it frequently until the water be- 
 comes milky. 
 
 Starch, soda, and bran baths are often used in place of the 
 ordinary soap and water bath when the skin is inflamed, as in 
 cases of chafing or prickly heat. 
 
 FEAR OF BATHS 
 
 Force and harshness are not likely to cause baby to overcome 
 very much of the fear of a tub bath. Patience, perseverance, 
 and purposeful diversion of mind will bring sure results. 
 
 In the case of a very young baby, have a helper stretch a 
 towel across the filled baby tub, lay the baby in it, with its 
 head well supported, and then gently lower the towel into the 
 water, keeping the head out. (Most anyone would fear an 
 all-over ducking, if he had ever been completely ducked into 
 water by a careless or mischievous friend). 
 
 In the case of older children, celluloid ducks, fish, or boats 
 may float about on the water, and the entire bath be forgotten 
 by the little fellow's enjoyment of " his boats." 
 
 OUT OF DOOR BATHING 
 
 Although a baby under two years should never be given a sea 
 bath, a word of caution about sea bathing for young children may 
 not be amiss. The cruelty with which well-meaning parents treat 
 young, tender children by forcibly dragging them into the surf, a 
 practice which may be seen at any seaside resort in the summer, 
 can have no justification. The fright and shock that a sensitive 
 child is thus subjected to is more than sufficient to undo any 
 conceivable good resulting from the plunge. On the other hand, a 
 child who is allowed to play on the warm sand and becomes 
 accustomed to the water slowly and naturally will soon learn to 
 take delight in the buffeting of the smaller waves, but he should 
 
198 THE MOTHER AND HER CHILD 
 
 not be permitted to remain more than a minute or two in the water, 
 and should be thoroughly dried, dressed immediately, and not left 
 to run about the beach in wet clothing. 
 
 MILK CRUST 
 
 Any roughness on the scalp must receive immediate atten- 
 tion. This roughness, or milk crust, is entirely avoidable; it 
 is the result of accumulated oil and dirt. When it has formed 
 a complete crust or cake, it may quickly become eczematous 
 and require a physician's advice; however, in the beginning, 
 at the first sight of brown patches or roughness, oil the scalp 
 thoroughly at night with vaseline or cold cream, which should 
 be gently rubbed off in the morning. 
 
 This vaseline or cold cream should be applied repeatedly, 
 several nights in succession, followed by the morning's gentle 
 rubbing and daily washing of the head. Often the washing 
 with water must be entirely avoided; only sweet oil or 
 vaseline being used in those cases where the crusting seems to 
 be persistent. 
 
 THE EYES, EARS, AND NOSE 
 
 At birth the eyes are particularly cared for. First, the mucus 
 is gently swabbed off the closed lids from the nose side out- 
 ward, and then follows the application of one drop of twenty 
 per cent argyrol or two per cent silver nitrate, either of which 
 thoroughly disinfects the eye and prevents the growth or 
 development of any bacteria that may have gotten into the 
 child's eye during the descent of the head through the birth 
 canal. The neglect of this procedure may sometimes result 
 in lifelong blindness. 
 
 Under no circumstances should " a mere cold in the eyes " 
 be neglected; it may result in blindness. Call your physician 
 at once, and if he is not at hand, wash out the eye thoroughly 
 every hour with warmed ten per cent boracic acid solution, by 
 means of a medicine dropper, using a separate piece of cotton 
 for each eye, for if the slightest bit of discharge be carried 
 from one eye to the other an inflammation will quickly appear. 
 
 From birth, especially during the first week, baby's eyes are 
 
BABY'S BATH AND TOILET 199 
 
 very sensitive to light; hence they must be carefully protected. 
 Babies should be so placed during their outings, sleep, or naps, 
 that they do not directly gaze at either the sunlight or sky. 
 The lining of the hood of the carriage should be green, instead 
 of white, as much eye strain is thus prevented. 
 
 The daily care of the normal, well eye has been already de- 
 scribed, and while it need not be reiterated, we may say, in 
 passing, that if the eyelid be at all inclined to be sticky or 
 adherent, never use force, but instead, gently swab with boracic 
 acid. As a preventive of this condition, a little vaseline from 
 the tube may be rubbed on the edges of the lids at night. 
 
 In the toilet of the ears, never attempt to introduce anything 
 beyond the external ear, which may be carefully cleansed with a 
 soft cloth. It is often found necessary to apply oil to the creases 
 behind the ears before the daily bath. There should be no 
 irritation, redness, or roughness present, all such conditions 
 being readily prevented by the use of oil or vaseline before the 
 bath. 
 
 With the sharp point removed, make a cotton applicator out 
 of a toothpick, and gently (with no force, whatever) intro- 
 duce vaseline or oil into the nose. This should be a part of 
 baby's daily toilet. Any stoppage of mucus or snuffiness in the 
 nose should be reported at once to baby's physician. Young 
 babies often have adenoids. 
 
 CARE OF THE MOUTH 
 
 Leave the well mouth alone until the teeth appear, and then 
 keep the teeth very clean (allowing no particles of milk to 
 accumulate at their bases) with a soft bit of cotton and gentle 
 rubbing. When a child attains the age of two, he should have 
 his own toothbrush; previous to this time all food particles 
 should be removed from between the teeth with waxed silk 
 floss. All decay should be promptly attended to by a competent 
 dentist. 
 
 Thrush and ulcers are often caused, not prevented, by the 
 frequent wiping out of baby's tender mouth. The treatment 
 of thrush and other mouth infections will be considered in a 
 later chapter, " The Common Disorders of Infancy." 
 
200 THE MOTHER AND HER CHILD 
 
 THE CARE OF THE GENITAL ORGANS 
 
 Before the bath, the baby girl's genitals are carefully swabbed 
 between all the folds with boracic acid solution. The fore- 
 skin of the boy baby should be pushed well back and washed 
 gently with water. If the foreskin of the male child be 
 long, tight, or adherent, circumcision is advised. See our chap- 
 ter, " Teaching Truth." 
 
 The genitals of both the boy and girl should be kept scrup- 
 ulously clean every day, with as little handling as possible, and, 
 upon the appearance of the least swelling, discharge, or even 
 redness, the physician's attention should be at once called to it. 
 In a later chapter, the subject of irregularities of sex habits 
 will be taken up. 
 
 CARE OF THE BUTTOCKS 
 
 Often, because of irritating bowel movements, the buttocks 
 become reddened, chafed, and sometimes raw in places. Some 
 poor little babies are sometimes roughly rubbed — scoured on 
 the buttocks — much like the kitchen sink, many times a day, 
 and it is not surprising that they become reddened, chafed, and 
 very much inflamed. 
 
 The buttocks require a gentle swabbing and thoroughgoing 
 " patting dry " after each soiling or wetting of the diaper, but 
 no soap is required in this region but once a day, and even 
 then it should be used sparingly. 
 
 When the buttocks are inflamed, after a good cleansing with 
 water and a thorough drying, vaseline or zinc ointment should 
 be applied on a piece of sterile cotton, and this application should 
 be repeated after each changing of the diaper. Wet diapers 
 should be removed at once, for the acidity of the urine causes 
 more chafing. A dusting powder composed of starch two parts, 
 and boracic acid one part, may be dusted on after a cleansing 
 with oil. 
 
 Great care should be exercised in the thorough daily rinsing 
 of the diapers as well as in the tri-weekly boil in the laundry. 
 White soap only should be used in their cleansings ; no washing 
 sodas or other powders should be used. 
 
BABY'S BATH AND TOILET 201 
 
 OTHER SPECIAL CARE 
 
 Under the arms and in the creases of the neck the skin some- 
 times becomes irritated because of neglect. To prevent such 
 chafing the following program should be carefully carried out: 
 
 1. Not too much soap — and no strong soap. 
 
 2. Careful rinsing of the skin area. 
 
 3. Avoid harsh rubbing, but thoroughly dry. 
 
 4. The use of talcum powder in all folds of the skin. 
 
 With a fine camel's hair brush the hair should receive its 
 brushing after the cleansing of the scalp. Combs are for just 
 one purpose and that is to part the hair. The brush should be 
 used to do all the smoothing. 
 
 While the frequent trimming of the hair has no marked effect 
 upon its growth, yet the comfort the little girls enjoy, especially 
 during the warm-weather months, should not be denied them. 
 
 And certainly the boy should become a boy when he puts on 
 trousers and not be made the laughing stock of his mirthful 
 companions just because his " beautiful long curls are much 
 admired by the mother and his aunts." 
 
 The finger nails should be trimmed round with the scissors, 
 while all hangnails are properly cared for every day. Toe nails 
 should be cut straight across and the corners never rounded off. 
 Many ingrowing nails may be thus avoided. 
 
CHAPTER XXI 
 BABY'S CLOTHING 
 
 THE Eden story suggests that in the beginning of our racial 
 experience artificial clothing was unnecessary; but after a 
 time, in that selfsame garden, proper clothing became an im- 
 portant problem and has remained so ever since. Everybody 
 seems to agree, however, that baby's clothing in particular should 
 at least be comfortable. It may give the child great discomfort 
 because it may be too warm, or it may not be warm enough, or it 
 may be too tight, and so, in the discussion of baby's clothing in 
 this chapter, we are going to keep in mind these two things — 
 comfort and heat. 
 
 GENERAL SUGGESTIONS 
 
 The choice of material demands some thought and attention. 
 As a rule, baby's clothing materials should be light in weight, 
 good moisture absorbers, and at the same time able to retain the 
 body heat. Most layettes have the common fault of being pre- 
 maturely outgrown; and so it is well to allow for ample growth 
 in making baby's first clothes. Since the principal object of 
 clothing is to insure a uniform body temperature, it is important 
 that the mother be constantly on her guard to keep the baby 
 cool enough in the summer and warm enough in the winter. 
 
 The mothers of various races and nations have their own ideas 
 concerning the clothing of their babies. One mother will wrap 
 her baby in cotton, which is held in place by means of a roller 
 bandage, and as you visit this home during the first week of 
 baby's life, you will be handed a little mummy-shaped creature 
 — straight as a little poker — all wrapped up in cotton and a 
 roller bandage. The surprising feature is that the baby does not 
 seem to complain. 
 
 202 
 
BABY'S CLOTHING 203 
 
 In another district of the city we find the baby dressed in 
 starched clothes, ribbon sashes, bright ribbon bows on its arms 
 and around its neck. At first glance you wonder if the little 
 child is not many years older and is about to make a visit to a 
 county fair, but on inquiry we find that he has only been pre- 
 pared for the event of circumcision on the eighth day. 
 
 And if you go into the forest of primeval days you will find 
 another mother bandaging her baby to a board, head and all, and 
 he seems to live and thrive in his little woven nest strapped on 
 the back of his Indian mother. 
 
 Other babies in the warmer portions of the earth have almost 
 less than nothing on, and are left to be swung by the breezes 
 in little baskets tied to the boughs of trees; being taken up only 
 when it is time to feed. 
 
 baby's layette 
 
 In preparing an outfit for the newcomer it is wise to provide 
 for the necessities only, because of the fact that since the baby 
 grows very fast the layette will soon have to be discarded; it 
 is always possible to get more clothing after the baby is here 
 and started on his little career. We offer the following list of 
 essentials for the new born baby: 
 
 Slips 8 to 10 
 
 Skirts (flannel) 3 
 
 Shirts , 3 
 
 Light-weight wool wrappers 2 
 
 Abdominal bands 3 to 5 
 
 Diapers (first size) 2 doz. 
 
 Diapers (third size) 2 doz. 
 
 Stockings, pairs 3 
 
 Booties, pairs 3 
 
 Nightgowns 7 
 
 Handling blankets 2 
 
 Silkaline puffs 2 
 
 Baby blankets, pair 1 
 
 Hair or cotton mattress 1 
 
 Basinet 1 
 
204 THE MOTHER AND HER CHILD 
 
 BANDS AND SHIRTS 
 
 The binder should be made of an unhemmed strip of flannel 
 six inches wide and twenty inches long, so that it goes around 
 the abdomen once with a small overlap. This binder should be 
 sewed on instead of being pinned, and serves the purpose of 
 holding the dressings of the cord in place. It is usually worn 
 from four to six weeks, when it is replaced by a silk and wool 
 barrel-shaped band with shoulder straps and tabs at the bottom, 
 both front and back, to which may be pinned the diaper. This 
 band is worn through the first three or four years to protect 
 the abdomen from drafts and chilling, thus guarding against 
 those intestinal disturbances which are caused by sudden weather 
 changes. 
 
 There is great danger of having the bellyband too tight, and, 
 in the early weeks, it is often the cause of great discomfort — 
 often interfering with the normal expansion of the stomach at 
 meal time. 
 
 No matter what the season, the new-born baby should be 
 clothed in a light-weight silk and wool shirt, preferably the sec- 
 ond size. After the first month, if the weather is exceedingly 
 warm, this woolen shirt may be displaced by a thin silk or lisle 
 shirt. In buying the second-size shirts always secure the 
 stretchers at the same time, for in the laundering they soon 
 shrink so that they are very uncomfortable for the young babe. 
 
 DIAPERS 
 
 There are a number of materials on the market from which 
 comfortable diapers may be made for the baby. The cotton 
 stockinet (ready-made shaped diaper) is excellent, fitting 
 smoothly at the waist, while it is large and baggy at the seat, 
 thus permitting not only a comfortable feeling but the free use 
 of the hips, without the bulkiness of the ordinary diaper. 
 
 The large square of cheesecloth is easily laundered, and if an 
 inside pad is used makes a very acceptable diaper. 
 
 The stork diapers are made of materials resembling turkish 
 toweling and are used to some extent. This diaper should not 
 be confused with the stork rubber diaper which will be spoken 
 of later. 
 
BABY'S CLOTHING 205 
 
 Birdseye cotton is popular and extensively used. It absorbs 
 quickly, and is much lighter in weight than linen. The first- and 
 third-size widths should be purchased as a part of the layette, 
 and the number of diapers needed depends upon the opportuni- 
 ties to wash them out, for diapers are never used but once with- 
 out washing; they should always be quickly rinsed and dried 
 in the sunshine if possible. So if there are good laundry 
 privileges, and daily washing is possible, the mother can get 
 along with fewer diapers, but no less than four dozen should 
 be provided. 
 
 The diaper pad will be found convenient and serviceable in 
 the early days when the skin of the child is so very tender. This 
 pad should be pieces of clean old linen or small pads of ab- 
 sorbent cotton. 
 
 CHANGING THE DIAPER 
 
 During the mother's waking hours, the diaper should be 
 changed as soon as it is soiled or wet. If the child cries 
 during the night it should be changed immediately, but 
 the mother should not feel called upon to lay awake nights 
 merely to change the baby's napkin when it is soiled. If she 
 places a pad underneath the baby, which will absorb the urine 
 quickly, he often does not awaken or become chilled. The pad 
 should be sufficiently thick to ensure that the nightgown does 
 not get wet. 
 
 RUBBER DIAPERS 
 
 Rubber sheeting diapers of any description should never be 
 used. Avoid all patent diapers with a covering or an inner lin- 
 ing of rubber, for, like the rubber diaper, they not only irritate 
 the child but also retain moisture and heat, which produce 
 such irritation and itching that the subsequent " habit-scralch- 
 ing " often lays the foundation for future bad practices. It is 
 far better for the mother to carry about with her, whenever it 
 is necessary to take the baby away from home, a rubber pad 
 which she puts on her lap underneath the little fellow, thus 
 affording ample protection to herself without in the least harm- 
 ing the baby. 
 
206 THE MOTHER AND HER CHILD 
 
 STOCKINGS AND BOOTIES 
 
 During the winter months merino stockings are required, 
 while during the summer months a thin wool or silk stocking is 
 sufficient; on the extremely hot days thin cotton hose may be 
 worn. During infancy, the stockings should be fastened to the 
 diaper with safety pins, while on the second-year child, hose 
 supporters attached to the waist are found very convenient. 
 
 A friend told me the other day of a mother who told her 
 the following story : " Do you know, I don't have any trouble 
 any more about my baby keeping up his socks for I have fixed 
 it so they won't come off any more. Every time I looked at his 
 feet he had kicked off his socks and they were no good to him 
 at all, so I took little chunks of brown laundry soap, moistened 
 them and rubbed his legs, as well as the inside of his socks and 
 I never, never have any more trouble with them coming off." 
 
 It does not seem possible in this enlightened age that a mother 
 could be so ignorant as to keep the socks up with brown soap, 
 but the friend assured me it was a true story, and while it may 
 shock some of my readers as it did me, I must add, in passing 
 to another subject, that the use of round garters on little babies 
 and young children is just about as shocking. 
 
 During the fall, winter, and spring, booties are worn on top 
 of the stockings. These booties should be crocheted or knitted 
 out of the heavy Germantown yarn, and there should be enough 
 of them so that the child may have a clean pair on every day. 
 
 SKIRTS AND PETTICOATS 
 
 The flannel petticoat is made with yokes instead of bands, 
 and during the fall, winter, and spring these yokes are made of 
 flannel like the skirt and should have long sleeves of the same 
 material. The yokes should be made large enough so that they 
 may be used during the entire first year (the plait in the front 
 can easily be taken out when the baby is six months old so that 
 it may be used much longer than if the yoke is made without a 
 plait). For the hot summer months, the yokes should be a 
 thin cotton material without sleeves; and, if the baby is housed 
 in an over-heated apartment, this fact should be borne in mind 
 and the winter skirt should be made accordingly. We have 
 
BABY'S CLOTHING 207 
 
 found, however, that the baby who is amply protected and uni- 
 formly dressed, does not require the outer bundlings that the 
 poorly dressed child requires. Part wool and cotton materials 
 are very comfortable in the overheated city apartments. White 
 skirts are not necessary for small babies. They only add extra 
 weight and it is always foolish to put anything on a small baby 
 simply for looks. 
 
 NIGHTGOWNS, WRAPPERS, AND SLIPS 
 
 The nightgowns should be made of soft cotton flannel or 
 stockinet. The latter is really the better, and can be pur- 
 chased in sizes up to two years; it is absorbent, easily laun- 
 dered, and may be conveniently drawn up at the bottom by means 
 of a drawstring. 
 
 At least seven nightgowns are needed. A fresh nightgown 
 should be used each day and each night during the first four 
 or five weeks of baby's life; while as he gets older (two or three 
 years), the night drawers with feet in them are used to ad- 
 vantage. 
 
 The wrappers are usually made of challis, nun's veiling, cash- 
 mere, or other light woolen materials which can be readily 
 washed. They are very serviceable to wear over the baby's 
 thin slips and on cool nights they may be used over the night- 
 dress. They should be simply made, containing no heavy seams, 
 and at the neck there should be the simplest kind of a soft band 
 that will in no way produce friction or in any other way irri- 
 tate the baby's skin. 
 
 Slips are usually made of some very soft material such as 
 nainsook, batiste, pearline, or sheer lawn cloth. Twenty-seven 
 inches is the length that will be found both comfortable and 
 convenient. All laces, ruffles, and heavy bands which will 
 scratch or irritate should be avoided as eczema is often caused 
 by such mistakes. 
 
 SLEEPING BAG 
 
 The sleeping bag is of inestimable value, affording extra and 
 secure covering for the child, and peace of mind for the 
 mother. In the early weeks it should be made of light flan- 
 
208 THE MOTHER AND HER CHILD 
 
 nel, but as the child gets older the sleeping blanket is made 
 according to illustration (See Fig. 5) by merely folding a 
 blanket in such a manner that the child cannot possibly uncover 
 himself. The mother can sleep undisturbed, knowing that the 
 baby is always safely protected by at least one warm blanket 
 cover. 
 
 COMMON FAULTS WITH MOST LAYETTES 
 
 As a usual thing the first clothes are made too small. The 
 sleeves are too short as well as too small around. There is 
 nothing more uncomfortable than a tight sleeve. Everyone of 
 our readers knows that, and we recall one poor little fellow who 
 kept up a fretful cry until we took the scissors and cut the 
 tightly stretched sleeve up to and including the arm hole. He 
 then relaxed and went to sleep. Sleeves should be made two 
 inches longer than they are needed at first, and it is a very sim- 
 ple matter to pin them up or turn them back at the wrist. They 
 should be loose and roomy. 
 
 The yokes of the dresses usually are too tight before the slips 
 are discarded. Heavy seams and raw seams irritate and often 
 make ugly impressions on the baby's skin. 
 
 Usually the first layette is profusely embroidered, and, while 
 it is beautiful to look at, the mother feels when she sees it out- 
 grown so quickly that a lot of vital energy was wasted on gar- 
 ments that mattered so little as long as baby was comfortable. 
 Baby is dear and sweet enough without the fuss and furbelows 
 of such elaborate garments. 
 
 Heavy materials are sometimes used where lighter ones would 
 serve better. 
 
 ERRORS IN CLOTHING 
 
 A soiled garment should never be put back on the baby. Dirt 
 draws flies, and flies are breeders of disease. Sour-smelling 
 garments should be changed at once. They are likely to make 
 the baby sick and interfere with his appetite if left on indef- 
 initely. The care of the diaper has already been mentioned. 
 
 The main symptom of too much clothing is sweating, and 
 when the baby sweats something must come off. If he has 
 
BABY'S CLOTHING 209 
 
 perspired so much that his clothes are moist, the clothing should 
 be changed and the skin well dried with talcum powder. The 
 feet and hands should be kept warm, but the little head should 
 always be kept cool. When the baby is crying and getting his 
 daily exercise, remove some of the covering, loosen his diaper, 
 and let him kick and wave his arms in perfect freedom. 
 
 When the baby's feet and hands are cool he is not warm 
 enough. Cotton underskirts cannot be used in the dead of win- 
 ter on little babies. They do not hold the body heat as woolen 
 garments do. The baby's feet should always be warm and this 
 is particularly necessary in poorly nourished children. The 
 outer wrapper of woolen material should be added to such 
 baby's clothing. It is a safe rule to follow that if baby's hands 
 are warm and he is not sweating, he is " just about right." 
 
 SHORT CLOTHES 
 
 At the age from four to six months, baby's clothes are short- 
 ened. This should not take place at the beginning of winter 
 if it can be avoided. If the first layette has consisted of only 
 the necessary garments, they are nearly worn out by the time 
 the short clothes are due; of those that do remain, the sleeves 
 should be lengthened, the arm holes enlarged, and all the little 
 waists let out. Creeping garments and bibs are now added to 
 baby's outfit, as well as leggings and other necessities for out- 
 door wear. Remember that all garments must be loose — then 
 baby is happy. 
 
 About the same number of garments are found necessary 
 for the short clothes as were required at first; except that a 
 large number of creeping rompers should be added. These 
 creeping rompers should not be made of dark materials that do 
 not show the soil. We desire the dirt to be seen that we may 
 keep the baby clean, and if the creeping romper is made of a 
 firm, white material it may be boiled in the laundry, thus afford- 
 ing ample and thorough cleansing. 
 
 We attributed a sick spell of one baby to the dark-blue calico 
 creeping romper which he wore day in and day out because it 
 " did not show " the soil. White ones are much to be preferred, 
 not only for looks but chiefly for sanitary reasons. 
 
210 THE MOTHER AND HER CHILD 
 
 CAPS AND WRAPS 
 
 The cap should be made of a material that will protect irom 
 drafts and cold air, but not of such heavy materials as will cause 
 too much sweating. There are a number of outside wraps that 
 can be purchased ready-made and which are comfortable, con- 
 venient, and warm. They should be long enough not only to 
 cover the baby's feet well, but to pin up over the feet, thus 
 giving good protection from winds and drafts. 
 
 During the summer months nainsook caps or other thin mate- 
 rials are to be preferred to the heavy crocheted caps that are 
 sometimes worn by babies. No starch should be used in the 
 caps or strings, and there should be no ruffles to scratch the 
 delicate skin of the baby. In all these outer garments, as well 
 as the under garments, the irritation of the skin must be con- 
 stantly borne in mind, as eczema is often produced in this 
 manner. 
 
 THE FIRST SHOES 
 
 The first shoe that is usually worn during the creeping days 
 is a soft kid shoe without hard soles. It is important that this 
 soft shoe be worn to protect the child's foot from chilling 
 drafts while creeping about. 
 
 As the baby nears one year of age the hard-sole shoe is 
 secured which must be wide, plenty long and comfortable in 
 every respect, and without heels. Rubbers and overshoes may 
 be worn on damp and cold days. Moccasins and slippers do not 
 give sufficient support to the ankles, so, when the baby begins to 
 walk, the shoes should be high and of sufficient support to the 
 tender ankles. 
 
 PLAY SUITS 
 
 As the baby grows up into the child, the tiny clothes are laid 
 aside and the boy is given substantial garments that in no way 
 remind him of girls' clothing. A child's feelings should be re- 
 spected in this manner, and while it often adds joy to the 
 mother's heart to see her boy " a baby still," remember that he 
 is not only chagrined but is nervously upset by these " sissy 
 clothes." 
 
BABY'S CLOTHING 211 
 
 A child three or four years of age should still wear the 
 woolen binder supported from the shoulders, over which is the 
 union suit, stockings, and the buttoned waist from which hang 
 the hose supporters. The most comfortable and easily laun- 
 dered garment we know of for the small lad is the " romper," 
 which should be made of washable materials that may be readily 
 boiled. For cool days a Buster Brown coat of the same mate- 
 rial, with patent-leather belt, may be slipped on over this wash- 
 able romper — which completes the boyish outfit. 
 
 We recall the pleasant days with our own little fellow when 
 he was between the ages of two and one-half and five years. 
 We were often compelled to be away from home — on the train, 
 in the hotel — and when traveling we used a black, smooth silk 
 material which was made up into rompers with low neck and 
 short sleeves. There were three such rompers, and two Buster 
 Brown coats with wide, black, patent-leather belts which com- 
 pleted the traveling outfit. During the warm days on the train 
 the coat was folded carefully and laid aside. In the early 
 morning and in the cool of the evening the coat was put on, 
 and he always looked neat and clean. At night, before un- 
 dressing him, the entire front of the romper was cleansed with 
 a soapy washcloth, rinsed, and rubbed dry with a towel, and, 
 after carefully spreading to avoid wrinkles, it was hung over 
 the foot of the bed. The coats were sponged or pressed once 
 or twice a week, and this simple outfit served its purpose so well 
 that it was repeated three different summers. 
 
 The little girl as she leaves her babyhood days should be put 
 into garments that do not necessitate the constant admonition, 
 " Keep your dress down, dear." We like to see knickerbockers, 
 the exact color of the dress, made for every outfit, in which the 
 little girl may kick, lie down, jump, dance, climb — do any- 
 thing she pleases — unmindful of the fact that her " dress is 
 not down." The same undergarments are used for the little 
 girl as were mentioned for the little boy. 
 
 WINTER GARMENTS 
 
 Always bear in mind the over-heating of the child with heavy 
 garments indoors, and the danger of skin chilling and drafts on 
 
212 THE MOTHER AND HER CHILD 
 
 going out to play in this over-heated condition. Let the chil- 
 dren dress comfortably cool in the house, and as they go out 
 to play add rubber boots or leggings and rubbers, sweaters, caps 
 with ear laps or the stockinet cap. Allow them the utmost 
 freedom in clothes, and always encourage romping in the cool 
 frosty air. 
 
 CLOTHING RULES 
 
 Do not overload the baby with clothing. 
 Dress according to the temperature of the day and not the 
 season of the year. 
 
 Avoid starched garments. 
 
 Avoid tight bellybands or old-fashioned pinning blankets. 
 
 Change all clothes night and morning. 
 
 Use woolen shirts and bands. 
 
 See that hands and feet are always warm. 
 
 Protect the abdomen night and day with the band. 
 
 Use the sleeping bag on cold nights. 
 
 Baby should sleep in loose stockings at night. 
 
 Avoid chilling the child. 
 
 Use hot water bags if necessary. 
 
CHAPTER XXII 
 FRESH AIR, OUTINGS, AND SLEEP 
 
 FRESH air is just as important and necessary for the baby- 
 as for the adult. Neither baby, youth, nor adult can re- 
 ceive the full benefit of his food — in fact it can not be burned 
 up without the oxygen — without an abundance of fresh air. 
 During the early weeks of life, the air baby breathes must be 
 warm; nevertheless, it must be warmed fresh air, for baby 
 requires fresh air just as much as he needs pure food. 
 
 INDOOR AIRING 
 
 The delicate child often requires more fresh air than does 
 the normal baby. Both appetite and sleep are improved by fresh 
 air. The digestion is better, the cheeks become pink, and all 
 the signs of health are seen in the child who is privileged to 
 breathe fresh air. 
 
 During the early days, say after the third week, baby should 
 be well wrapped up with blanket and hood, tucked snugly in 
 his basinet or carriage, while the windows are opened wide and 
 the little fellow is permitted to enjoy a good airing. Even in the 
 winter months the windows may be raised in this way for a few 
 minutes each day. These " airings " may be for ten minutes 
 at first, and, as the child grows older, they may be gradually 
 increased to four or five hours daily. The carriage or basket 
 should stand near the window, but not in a direct draft. 
 
 OUTDOOR LIFE 
 
 In summer, a baby one week old may be taken out of doors 
 for a few minutes each day; in the spring and fall, when baby 
 is one month old, it may go out for an airing; while, during 
 the winter months, the airing had better be taken indoors until 
 
 213 
 
214 THE MOTHER AND HER CHILD 
 
 lie is about two months old, and even at that age he should go 
 out only on pleasant days and should always be well protected 
 from the wind. 
 
 A young baby may enjoy the fresh air in his carriage or crib 
 on the porch, on the roof under suitable awnings, in the yard, 
 under the trees, and even on the fire escape. In fact, at proper 
 age and in season, he may spend most of his time out of doors 
 in the fresh air, if he has proper protection from the sun, wind, 
 and insects. 
 
 BEST HOURS FOR AIRING 
 
 During the balmy days of summer and early autumn, baby 
 may spend most of the time outdoors between seven in the morn- 
 ing and sunset. During the cooler days of winter and the cool 
 and windy days of spring, the best hours for the airing are to be 
 found between eleven in the morning and three in the after- 
 noon. 
 
 At six weeks, perhaps an hour a day in the fresh air is suffi- 
 cient; while at six months, four to six hours a day are a neces- 
 sity, and from then on — the more the better. 
 
 Now we realize that the mother of the farm household does 
 not always have as much time to take the baby out for his 
 airings as many of our city mothers; but we suggest to this busy 
 mother that the baby be rolled out on the porch or in the yard, 
 within her sight and hearing, and allowed to enjoy the fresh 
 air while the mother continues her work. 
 
 It is virtually a crime to try to keep baby in the kitchen, hour 
 after hour, while the busy mother is engaged at her tasks. A 
 hammock, a crib on casters, or a carriage, is just the coziest 
 place in the world for baby — out on the porch. 
 
 THE COUNTRY BABY 
 
 The average city baby really gets more fresh air than ninety 
 per cent of the country babies. Our city apartments are usually 
 steam heated, and our windows are open in the winter nearly as 
 much as in the summer. The country home is often only par- 
 tially heated by two or three stoves. The windows are closed 
 in summer to keep out the dust, heat, and flies, in the winter to 
 
FRESH AIR, OUTINGS, AND SLEEP 215 
 
 shut out the cold, and so the baby who lives in such a home has 
 little chance to get fresh air. 
 
 The city mother is constantly talked to about the benefits of 
 fresh air. The daily paper brings its health column to her, 
 her pastor talks of it on Sunday, and — best of all — the older 
 children come home from school and reiterate the doctrine of 
 fresh air that is constantly being preached to them at school. 
 
 Screen the windows, rural mother, and oil the roads in front 
 of your residence, and then keep your windows open. Remem- 
 ber that baby's health is of more value than the meadow lot 
 or even a fortune later on in life. Plan for a new heating plant, 
 if necessary, so that the home can be both warmed and venti- 
 lated during the winter. 
 
 WHEN NOT TO TAKE BABY OUT 
 
 If a sheltered corner of the porch is within the reach of the 
 mother, we can hardly think of a time when the baby cannot 
 be taken out. It may rain, the wind may blow, it may snow or 
 even hail, but baby lies in his snug little bed with a hot water 
 bottle or a warmed soapstone at his feet. As long as the finger 
 tips are warm, we may know he is warm all over, and a long 
 nap is thus enjoyed in the cool fresh air. When the sheltered 
 corner of the porch is lacking, we wisli to caution the mother 
 concerning the following weather conditions : 
 
 1. When the weather is excessively hot, take him out only 
 in the early morning and late in the afternoon. 
 
 2. In extremely cold, below zero, weather, let his airing be 
 indoors. 
 
 3. Sharp and cold winds may do much mischief to baby's 
 ears, as well as blow much mischief-making dust into his nose 
 and eyes. In the case of dust or sand storms, baby remains in 
 the house. 
 
 4. All little people enjoy the rain, and only when the rain- 
 coat, rubbers, and umbrella are missing should they be robbed 
 of the " rainy-day fun." In the case of baby's outing on rainy 
 days, ample roof protection is the only factor to be considered ; 
 if it is adequate, then take him out; if it is lacking, let the air- 
 ing be done indoors. 
 
216 THE MOTHER AND HER CHILD 
 
 WINTER OUTINGS 
 
 The very young baby is taken out for a fifteen -minute airing 
 during the noon hour when he is two months old; before this 
 time he receives his airing indoors. The interval is gradually 
 lengthened until most of the time between eleven and three is 
 spent out of doors. The reddened cheeks, the increased appe- 
 tite, all tell the story of the invigorating benefits of cool, fresh 
 air. Most babies dislike heavy veils, and they may be avoided 
 by a fold of the blanket arranged as a protection shield from 
 the wind. 
 
 The wind shield, procurable wherever baby carriages are 
 sold, should be a part of the outdoor equipment, as it greatly 
 helps in the protection of the baby. 
 
 The wind should never blow in his face; neither should he 
 lie, unprotected, asleep or awake to gaze up into the sunshine 
 or the sky — or even at a white lining of the hood of his car- 
 riage. The lining should be a shade of green, preferably dark 
 green. And while it may be necessary during the summer to 
 suspend a netting over the carriage to protect from flies, mos- 
 quitoes, etc., it should never lie on his face. 
 
 OPEN WINDOWS 
 
 Many of our readers recall with sadness of heart a little 
 hunchback child or a life-long invalid confined to a bed or wheel 
 chair because some careless but well-meaning caretaker or 
 mother left an open window unguarded; and — in an unlooked 
 for moment — baby crawled too near, leaned out too far, and 
 fell to the ground. The little fellow was picked up crippled 
 for life; and so while it is very essential to baby's health to 
 have open windows, admitting fresh air, they should be amply 
 guarded. Screens afford protection if well fastened, and in 
 their absence a slat three inches wide and one inch thick may 
 be securely fastened across the opening, thus preventing all such 
 tragedies with their life-long regrets. 
 
 SLEEP 
 
 If any of our readers have seen a new-born baby immedi- 
 ately after he has been washed, dressed, and comfortably 
 
FRESH AIR, OUTINGS, AND SLEEP 217 
 
 warmed, they have observed that he usually goes to sleep at 
 once, and that he generally sleeps from four to six hours. 
 Babies, especially new-born babies, need just four things: 
 warmth, food, water, and sleep. 
 
 And while the babies sleep they are not to be disturbed by 
 the fond mother's caresses and cuddling — feeling of the tiny 
 hands, smoothing out the soft cheek, or stroking his silky hair 
 — for all such mothers are truly sowing for future trouble. Let 
 baby absolutely alone while sleeping, and let this rule be main- 
 tained even if some important guest must be disappointed. If 
 such cannot wait till baby wakens, then he must be content with 
 the mental picture drawn from the mother's vivid description of 
 baby — his first smile, his first tooth, his first recognition of the 
 light, etc. The wise mother cat never disturbs her sleeping 
 kittens. 
 
 SLEEP REQUIREMENTS 
 
 Sleeping, eating, and growing occupy the whole time of young 
 babies. Until they are two months old they need from eighteen 
 to twenty hours sleep out of each twenty- four; and not less 
 than sixteen hours up to the end of the first year. 
 
 At six months, baby should sleep right through the night 
 from six in the evening until six in the morning, with a ten 
 o'clock feed, which should be given quietly, in a darkened 
 room, the babe being immediately returned to his bed. 
 
 At two or three years of age, twelve to fourteen hours of 
 sleep is required; while at four. to five years, eleven to twelve 
 hours are needed; when they attain the age of thirteen years 
 they should still have ten hours of unbroken sleep each night. 
 
 As a general rule, children should sleep alone; even in the 
 case of two brothers or two sisters, separate beds are far bet- 
 ter than a double bed for both hygienic and moral reasons. 
 
 Baby should have a separate bed. The temptation to nurse 
 him on the least provocation, as well as the danger of over- 
 lying, are reasons enough for such an arrangement. 
 
 PUTTING BABY TO SLEEP 
 
 At five-thirty in the afternoon, baby should be undressed, 
 rubbed or bathed, made perfectly comfortable, and fed; then, 
 
218 THE MOTHER AND HER CHILD 
 
 my mother reader, he should be lajd down in his little bed and 
 allowed to go to sleep, without any coaxing, singing, rocking, 
 or even holding his hand. Babies will do this very thing and 
 continue to do it if you never begin to rock, jolt, bounce, or sing 
 to them; and, mind you, if you do sing to them or rock them, 
 or even sit near without doing anything but " just hold their 
 tiny hands," there will come a time when you greatly desire to 
 do something else — you have many urgent duties awaiting 
 you — and baby not being old enough to understand the cir- 
 cumstances, begins to wail out his feeling of neglect and abuse. 
 It is nothing short of wicked thus to spoil a child. 
 
 We have seen so many beautiful babies go to sleep by them- 
 selves without any patting, dangling, or rocking, that we en- 
 courage and urge every mother to begin right, for if the little 
 one never knows anything about rocking and pattings he will 
 never miss them; and even if the baby is spoiled through extra 
 attention which sickness often makes necessary, then at the first 
 observance of the tendency on the part of the child to insist on 
 the rocking, or the presence of a light in the sleeping-room, or 
 the craving for a pacifier, we most strongly urge the mothers 
 to stick to the heroic work of " letting him cry it out." 
 
 The notion that the household must move about on tiptoes 
 is not only unnecessary but perfectly ridiculous. From the very 
 hour of his birth, let the child become accustomed to the ordi- 
 nary noises of the home, and if this plan is early started he 
 will prove a blessing and a ray of sunshine to the family and 
 not an autocrat to whom all must bow and bend the knee. 
 
 BEDTIME AND SLEEPING POSITION 
 
 Bedtime is regulated somewhat by the hour of rising in the 
 morning. Usually, up to two years, baby is put to bed from five 
 to six p. m. Regularity is urged in maintaining the bedtime 
 hour. 
 
 The seven o'clock bedtime hour is later established and con- 
 tinued until the young child attains school age, when retiring 
 at the curfew hour of eight o'clock gives our boy or girl from 
 ten to eleven hours of sleep, which is essential to proper growth, 
 calm nerves, and an unruffled temper. 
 
FRESH AIR, OUTINGS, AND SLEEP 219 
 
 The first few days finds our little fellow sleeping nine-tenths 
 of his time. Let him lie on his right side, for this favors the 
 complete closure of the fetal heart valve, the foramen ovale. 
 
 Whether baby lies on his stomach, his side, or with the hands 
 over his head is of little or no consequence. His position should 
 be changed first from one side to the other until he is old enough 
 to turn himself. 
 
 WAKING UP AT NIGHT 
 
 Before baby is three months old, he should receive nourish- 
 ment during the night at nine and twelve, and again at six in 
 the morning. After four or five months a healthy child should 
 not be fed between the hours of ten p. m. and six a. m. At this 
 age, many children sleep right through from six p. m. to six 
 a. m. without food. 
 
 After five months, if a healthy baby awakens between ten 
 p. m. and six a. m. warm water may be given from a bottle ; he 
 soon forgets about this and the night's sleep becomes unbroken. 
 There are many other reasons than the need of food that cause 
 the wakefulness of the child; and since the baby should, after 
 a few months, sleep undisturbed and peacefully, if he is wake- 
 ful and restless — crying out in a peevish whine — and then 
 quiets down for a few moments only to cry out again, you may 
 suspect one of a half-dozen different things. Let us, therefore, 
 summarize the things which may disturb baby's sleep : 
 
 1. Lack of Fresh Air. Babies cannot sleep peacefully in a 
 hot, stuffy room, or in a room filled with the fumes of an oil 
 lamp turned low. A crying fretful baby often quiets down as 
 if by magic, providing he is not hungry and the diaper is dry, 
 when taken into a cool room with fresh air. After the first two 
 months the temperature of the sleeping room should be fairly 
 cool and fresh. 
 
 2. Clothes and Bedding. The night clothes may be irritating 
 and causing perspiration, while the bedding may be wrapped too 
 snugly about the child. If baby's neck is warm and moist, you 
 may know that he is too warm. If the diaper is wet it should 
 be changed at once. One of the worst habits a baby can pos- 
 sibly get into is to become so accustomed to a wet diaper that 
 
220 THE MOTHER AND HER CHILD 
 
 it does not annoy him. In cold weather he is changed under 
 the bed clothing without exposure or chilling. It may be the 
 bedding is cold and, if so, it should be warmed up by the 
 use of the photophore previously described, or by means of the 
 flannel-covered hot water bottle. 
 
 3. The Food. Too little, too much, or the wrong kind of food, 
 will disturb baby's sleep. Indigestion is very easily produced in 
 babies who are improperly fed. For instance, the mother's milk 
 may be lacking in nourishment and baby may really be hungry ; 
 or, as in the case of a bottle-fed baby, it is usually due to over 
 feeding. Many mothers we have known who sleep with their 
 babies or who sleep very near them, nurse them every time they 
 wake up or murmur, and this soon becomes one of the biggest 
 causes of disturbed sleep. 
 
 4. Spoiling. A lighted nursery or bedroom, rocking to sleep, 
 jolting the carriage over a door sill or up and down, the habit of 
 picking baby up the moment he cries, late rompings — any and 
 all of these may disturb sleep, as well as unsettle the tender 
 nervous system of the child, thus laying the foundation for 
 future nervousness, neurasthenia, and possibly hysteria. This 
 is particularly true in the case of the children who have nervous 
 parents. 
 
 5. Reflex Causes. Wakefulness is sometimes due to reflex 
 nervous causes such as the need for circumcision, or the pres- 
 ence of adenoids, enlarged tonsils or worms. Does baby have to 
 breathe through his mouth? Then you may suspect adenoids 
 or other conditions which should be removed. 
 
 6. Chronic Disorders. The presence of scurvy or syphilis 
 causes the child to cry out sharply as if in acute pain, while 
 in older children tuberculosis of the spine or hip is attended by 
 a sharp, painful crying out during sleep. Malnutrition or 
 anemia are also conditions which greatly disturb sleep. 
 
 7. Soothing Syrups. Untold trouble, both physical and nerv- 
 ous, is bound to follow the giving of soothing syrups. These 
 medicines soothe by knocking the nerves senseless and never by 
 removing the cause. They contain morphin, opium, cocain, 
 heroin, and other drugs which deaden pain, and are most dan- 
 gerous to give baby. 
 
FRESH AIR, OUTINGS, AND SLEEP 221 
 
 DAILY NAPS 
 
 The morning nap from the sixth month on should be from 
 two to three hours long, out on the porch, well protected ; while 
 the afternoon nap may be from one to one and a half hours 
 long with an interval of two or three hours before bed- 
 time. The child should be wakened at regular intervals for 
 feedings during the day — every three hours until he is six 
 months old, and then every four hours. These naps should 
 be taken in a cool place — on the porch, on the roof, in the yard, 
 under a tree, or on the protected fire escape. 
 
 If the nap is to be taken indoors, then lower the windows from 
 the top and darken the room. All children should take daily 
 naps until they are five or six years old. 
 
CHAPTER XXIII 
 BABY HYGIENE 
 
 POSSIBLY if all our babies could grow up in a mild, warm 
 climate, out of doors, where they were cared for by mothers 
 who had nothing else to do but enjoy nature in a garden, their 
 babies unhampered by clothes and other conventionalities in- 
 flicted upon us by our present standards of living — well, if that 
 were our environment, probably this chapter on baby hygiene 
 would not need to be written. But realizing that variable 
 climatic conditions, the indoor life, and the necessary bundling 
 up with clothes, all tend to increase the ever-present danger of 
 infection from thickly settled peoples and their domestic pets — 
 these facts, together with the further fact that modern social 
 conditions make it necessary for some mothers to toil long hours 
 — all these influences, I say, considered separately or com- 
 bined, make it imperative for us to give thoroughgoing con- 
 sideration to the essentials of baby hygiene. The subjects of 
 fresh air, sleep, bathing, etc., have been duly discussed in pre- 
 vious chapters. 
 
 WATER DRINKING 
 
 As soon as the newborn baby has been washed and dressed, 
 before he is put to sleep, he is given two teaspoons of warm, 
 boiled water in a sterile bottle with a clean nipple. This is re- 
 peated every two hours when he is awake, until he is old enough 
 to ask for water himself. This water should contain no sugar, or 
 anything else — just clean, boiled water. It is better to give 
 this water from a bottle; for in case of enforced weaning, this 
 practice of taking his water from a bottle, will have made 
 him acquainted with that method of feeding. 
 
 222 
 
BABY HYGIENE 223 
 
 URINATION 
 
 The baby may pass very little urine during the first day or 
 two of his life, but if the warm, boiled water is administered 
 regularly, the urine will soon become more abundant. 
 
 As the child nears two years of age, if put to bed at six p. m. 
 he should be taken up at ten or eleven to urinate. 
 
 In older children, bed wetting is often corrected by serving 
 the last meal not later than four p. m. and not allowing any 
 liquids after that hour. 
 
 The physician should be consulted in all instances where the 
 habit of bed wetting extends beyond three years. The sub- 
 ject will be treated more fully in a later chapter. 
 
 EXERCISE 
 
 A baby pen, lifted up from the floor, well protected at the 
 sides, and covered with mosquito bar — if exposed to flies or 
 mosquitoes — affords splendid opportunity for exercise. Here 
 the little fellow may lay on a well-padded mattress and kick, 
 move his arms, and otherwise roll about to his own satisfaction. 
 It should not be in the direct sunshine, but rather in a protected, 
 somewhat shady place, yet where the air is pure and fresh. 
 
 Much exercise is obtained from the daily cry. Here, the arms, 
 legs, hands and feet, as well as the body, are all exercised until 
 the "baby is pink. A good rebound of blood is flowing through 
 the well-warmed skin, while the baby is greatly benefited by 
 such daily exercise. 
 
 Later on, " creeping " is urged, but not forced. With regard 
 to standing — he will pull himself up on his feet just as soon as 
 nature qualifies him, and so he needs no urging or coaxing 
 in this matter. Older children should be encouraged in active 
 romping, games, etc., rather than to spend the entire day in the 
 more sedentary amusements, puzzle pictures, etc. 
 
 It is a most abnormal situation when a three-, or four-year-old 
 child is content to sit quietly all day. There is usually some- 
 thing seriously wrong with a child who never soils his rompers, 
 who never makes a noise, and who does not seem to enjoy 
 normal play and fun. 
 
224 THE MOTHER AND HER CHILD 
 
 Let the little folks early learn that the home is theirs to enjoy 
 and that their little friends are welcome; and thus you may be 
 spared such a reproof as one little lad of four unknowingly 
 gave his mamma. His little friend was approaching the stairs 
 of the play room, when the thoughtless mother carelessly and 
 impatiently remarked : " Oh, are you going to bring Ned up- 
 stairs? you'll make so much noise." The little host met his 
 friend at the top with the words : " They don't want boys in 
 the house, we'd better go outdoors." The mother " woke up " 
 and arranged a little " party " upstairs for the two husky, 
 healthy — and noisy — boys. 
 
 During the creeping days remember that the floor is the 
 coolest part of the room, and in the absence of the creeping 
 pen, which is " built up " two feet above the floor, extra cloth- 
 ing should be put upon the child while on the floor. During the 
 damp days of early spring and the cool days of late fall, as well 
 as on the bleak days of winter, baby is better off if he is kept 
 off the floor. It is a fine plan to put a number of table boards 
 on top of the springs of the baby's bed; in this way a sort of 
 pen is produced which is high above the cold floor and the baby 
 is content to spend much of his time in this little pen, happy 
 with his playthings. 
 
 KISSING THE BABY 
 
 We most strongly protest against the haphazard, promiscuous 
 kissing of babies. Many forms of disease, such as tuberculosis, 
 syphilis, diphtheria, influenza, common colds, etc, may be car- 
 ried to the child in this way. 
 
 The baby, notwithstanding his attractiveness, his beauty, and 
 his grace, should not be overfondled. Kissing the hand is not 
 much better than the mouth, for the hand quickly finds its way 
 to the mouth. If it be necessary to kiss a baby, then let the 
 kissing be done on the back of the neck or on top of his head, 
 but never on the face or hand. 
 
 SUCKLING HABITS 
 
 There came into the office one day a woman forty or more 
 years of age, whose mouth was markedly disfigured, and on my 
 
BABY HYGIENE 225 
 
 inquiring as to the probable cause she said : " Doctor, it is the 
 result of sucking my thumb when I was a mere child, too young 
 to know better, and every time I look into the glass, which I 
 assure you is only when I am compelled to, I curse my parents 
 for not breaking me of that habit." The indulgent parents were 
 hated and despised for neglecting their duty, because of the 
 disfigurement which resulted from this unrestrained habit of 
 early childhood. 
 
 Thumb sucking, finger sucking, or pacifier sucking, are all 
 filthy habits, and should be early discouraged. To aid in over- 
 coming the habit of sucking the thumb or biting the finger- 
 nails, the ends of the fingers and edges of the nails may be 
 painted with a solution of aloes or quinine. In extreme cases, 
 a splint may be placed on the anterior bend of the elbow, thus 
 preventing the possibility of raising the hand to the mouth. 
 
 The " sugar teat " of our mother's generation has passed, as 
 has also the " mumbling " of food for the young child ; we no 
 longer give the babies concentrated sugar, nor do we " chew " 
 our children's food at the table. 
 
 Extreme cases of chalk or dirt eating have been noted; such 
 tendencies are decidedly abnormal, and require medical attention. 
 
 KEEP BABY WARM 
 
 Much colic and fretfulness may be avoided if baby is kept 
 warm. The finger tips are a good thermometer, for if they are 
 warm the feet usually are. " Bundling " is unnecessary, but 
 careful attention should be paid to keeping the feet and hands 
 warm without making the child sweat; that is an art, and all 
 mothers should attain it. An extra flannel wrapper and a pair 
 of heavy wool booties in the winter are good warmth producers. 
 Cotton flannel petticoats should be replaced by warm woolen, 
 ones, and when the baby begins to get about on his hands and 
 knees a pair of loosely fitting wool tights, made from discarded 
 woolen underwear are of inestimable comfort and value. In 
 the effort to avoid draughts and body chilling, ever bear in mind 
 baby's need of fresh air and the dangers of sweating, for the 
 sudden cooling of a sweating child is a forerunner of pneu- 
 monia, cold catching, diarrhoea, and other troubles. 
 
226 THE MOTHER AND HER CHILD 
 
 baby's temperature 
 
 During early infancy, baby's temperature sometimes varies 
 greatly; for instance, a rectal temperature may register 97.5 or 
 100.5 F. while the child may be in perfectly good health. 
 
 The baby's temperature should be taken at the rectum — which 
 should normally register 99.5 F. This temperature, as stated 
 above, may register 100.5 F., with no other symptoms of ill- 
 ness. In taking rectal temperature the thermometer should re- 
 main in place two minutes. 
 
 The groin is the next best place to take the temperature ; here 
 the thermometer should remain five minutes, and the registry 
 is usually a degree lower than that of the rectum. 
 
 The baby's temperature usually is a good guide to the severity 
 of any illness. In case the temperature runs above 101 F. the 
 physician should always be notified and his orders carefully fol- 
 lowed. Slight causes often produce a "high temperature of 
 103 to 105 F. for a short time; but such a temperature of 
 long duration means serious trouble and demands expert 
 advice and attention. Abnormal temperature will be more fully 
 considered in that section of this work entitled " Common Dis- 
 orders of Infancy." 
 
 BABY BOUNCING 
 
 The common custom of bouncing or trotting baby on the knee 
 is a harmful one. The young and growing nervous system of 
 the child is decidedly injured by this constant jolting and jig- 
 gling, to say nothing of the " spoiling " effects of this practice. 
 There is a vast difference between the sensitive nervous system 
 of the infant, with its liability to shock and disturbances, and 
 that of the settled and developed nervous system of an adult. 
 The strength of the mother or nurse is so great that the jarring 
 not only often causes indigestion and vomiting in the infant, 
 but sometimes also lays the foundation for " wrecked nerves " 
 in later life. 
 
 The tossing of baby in the air comes in for the same con- 
 demnation. Baby is not "our plaything," and must not be 
 bounced and tossed about like a rubber ball. 
 
BABY HYGIENE 227 
 
 CARRIAGES AND GO-CARTS 
 
 The first carriage should be roomy and comfortable. The bed 
 should be thirty-three inches long and fourteen inches wide, and 
 should be twenty-eight or thirty inches from the floor. The 
 wheels should be rubber tired. The cover should be a good sized 
 hood containing a dark lining, and provided with a wind shield. 
 This dark lining creates a neutral shade for the eyes and pro- 
 tects them from the glare of the sun and the bright skies. 
 
 The bed of the carriage should be soft and warm; and, with 
 the size before mentioned, there is ample room for the " tuck- 
 ing in " with warm blankets, which are first spread out on the 
 bed and then the baby placed into the blanket, after which it 
 is brought up and over him. 
 
 The folding go-cart and the small carrying-basket are to be 
 used only in an emergency. They are convenient in traveling 
 or shopping for the mother who has no maid or caretaker with 
 whom to leave the baby; but they are not satisfactory pleasure 
 vehicles, neither should the baby be left to sit fastened in one 
 of these carts for any great length of time. 
 
 The mattress of the carriage should be of hair, while needed 
 warmth may be secured by the use of a thick, light-weight 
 woolen blanket, placed under the child and brought up and 
 around him. 
 
 A top covering for the carriage must have washing or dry 
 cleaning qualities. A crocheted afghan, a washable embroidered 
 cover, or a firm silk puff, are good covers. The one thing to be 
 remembered is that everything about the carriage soils readily, 
 and if this thought enters into the selection of fabrics, you will 
 not be disappointed when cleaning time comes. 
 
 The carriage pillow should be of down, except in the very hot 
 months, when hair is preferable. Simple, easily laundered slips 
 may be made from two men's-size handkerchiefs. 
 
 BOW LEGS 
 
 Particularly in boys and men, bow legs are not only awkward 
 but are a noticeable deformity ; even the little folks notice them 
 and often remark about it, as did one child who sat profoundly 
 eyeing a very important visitor who stood before the cheerfully 
 
228 THE MOTHER AND HER CHILD 
 
 lighted grate warming himself. The little fellow suddenly ex- 
 claimed, " Oh, Mister, look out ! You're warping." Such a 
 painful experience might have been saved this distinguished 
 gentleman had his mother or caretaker not urged his standing 
 too soon ; and at the same time had fed him on the proper food, 
 so as to avoid " rickets." The ossification or hardening of the 
 bones of the legs continues all through childhood and is often 
 interfered with by improper feeding during the first two years 
 of life. Urging the little people to stand too early is to be dis- 
 couraged. Nature prepares them for it when the right time 
 comes; which time varies — thin children standing and walking 
 usually much earlier than heavy children. 
 
 LIFTING THE BABY 
 
 A very young baby should be lifted from his bed by grasping 
 the clothing below the feet with the right hand, while the left 
 hand slips underneath the back and with spreading fingers sup- 
 ports the neck and head. It is then raised upon the left arm. 
 During the early months the entire spine must be supported in 
 this manner (See Fig. 6). In grasping a baby under the arms 
 or about the waist, undue pressure is made upon the abdomen 
 and chest. Serious injury often follows the careless lifting of 
 the older child by his wrists or hands. The throwing or whirling 
 of the older children by the arms is strongly condemned. Dis- 
 locations have followed such careless so-called fun. 
 
 PREVENTION OF FALLS 
 
 In the selection of the high chair, care should be given to the 
 possibility of overturning. Fortunately, baby's bones are only 
 partially ossified, else he would sustain many fractures in the 
 frequent falls and bumps. When we pause to consider the 
 thoughtless manner in which many babies are left on beds and 
 in unguarded chairs, it is not strange that they fall so often. 
 
 Open windows must be carefully protected by well-fastened 
 screens or by slats of wood. Beds afford a good place for a 
 romp or play, but high-backed chairs should be placed at the 
 side to prevent a fall. A strap across the waist should be fast- 
 ened to the sides of the carriage to prevent falling out. Every- 
 
BABY HYGIENE 229 
 
 thing possible should be done to prevent falls. Outdoor ham- 
 mocks are exceedingly dangerous for the baby. Never leave a 
 child in one unguarded. A little caution, a large amount of 
 common sense — the " good use of brains " — will prevent 
 scars and other lifelong deformities. 
 
 THE BABY'S BREASTS 
 
 Never allow anyone to manipulate or " break down " a swollen 
 breast in a girl or boy baby during the first week or two. This 
 swelling occurs often and should not be interfered with. A hot 
 compress of boracic acid solution may be applied, after which 
 a piece of sterile gauze should be placed over the swollen part 
 and held on by a muslin bandage. Secure medical attention if 
 the swelling does not go down in a day or two. 
 
 VISITING 
 
 Unless absolutely necessary, babies should not be taken on 
 trains and street cars; nor should they take long journeys into 
 the country to attend " reunions." Infections accompany crowds, 
 and baby is far better off at home, in the quiet of his natural 
 surroundings, than he is in the dust, closeness, and bustle of 
 illy ventilated cars, streets, shops, movies, or even at church. 
 Many an infant has been sacrificed by a train journey to " show 
 him off" to the fond grandparents; scores of babies acquire 
 whooping cough at the movies ; and many a baby has nearly 
 lost his life by catching measles, scarlet fever, or diphtheria at 
 church; while the only thing accomplished by the church ex- 
 periment was the spoiling of the entire service by its fretful, 
 tired cry — the infant's only means of protest. 
 
 THE RUNABOUT BABY 
 
 " Runabouts " are the little folks between the age of one and 
 three years, and they require good care, good feeding, and warm 
 and comfortable dressing. 
 
 In general, they need the same fresh air, daily outings, and 
 daily naps of the younger child. Their hands need washing 
 oftener, and their clothing, which is usually a play romper, 
 should be either of white or fast colors that it may be most thor- 
 
230 THE MOTHER AND HER CHILD 
 
 oughly boiled, thus getting a good disinfection. Their eyes, nose, 
 and ears, as well as the genital organs, all require the most rigid 
 daily cleanliness. 
 
 The " bugbear " second summer need not be feared by the 
 mother who takes particular care to see that: 
 
 1. The drinking water is boiled or distilled. 
 
 2. The orange is not overripe. 
 
 3. The banana is not underripe or overripe and is not eaten 
 in chunks. 
 
 4. The milk is fresh and pasteurized. 
 
 5. The baby does not eat candy, ice cream, or other forbid- 
 den foods. 
 
 6. The baby's bowels move daily. 
 
 7. He does not remain dirty. 
 
 8. He naps daily. 
 
 9. He is protected from dust, flies, flees, and mosquitoes. 
 10. He does not go visiting, to church, shops, or " movies." 
 
 The second summer is no harder than the first, as good clean 
 water, easily digested foods, and good general hygiene are all 
 a baby needs at this time. A large army of little folks grow up 
 in spite of the little care they get and the place in which they 
 live. Did they not possess good vital resistance, sound nerves, 
 and good digestion, the children of the " slums " and of the 
 " ghetto " would quickly succumb to their unhygienic sur- 
 roundings. 
 
 TOYS 
 
 In selecting toys for the infant, it must be borne in mind that 
 they will be put to the mouth, and hence they should not be: 
 
 1. Toys with sharp points. 
 
 2. Small enough to swallow, or to push into the nose. 
 
 3. Covered with hair or wool. 
 
 4. Glass that is easily broken. 
 
 5. Painted toys. 
 
 6. Toys that may be taken apart and the small parts swallowed. 
 
 7. Paper books that may be chewed or torn. 
 
BABY HYGIENE 231 
 
 Bear in mind that babies are easily amused with such simple 
 toys as : 
 
 1. A half-dozen clothes pins. 
 
 2. An aluminum pan and a spoon. 
 
 3. Rubber toys (easily washed). 
 
 4. Celluloid dolls, ducks, and other floating toys. 
 
 5. Blocks. 
 
 6. A large rubber ball. 
 
 The older children have wonderfully good times out of doors 
 with a spade, a cart, and the sandpile. Boys most thoroughly 
 enjoy a track with its engine and cars, switches, etc. They build 
 sham fortifications, truly works of art, with their blocks, while 
 the girls are happiest with dolls and household sets. However, 
 occasionally we meet a mother who has a girl who is really a 
 boy in her tastes for toys, and so we say to that mother: give 
 the little girl the desire of her heart; if it's a train instead of a 
 doll, or a toy gun instead of a doll's trunk, well and good, let 
 her have them. What we want are free and easy, natural, chil- 
 dren. They are much more likely to have good nerves, clean 
 thoughts, sound digestion, and equalized circulation. 
 
CHAPTER XXIV 
 GROWTH AXD DEVELOPMENT 
 
 THE newborn baby comes into the world in an absolutely 
 helpless condition and completely unconscious of his sur- 
 roundings. He unconsciously performs certain acts, such as 
 opening his eyes, crying, urination, movement of the bowels, 
 and even nursing of the breast; but there is probably no dis- 
 tinct voluntary action connected with any of these acts. All 
 of his senses at birth are practically dormant, but as the days 
 and weeks go by, they begin to awaken. 
 
 SPECIAL SENSES 
 
 The baby cries, but the tears do not actually flow over the 
 lids until he is three or four months old, and while the baby 
 may fix his eyes upon objects and distinguish light from dark- 
 ness, he will not wink nor blink when the finger is brought close 
 to the eye. Vision is probably not complete until the beginning 
 of the third month. 
 
 Infants are said to be deaf for the first twenty-four to forty- 
 eight hours after birth, and some authorities hold that they are 
 deaf for several days. 
 
 Taste is early developed, as a newborn baby will often re- 
 peatedly show a desire to taste sweet things, while if sour or 
 bitter things are put to the tongue, it shows its displeasure. 
 
 HAIR AXD SCALP 
 
 The newborn baby usually comes into the world with a good 
 head of hair, but the end of the first or second week witnesses 
 the falling out of much of this hair, and falling may continue 
 for even another week or two. The hair is often worn ofY on 
 the back of the head because of constant friction upon the 
 pillow. 
 
 232 
 
GROWTH AND DEVELOPMENT 233 
 
 Children differ greatly in the growth of hair. Some of them 
 come into the world with heavy hair, and others lose it quickly 
 and remain nearly bald-headed until after the first year. 
 
 As the second hair grows in, it is usually lighter than it was 
 at birth and lighter than it will be later in life, as the hair has 
 a tendency to grow darker as the years go by. 
 
 The scalp should receive the care already mentioned. As the 
 hair comes in it should be shampooed once in two weeks and 
 brushed often, making it healthy and vigorous. 
 
 MISSHAPEN HEADS 
 
 It is wise to turn the baby first on one side and then on the 
 other and not allow him to sleep night after night on one side 
 of his head. The newborn head may be misshapen by laying 
 the child constantly on one side, and the ear may be misshapen 
 if it is allowed to curl under or become pressed forward. Mark- 
 edly protruding ears may be partially corrected by having the 
 child wear a well-ventilated cap made for the purpose. 
 
 THE SALIVA 
 
 Many mothers think that the presence of drooling or the ex- 
 cessive flow of saliva is associated with teeth cutting. While 
 it may be associated with the teeth, this is not usually the case ; 
 it is more probably due to the beginning of a new function of 
 secretion. The newborn baby has only enough saliva to fur- 
 nish moisture for the mouth, and not until the age of four 
 or five months does saliva really flow, and since the teeth 
 appear a bit later we often confuse the institution of a new 
 secretion with the oncoming teeth. 
 
 SENSATIONS AND RECOGNITION 
 
 The young baby manifests a number of sensations early in 
 its career. Hunger and satisfaction as well as comfort and 
 discomfort seem to be recognized by the little fellow. He 
 early learns that the approach of someone when he cries 
 usually means that he is to be taken up, and he usually 
 ceases crying as soon as he is taken up. He early manifests 
 a sense of comfort when he is cuddled; there also is early 
 
234 THE MOTHER AND HER CHILD 
 
 present a manifestation of the desire to sleep, and the satisfy- 
 ing pleasure of a drink of water. 
 
 At the age of three months he has recognized many things 
 such as the light or a bright object. He distinctly recognizes 
 his mother and often smiles at her approach. He recognizes 
 his hands at four months, and now begins to recognize other 
 members of the household aside from his mother. Even as 
 early as one month, he may smile at his mother. At two months 
 of age he will often smile at other members of the family. He 
 laughs out loud or chuckles during the fourth or fifth month. 
 But, on the whole, he must be considered as just a little animal 
 whose greatest needs are to have his appetite and thirst satisfied, 
 his little body clothed, and his little nerves put to rest — to sleep. 
 
 SITTING ALONE 
 
 At four months the normal baby will hold up his head; and 
 if he is supported at the back with a pillow, he will sit erectly 
 — holding his head up — at six months ; while at eight months 
 or not later than nine, the normal child should sit alone on the 
 floor with no support. Later in the ninth month he often mani- 
 fests a desire to bear his weight upon his feet. Care is here 
 urged that the mother protect the little fellow at this time 
 and not allow him to rest his weight upon his feet but a 
 moment or two at a time. 
 
 He will reach for a ball suspended from the top of his 
 carriage or bed as early as the fifth month. About this time 
 he discovers his toes while in his bath. He will handle a 
 rattle at six or seven months, and shows delight in such toys. 
 
 DENTITION 
 
 In both the upper and lower jawbones of the newborn 
 infant there are hidden away in snug little cavities two sets 
 of tiny teeth; the first set, or milk teeth, and the second set, 
 or permanent teeth. These rudimentary teeth grow as the 
 baby grows and push their way up or down from the jaw- 
 bones until they finally make their appearance through the 
 gums. The milk teeth appear in a definite way and in five 
 definite groups. 
 
GROWTH AND DEVELOPMENT 235 
 
 There should be no physical disturbance at the appearance 
 of the teeth, which is a physiological process, and it is to be 
 deplored that all of the ills of babyhood are laid upon the 
 teeth with the careless remark : " Oh, its his teeth ! " Many, 
 many illnesses are neglected because our inexperienced mother 
 has been told that she can expect " anything to happen when the 
 baby is cutting its teeth." Now, it is true that the babies of 
 many families do have trouble in cutting their teeth, but the 
 majority of babies cut their teeth comfortably and the first 
 knowledge anyone has of it is the appearance of the tooth itself. 
 As the teeth push their way nearer the surface of the gums, 
 there is a broadening and a hardening of the gums themselves, 
 and it is the exception rather than the rule that the baby needs 
 any help in cutting his teeth. 
 
 Usually by the time the baby is seven months old it has two 
 central teeth on the lower jaw (the central incisors), which 
 constitute the first group. The second group of teeth to appear 
 is the four upper central teeth which are all through by the 
 time the baby is twelve months old, and are often through at 
 ten months. Then there is a pause of from one to three months 
 before the next teeth appear — the four anterior molars. As 
 these four anterior molars come in, the two lateral incisors 
 appear on the lower jaw, which now gives us, by the time the 
 baby is fourteen or fifteen months old, four central teeth upper, 
 four central teeth lower, and the four anterior molars, which 
 make twelve teeth. 
 
 Another pause of two or three months and then we get the 
 four canine, which fill in the space between the first molars and 
 the front teeth. The canine on the upper jaw are commonly 
 known as the eye teeth, while the canine teeth on the lower 
 jaw are spoken of as the stomach teeth. This brings us to the 
 age of eighteen to twenty-four months, when there is still 
 another pause of two or three months, after which time the 
 big teeth or the four posterior molars appear, which completes 
 the first set of twenty teeth — the milk teeth. When baby is 
 twenty months old the milk teeth are often all in. The complete 
 set should appear not later than the thirtieth month. 
 
 During the life of the milk teeth the child should be taken 
 
236 THE MOTHER AND HER CHILD 
 
 to the dentist at least once a year, better once in six months, 
 for all defective teeth must be properly and promptly cared for. 
 Inexpensive but sanitary fillings should be placed in all decayed 
 teeth, for the roots of the first teeth are very soft and infec- 
 tion readily spreads to the jaws and the permanent teeth and 
 serious trouble often begins thus early. 
 
 If dentition is seriously delayed, investigation should be 
 started concerning the general condition of the child, for this 
 delay often accompanies ill health. 
 
 When the child is six years old, the mother should be watch- 
 ful, for it is at this time that the first permanent teeth appear 
 just behind the last molar of the milk teeth. They do not 
 replace any of the teeth present, and many times they come 
 through and decay without receiving any attention. It is sel- 
 dom necessary to assist these milk teeth as they come through 
 the gum, and should the gums become highly colored and 
 swollen it is not wise to lance them, for if the teeth are not 
 ready to come through immediately, the gum only toughens 
 the more and makes the real cutting still more painful. 
 
 This is the time to cut down the baby's food as well as to 
 look for other digestive disturbances, for the number of stools 
 may increase and vomiting may occur, and by reducing the 
 quantity and quality of the food and encouraging abundant 
 water drinking, much trouble may be avoided. Under no cir- 
 cumstances urge the baby to eat when he refuses his food, 
 when the gums seem swollen and red during the teething time. 
 You will find that he will enjoy orange juice, pineapple juice, 
 or prune juice. All of these digestive symptoms are simply 
 the result of " feeling bad, " and if heavy food or his regular 
 feeding is greatly diminished he will get along much better 
 than if fed his regular allowance of food. 
 
 APPEARANCE OF THE TEETH 
 
 The normal child has: 
 
 Six teeth at one year. 
 
 Twelve teeth at one and one-half years. 
 
 Sixteen teeth at two years. 
 
 Twenty teeth at two and one-half years. 
 
GROWTH AND DEVELOPMENT 237 
 
 When the child is six years old the first permanent tooth 
 appears just back of the last of the milk teeth. By the time 
 he is seven, the four central teeth, two above and two below, 
 are out and the new ones begin to appear. The order of their 
 appearances is as follows: 
 
 Four first molars 6 years 
 
 Four central incisors 7 years 
 
 Four lateral incisors 8 years 
 
 Four first bicuspids 9 to 10 years 
 
 Four second bicuspids 10 to 11 years 
 
 Four canines 11 to 13 years 
 
 Four second molars 12 to 15 years 
 
 Four third molars 17 to 25 years 
 
 DENTAL SUGGESTIONS 
 
 A better plan than to lance swollen gums is to rub them 
 gently with ice wrapped in a soft cloth, or to dip the finger in 
 ice water and rub the gums — this often gives the baby much 
 relief. 
 
 Often the baby finds comfort in biting on an ivory ring, but 
 the utmost care must be used in keeping it clean and avoiding 
 contamination by allowing it to drop on the floor. 
 
 Convulsions are never the symptoms of teething. Consult 
 a physician at once, as such seizures probably spring from 
 causes other than teething. 
 
 Cleansing of the teeth should be carried out systematically 
 every morning by means of a piece of cotton which has been 
 dipped in a boric-acid solution or a solution of bicarbonate of 
 soda (common baking soda). A soft brush may be used for 
 cleansing, and when there are particles of food between the teeth 
 they should be removed by strands of waxed floss. 
 
 Throughout life, frequent visits should be made to the den- 
 tist; during early childhood days he should be on the lookout 
 for symptoms which indicate deformity — narrow jaws and 
 other conditions which affect the permanent teeth. During 
 adolescence and adult life the teeth should be examined every 
 six months and cleansings of the mouth should become a part 
 of the daily toilet. 
 
238 THE MOTHER AND HER CHILD 
 
 THE WEIGHT 
 
 During the first year, nothing gives us so much information 
 concerning the child's general well-being as the weight. Such 
 a record will not only enlighten the mother concerning the 
 development of the child, but the grown-up child appreciates 
 the record and preserves it along with the other archives of 
 babyhood days. Every Sunday morning, when the father is 
 at home, the baby should be weighed and an accurate record 
 kept. It is important that the baby be weighed each time in 
 the same garments — shirt, band, diaper, and stockings — for 
 every ounce must be accounted for. 
 
 Until the baby is five or six months old he should gain from 
 four to eight ounces a week. Anything short of this is not 
 enough and should be reported to the physician. After six 
 months the gain is about a pound each month. This varies 
 somewhat; possibly during the tenth and eleventh month the 
 gain is lessened, but by the close of the first year the baby 
 should have trebled its birth weight. 
 
 Dr. Griffith gives us the following very interesting bit of 
 information concerning the weight of boys and girls after the 
 first year, and to him also belongs the credit for the accom- 
 panying table showing the growth, height, and weight of the 
 child up to sixteen years of age. 
 
 After the first year we notice that, taking it all together, there is 
 a gradual increase in the number of pounds and a decrease in the 
 number of inches added yearly, four inches being gained in both 
 the second and third years, three inches in the fourth and fifth years, 
 and after this two inches a year. The gain in weight is four pounds 
 yearly from the age of three to that of seven years, then five, then 
 six, and then about nine pounds. It sometimes happens that at about 
 the age of nine in girls and eleven in boys there is almost a cessation 
 of growth for a short time. Later, at about twelve years, girls take 
 on a particularly rapid growth, and decidedly exceed boys of the 
 same age in weight, and sometimes in height also. At fifteen or 
 sixteen years the rapidity of growth in girls, both in weight and 
 height, will be greatly diminished, while boys of this age will often 
 begin to develop very rapidly, and will soon materially exceed the 
 other sex in both respects. 
 
GROWTH AND DEVELOPMENT 
 
 239 
 
 TABLE SHOWING GROWTH IN HEIGHT AND WEIGHT 
 
 Age. Height. 
 
 Birth 19 inches. 
 
 1 week 
 
 2 weeks 
 
 3 weeks. 
 
 1 month 2oy 2 inches. 
 
 2 months. . . .21 
 
 3 months. . . .22 
 
 4 months. . . .23 
 
 5 months 2^/2 " 
 
 6 months. .. .24 
 
 7 months. .. .24^ " 
 
 8 months . ... 25 
 
 9 months 25^ " 
 
 10 months. . . .26 
 
 11 months 26^ " 
 
 1 year 27 
 
 2 years 31 
 
 3 years 35 
 
 4 years ZIV2. " 
 
 5 years 40 
 
 6 years 43 
 
 7 years 45 
 
 8 years 47 " 
 
 9 years 49 
 
 10 years 51 
 
 ii years S3 
 
 12 years 55 " 
 
 13 years 57 
 
 14 years 59 
 
 15 years 61 " 
 
 16 years 63 " 
 
 Weight. 
 7 lbs. 8 oz. 
 7V2 " 
 
 m 
 
 10M 
 
 1234 
 mi 
 
 15 
 m 
 
 17V4 
 1854 
 1834 
 1934 
 
 20^4 
 21^4 
 
 27 
 
 32 
 
 36 
 40 
 
 44 
 48 
 
 53 
 58 
 
 64 
 
 70 
 
 79 
 
 88 
 100 
 109 
 117 
 
 10^ " 
 
 2 " 
 
 Gained 1 oz. a day; 
 7 oz. a week. 
 
 "\ f Gained 34 oz. a day; 
 J I 5^2 oz. a week. 
 
 Double original weight. 
 Gained ^3 oz. a day; 
 4^ oz. a week. 
 
 Gained ^4 in. a month. 
 Gained about 1 lb. a month. 
 
 Treble original weight. 
 
 J- 4 Gained 4 in. a year. 
 
 Double original length. 
 J Gained 3 in. and 4 lbs. a 
 I year. 
 
 "1 J Gained 2 in. and 4 lbs. a 
 J I year. 
 
 }{ 
 
 Gained 
 year. 
 
 in. and 5 lbs. a 
 
 J Gained 2 in. and 6 lbs. a 
 I year. 
 
 J Gained 2 inches and about 
 I 9 lbs. a 3'ear. 
 
240 
 
 THE MOTHER AND HER CHILD 
 
 GENERAL DEVELOPMENT 
 
 The accompanying illustration (Fig. 14), taken from Dr. 
 Yale, represents the developmental changes at one, five, 
 nine, thirteen, seventeen, and twenty-one years. Each figure 
 is divided into four equal parts, and as we watch the develop- 
 ment from the baby who at one year, as Dr. Yale says, is four 
 heads high, at the age of twenty-one the legs and the trunk have 
 much outgrown the growth of the head, so that at this age the 
 head is only two-thirteenths or less of the whole length of the 
 
 5 9 13 17 
 
 Fig. 14. Developmental Changes 
 
 body. The legs have grown more rapidly and equal one-half 
 the entire body length. The trunk has not kept pace with the 
 legs, for as you will see from the diagram the line reaches 
 the navel of the child in one year, while in the adult it is much 
 lower. The rapid growth of the legs is accomplished after 
 nine years of age. 
 
 The proportions of the head, chest, and abdomen are exceed- 
 ingly important in the growing child. At the end of the first 
 year the head, chest, and abdomen are about uniform in cir- 
 cumference. The head may measure one-fourth of an inch 
 more, but the chest and abdomen should both measure eighteen 
 
GROWTH AND DEVELOPMENT 241 
 
 inches in circumference at this time. Should the head or the 
 abdomen be two inches larger than the chest; the attention 
 of the physician should be called to it, for either are indicative 
 of conditions that should be carefully investigated. 
 
 NORMAL BREAST WEANING 
 
 As a general rule the normal, healthy, breast-fed baby is 
 given a feeding of a bottle each day after he is ten months 
 old. These bottles are increased in number until, by the time 
 the baby is a year old, he is gradually weaned from the breast. 
 Should the ninth month of baby's life arrive in the hot summer 
 months we urge the mothers to continue breast feeding, with 
 possibly the addition of some fruit juices, as noted elsewhere, 
 until early autumn. Under no circumstances should the baby be 
 weaned and compelled to use cow's milk during the season of 
 the year when the risks of contamination are greatest. If the 
 baby is nursed up to the close of his first year he hardly need 
 be trained to use the bottle, but may take his food from a cup. 
 From one to two months should always be consumed in wean- 
 ing the baby, unless sudden weaning is necessitated by ill 
 health, as noted elsewhere. The baby should have, if possible, 
 from thirty to forty days to accustom himself to cow's milk 
 exclusively. 
 
 If the child is weaned slowly there should be no trouble with 
 the breasts, but in the instance of sudden weaning the mother 
 should restrict her liquids, put on a tight breast binder, and 
 for a day or two should take a dose of a saline cathartic, 
 which will assist in taking care of the liquids and thus decrease 
 the secretion of milk. 
 
 NORMAL BOTTLE WEANING 
 
 If the bottle food is agreeing with the baby he should be 
 allowed to use it up to the end of the first year when he will 
 be given whole milk with possibly the addition of a little lime 
 water. We see no reason why the child should give up his 
 bottle during the second year unless other food is refused — 
 unless he will not accept other food than from his bottle — and 
 if you are convinced that he has formed the " bottle habit, " 
 
242 THE MOTHER AND HER CHILD 
 
 then the milk should be put into a tiny cup or glass, and he 
 should learn to sip it along with his solid foods; but if he takes 
 his other foods without any hesitancy, then we know no reason 
 why he should not take his milk in this comfortable manner 
 from his bottle at least two or three feedings each day. 
 
 If you desire to wean him from his bottle, serve the first part 
 of it with a spoon from a cup or glass and then give him the 
 remainder in the bottle. The beautiful picture of a big, robust 
 baby lying on his back, knees flexed, both hands holding his 
 beloved bottle still lingers in my mind as one of the pleasant 
 memories of my lad's babyhood days, and at the close of the 
 second year, when the beloved bottle was left behind, I believe 
 I missed something as well as did the lad. 
 
 I recall no difficulty with his taking the food from a cup. 
 The success of all normal weanings is due entirely to the fact 
 that it is done gradually and slowly, and under no circum- 
 stances should it be roughly and abruptly attempted — partic- 
 ularly in case of the bottle feeding. 
 
 TRAINING THE BOWELS AND BLADDER 
 
 Reference is made to this subject in another part of this 
 book — where we went into the detail of keeping the daily record 
 of these physiological occurrences — and it was found that the 
 bowels moved and the bladder was emptied at about the same 
 time each day. Any mother, caretaker, or nurse, who will take 
 the time to keep a daily record of the hours of defecation and 
 urination, will observe the time carefully and will catch the 
 child on nearly every occasion before an accident occurs. Often 
 as early as four months the bowels will move in an infant's 
 chamber at regular times each day. The nurse or mother 
 places this receptacle in her lap and holds the child gently and 
 carefully upon it. A little later it can be made to sit on a spe- 
 cial chair prepared for the purpose, and at eight or nine months 
 by careful training the urination can be controlled, and by the 
 end of the first year the diapers ought to be discontinued. 
 
 If the child has not learned to control the bladder by the 
 age of two years, medical attention should be called to the 
 fact and remedial measures instituted. 
 
GROWTH AND DEVELOPMENT 243 
 
 baby's speech 
 
 The baby should begin to talk at one year. He early learns 
 to say " mamma " and " papa," and gradually adds nouns to 
 his vocabulary, so that at eighteen months the normal child 
 should have a vocabulary of one hundred to one hundred and 
 fifty words. As he nears the two-year mark, he has acquired 
 a few simple verbs and he can possibly put three words together, 
 such as, " Willie wants drink." Pronouns come in late, as we 
 all recall that the young child usually speaks of himself by 
 his own name. 
 
 Children are born mimics. If you talk baby talk to them, 
 they will talk baby talk back. For instance, a well known 
 author told us just the other day that for many years no other 
 name was given to the sewing machine in his house but the 
 word " mafinge," and not until he went to school did he cor- 
 rect the word " bewhind," for in the nursery he learned the 
 line " wagging their tails bewhind them." Baby talk is very 
 cunning, and often the adult members of the family pick it up 
 and keep it up for years, and only when they are exposed in 
 public, as one mother was on a suburban platform by her 
 four-year-old lad shouting, " Mamma, too-too tain tumin, too- 
 too tain tumin," do they sense their responsibility and realize 
 how difficult it is to form new habits. This poor mother tried 
 in vain to have her little fellow say, as did another little lad 
 two and one-half years old, "Mother, the train's coming; let's 
 get on." 
 
 Many words of our beloved language at best are hard to 
 understand; so let us speak correct English to the little folks 
 and they will reward us by speaking good English in return. 
 
 If at two years the child makes no attempt at speech, sus- 
 picions should be aroused concerning mutism or other serious 
 nervous defects. Medical advice should be sought. 
 
 DEFECTIVE SPEECH 
 
 All guttural tones which may be occasioned by adenoids or 
 enlarged tonsils, all lisping, stuttering, or defective speech of 
 all words should be taken in hand at the very start, as they 
 
244 THE MOTHER AND HER CHILD 
 
 are usually overcome by constant repetition of the correct 
 manner of speaking the particular word in question. Children 
 of defective speech need special training, and should in no way 
 be allowed rapidly to repeat little nursery rhymes, as oftentimes 
 this rapid repetition of rhymes by a child with hereditary 
 nervous defects may occasion stuttering or stammering later on. 
 
 CALISTHENICS 
 
 Special exercise should not be forced upon young children. 
 Physical culture, along with many other things intended for 
 sedentary adults, should never be forced upon little folks who 
 get all of the exercise they need in the many journeys they 
 take building their blocks, sailing their boats, tearing down 
 imaginary houses, making imaginary journeys — from morn- 
 ing until night the little feet are kept busy — never stopping 
 until the sandman comes at sleepy time. Do not yourself 
 attempt to stimulate a child who seems backward. Consult your 
 physician. You had much better put a child out to grow up 
 in the yard by himself with his sandpile than to force calis- 
 thenics or advance physical training upon him. 
 
 BOW LEGS AND WALKING 
 
 Do not attempt to hasten nature in aiding the child to walk. 
 Let him creep, roll, slide, or even hunch along the floor — wait 
 until he pulls himself to his feet and gradually acquires the art 
 of standing alone. If he is overpersuaded to take " those cute 
 little steps " it may result in bow legs, and then — pity on him 
 when he grows up. Sometimes flat foot is the result of early 
 urging the child to rest the weight of the body upon the unde- 
 veloped arch. A defect in the gait or a pigeon toe is hard to 
 bear later on in life. A certain amount of pigeon-toeing is 
 natural and normal. If the baby is heavy he will not attempt 
 to walk at twelve months. He will very likely wait until four- 
 teen or fifteen months. The lighter-weight children sometimes 
 walk as early as eleven months, but they should all be walking 
 at eighteen months, and if not, it is usually indicative of back- 
 ward mentality. 
 
 If the training of the bowels and bladder will replace the 
 
GROWTH AND DEVELOPMENT 245 
 
 diapers with drawers, the baby will attempt to walk sooner than 
 when encumbered with a bunglesome bunch of diaper between 
 the thighs. The little fellow runs alone at sixteen months and 
 thoroughly enjoys it, and the wise mother will pay no attention 
 to the small bumps which are going to come plentifully at this 
 particular time. 
 
 SUMMARY OF BABY'S DEVELOPMENT 
 
 He discovers his hands at three or four months. At six 
 months he sits alone, plays with simple objects, grasps for 
 objects, and laughs aloud from the third to the fifth month. 
 He says " goo goo " at four or five months. At one year he 
 should stand with support, listen to a watch tick, follow mov- 
 ing objects, know his mother, play little games, such as roll- 
 ing a ball, should have trebled his birth weight, and have at 
 least six teeth, and should use three words in short sentences. 
 At eighteen months he should say " mamma " spontaneously, 
 walk and run without support, should have quite a vocabulary, 
 should be able to perform small errands like " pick up the book," 
 and should have twelve to sixteen teeth. At two years he 
 should be interested in pictures, able to talk intelligently, and 
 know where his eyes, nose, mouth, hands, and feet are. At 
 three years, he should enumerate the objects in a picture, tell 
 his surname, and repeat a sentence with six words. 
 
 In the case of a premature baby or a very delicate child, or 
 as a result of a prolonged illness or a very severe sickness, 
 such as spinal meningitis, the time of these mental and physi- 
 cal developments may all be postponed, while rickets, which 
 will be spoken of later, is often the cause of late sitting, late 
 standing, and late walking. 
 
 DIET AFTER THE FIRST YEAR 
 
 Milk is the principal article of diet during the second year. 
 It should be given with regularity at distinct intervals of four 
 meals a day. It may be given from the nursing bottle, unless 
 the child has acquired the bottle habit and refuses to eat any- 
 thing else but the food from his bottle, in which case it should 
 be given from a cup. Beginning with the sixth month, aside 
 
246 THE MOTHER AND HER CHILD 
 
 from his milk, be it breast milk or bottle milk, he is to be 
 given orange juice once each day as well as the broth from 
 spinach and other vegetables. This is necessary to give the 
 child certain salts which are exceedingly essential to the bottle 
 baby. 
 
 At the close of the year when he is taking whole milk he 
 should be given arrowroot cracker, strained apple sauce, prune 
 pulp, fig pulp, mashed ripe banana (mashed with a knife), a 
 baked potato with sauce or gravy (avoiding condiments), and 
 a coddled egg. Fruit juices may be added to the diet, such as 
 grape, pineapple, peach, and pear juice. Later in the second 
 year he may be given stale bread and butter, and for desserts 
 he may have cup custard, slightly sweetened junket, and such 
 fruit desserts as baked apple and baked pear. 
 
 We do not think it is necessary to give children much meat 
 or meat juices. We appreciate that there is a diversity of 
 opinion upon this subject, but we do not hesitate to say that 
 in the families where meat is little used, the children seem to 
 grow up in the normal manner with sound healthy bodies, 
 sometimes having never tasted it. When meat is used, it should 
 be well cooked to avoid contamination with such parasites as 
 tapeworm and trichina; it should also be well chewed before 
 swallowing, as many of the intestinal disturbances of the older 
 children are due to the swallowing of unmasticated food such 
 as half-chewed banana, chunks of meat, rinds of fruit, and the 
 skins of baked potatoes. 
 
 Let the children's diet be simply planned, well cooked, thor- 
 oughly masticated, and above all things have regular meal 
 hours, and no " piecing " between meals ; and if the mother 
 begins thus early with her little fellow, she will be rewarded 
 some later day by hearing him say to some well-meaning neigh- 
 bor, who has just given him a delicious cookie or a bit of 
 candy : " Thank you, I will keep it until meal time." Chil- 
 dren learn one of the greatest lessons of self control in follow- 
 ing the teaching that nothing should pass the lips between 
 meals but water or a fruit -ade. Children in the second year 
 require four meals a day, one of which is usually only the 
 bottle or a cup of milk. These meals are usually taken at six, 
 
GROWTH AND DEVELOPMENT 247 
 
 ten, two, and six in the evening. Oftentimes this early six 
 o'clock meal is just a bottle or cup of milk, as may also be the 
 evening meal. 
 
 CANDY 
 
 Now, a word about candy. Pure candy is wholesome and 
 nourishing. It is high in calorific value, and children should 
 be allowed to have it if it does not enter the stomach in solu- 
 tions stronger than ten or fifteen per cent. We can see at a 
 glance that chocolate creams, bonbons, and other soft candies 
 should never be given to children. Candies that they can 
 suck, such as fruit tablets, stick candy, sunshine candy, and 
 other hard confections that are pure, and free from mineral 
 colorings and other concoctions such as are commonly used 
 in the cheaper candies, may safely be given at the close of 
 the meals — but never between meals. 
 
 All such articles as tea, coffee, beer, soft candies, condi- 
 ments, pastries, and fried foods, should be positively avoided in 
 the case of all children under five and six years of age. 
 
 The diet from now on will be considered in the chapter 
 " Diet and Nutrition." 
 
PART III 
 THE CHILD 
 
PART III 
 THE CHILD 
 
 CHAPTER XXV 
 THE SICK CHILD 
 
 TO the mother who has passed through the experience of 
 bringing the child into the world is usually given that 
 intuitiveness which helps her in caring for that child when it 
 is well and in recognizing certain symptoms when it is sick. 
 The newborn baby brings with him a large responsibility, but 
 as the weeks pass by his care becomes less and less of a nervous 
 strain, as the routine duties, so nearly alike each day of his 
 little life, have made the task comparatively easy; but when the 
 baby gets sick, particularly if he is under one year of age, and 
 it is impossible for him clearly to make known his wants, and 
 being unable to tell where it hurts or how badly it hurts, the 
 average mother is likely to become somewhat panicky; and 
 this confusion of mind often renders her quite unfit success- 
 fully to nurse the sick baby. 
 
 THE NURSE 
 
 It is often wise to secure the services of a trained nurse, 
 and if the family purse will allow such services, a good, sin- 
 cere, capable, practical nurse should be engaged, for her firm 
 kindness will often accomplish much more than the uninten- 
 tional irritability and anxious solicitude of an overworked and 
 nervous mother. 
 
 Usually the mother not only attempts the care of the sick 
 baby with the long night vigil — often not having the oppor- 
 tunity to take a bath or change her raiment day in and day 
 out — but she often attempts to manage the entire household 
 
 251 
 
2$2 THE MOTHER AND HER CHILD 
 
 as well, including the getting of the meals and' keeping the 
 house cleaned, and it is not to be wondered at that her nerves 
 become overtaxed and in an unlooked for moment she becomes 
 irritable and cross with the sick child. 
 
 No matter how low the financial conditions of the family may- 
 be, outside help is always essential in cases of severe or long- 
 continued illness of the children. Should the mother insist 
 upon caring for the baby herself, then all household duties 
 should be given over to outside help, and as she takes the role 
 of the nurse, the same daily outing and sleep that an outside 
 nurse would receive should be hers to enjoy. 
 
 Dr. Griffith has so ably detailed the " features of disease " 
 that we can do no better than to quote the following : * 
 
 The position assumed in sickness is a matter of importance. A 
 child feverish or in pain is usually very restless even when asleep. 
 When awake it desires constantly to be taken up, put down again, 
 or carried about. Sometimes, however, at the beginning of an acute 
 disease it lies heavy and stupid for a long time. In prolonged ill- 
 nesses and in severe acute disorders the great exhaustion is shown 
 by the child lying upon its back, with its face turned toward the 
 ceiling, in a condition of complete apathy. It may remain like a log, 
 scarcely breathing for days before death takes place. Perfect immo- 
 bility may also be seen in children who are entirely unconscious 
 although not exhausted. 
 
 A constant tossing off of the covers at night occurs early in 
 rickets, but, of course, is seen in many healthy infants, especially if 
 they are too warmly covered. A baby shows a desire to be propped 
 up with pillows or to sit erect or to be carried in the mother's arms 
 with its head over her shoulder whenever breathing is much inter- 
 fered with, as in diphtheria of the larynx and in affections of the 
 heart and lungs. The constant assumption of one position or the 
 keeping of one part of the body still, may indicate paralysis. When, 
 however, a cry attends a forcible change of position, it shows that 
 the child was still because movement caused pain. 
 
 Sleeping with the mouth open and the head thrown back often 
 attends chronic enlargement of the tonsils and the presence of 
 
 * From Griffith's Care of the Baby, copyrighted by W. B. Saunders 
 Company. 
 
THE SICK CHILD 253 
 
 adenoid growths in young children, although it may be seen in other 
 affections which make breathing difficult. In inflammation of the 
 brain the head is often drawn far back and held stiffly so. Some- 
 times, too, in this disease the child lies upon one side with the back 
 arched, the knees drawn up, and the arms crossed over the chest. 
 A constant burying of the face in the pillow or in the mother's 
 lap occurs in severe inflammation of the eyes. 
 
 GESTURES 
 
 The gestures are often indicative of disease. Babies frequently 
 place the hands near the seat of pain ; thus in slight inflammation 
 of the mouth they tend to put the hand in the mouth ; in earache 
 to move it to the ear; and in headache to raise it to the head. 
 In headache or in affections of the brain they sometimes pluck at 
 the hair or the ears, although they may often do this when there 
 is no such trouble. Picking at the nose or at the opening 
 of the bowel is seen in irritation of the intestine from worms or 
 oftener from other cause. A child with a painful disease of its 
 chest may sometimes place its hand on its abdomen, or a hungry 
 child try to put its fists into its mouth. 
 
 In approaching convulsions the thumbs are often drawn tightly 
 into the palms of the hands and the toes are stiffly bent or straight- 
 ened. Very young babies, however, tend to do this, although 
 healthy. The alternate doubling up and straightening of the body, 
 with squirming movements, making of fists, kicking, and crying, 
 are indications of colic. This is especially true if the symptoms 
 come on suddenly and disappear as suddenly, perhaps attended 
 by the expulsion of gas from the bowel. 
 
 SKIN COLOR 
 
 The color of the skin is often altered in disease. It is yellow in 
 jaundice, and is bluish, especially over the face, in congenital heart 
 disease. There is a purplish tint around the eyes and mouth, with 
 a prominence of the veins of the face, in weakly children or in those 
 with disordered digestion. A pale circle around the mouth accom- 
 panies nausea. The skin frequently acquires an earthy hue in 
 chronic diarrhea, and is pale in any condition in which the blood 
 is impoverished, as in Bright's disease, rickets, consumption, or 
 any exhausted state. Flushing of the face accompanies fever, but 
 besides this there is often seen a flushing without fever in older 
 children the subjects of chronic disorders of digestion. Sudden 
 flushing or paling is sometimes seen in disease of the brain. 
 
254 THE MOTHER AND HER CHILD 
 
 FACIAL EXPRESSION 
 
 The expression of the face varies with the disease. In whooping 
 cough and measles the face is swollen and somewhat flushed, giving 
 the child a heavy, stupid expression. There is also swelling of the 
 face, especially about the eyes, in Bright's disease. Repeated mo- 
 mentary crossing of the eyes often indicates approaching convul- 
 sions. In very severe acute diarrhea it is astonishing with what 
 rapidity the face will become sunken and shriveled, and so covered 
 with deep lines that the baby is almost unrecognizable. The same 
 thing occurs more slowly in the condition commonly known as 
 marasmus. Often the face has an expression of distress in the 
 beginning of any serious disease. If the edges of the nostrils move 
 in and out with breathing, we may suspect some difficulty of res- 
 piration, such as attends pneumonia. The baby sleeps with its eyes 
 half open in exhausted conditions or when suffering pain. 
 
 THE HEAD 
 
 The head exhibits certain noteworthy features. Excessive per- 
 spiration when sleeping is an early symptom of rickets. It must be 
 remembered, however, that any debilitated child may perspire more 
 or less when asleep. Both in rickets and in hydrocephalus (water 
 on the brain) the face seems small and the head large, but in the 
 former the head is square and flat on top, while in the latter it is 
 of a somewhat globular shape. The fontanelle is prominent and 
 throbs forcibly in inflammation of the brain, is too large in rickets 
 and hydrocephalus, bulges in the latter affection, and sometimes 
 sinks in conditions with only slight debility. 
 
 THE CHEST 
 
 The chest exhibits a heaving movement with a drawing in of the 
 spaces between the ribs in any disease in which breathing is diffi- 
 cult. A chicken-breasted chest is seen in Pott's disease of the spine, 
 and to some extent in bad cases of enlargement of the tonsillar 
 tissue ; a " violin-shaped " chest in rickets ; a bulging of one side in 
 pleurisy with fluid; and a long, narrow chest, with a general flat- 
 tening of the upper part, in older children predisposed to con- 
 sumption. 
 
 THE ABDOMEN 
 
 The abdomen is swollen and hard in colic. It is also much dis- 
 tended with gas in rickets, and is constantly so in chronic indiges- 
 
THE SICK CHILD 255 
 
 tion in later childhood. It is usually much sunken in inflammation 
 of the brain or in severe exhausting diarrhea or marasmus. It 
 may be distended with liquid in some cases of dropsy. 
 
 THE CRY 
 
 The study of the cry furnishes one of the most valuable means 
 of learning what ails a baby. A persistent cry may be produced by 
 the intense, constant itching of eczema. 
 
 The paroxysmal cry, very severe for a time and then ceasing abso- 
 lutely, is probably due to colic, particularly if accompanied by the 
 distention of the abdomen and the movements of the body already 
 referred to. A frequent, peevish, whining cry is heard in children 
 with general poor health or discomfort. A single shrill scream 
 uttered now and then is often heard in inflammation of the brain. 
 In any disease in which there is difficulty in getting enough air into 
 the lungs, as in pneumonia, the cry is usually very short and the 
 child cries but little, because it cannot hold its breath long enough 
 for it. A nasal cry occurs with cold in the head. 
 
 A short cry immediately after coughing indicates that the cough 
 hurts the chest. Crying when the bowels are moved shows that 
 there is pain at that time. A child of from two to six years, waking 
 at night with violent screaming, is probably suffering from night 
 terrors. In conditions of very great weakness and exhaustion the 
 baby moans feebly, or it may twist its face into the position for 
 crying, but emit no sound at all. This latter is also true in some 
 cases of inflammation of the larynx, while in other cases the cry 
 is hoarse or croupy. Crying when anything goes into the mouth 
 makes one suspect some trouble there. If it occurs with swallow- 
 ing, it is probable that the throat is inflamed. 
 
 With the act of crying there ought always to be tears in children 
 over three or four months of age. If there are none, serious disease 
 is indicated, and their reappearance is then a good sign. 
 
 COUGHING 
 
 The character of the cough is also instructive. A frequent, loud, 
 nearly painless cough, at first tight and later loose, is heard in bron- 
 chitis. A short, tight, suppressed cough, which is followed by a 
 grimace, and, perhaps, by a cry, indicates some inflammation about 
 the chest, often pneumonia. There is a brazen, barking, " croupy " 
 cough in spasmodic croup. In inflammation of the larynx, includ- 
 ing true croup, the cough may be hoarse, croupy, or sometimes 
 almost noiseless. 
 
256 THE MOTHER AND HER CHILD 
 
 The cough of whooping cough is so peculiar that it must be de- 
 scribed separately when considering this disease. Then there are 
 certain coughs which are purely nervous or dependent upon remote 
 affections. Thus the so-called " stomach cough " is caused by some 
 irritation of the stomach or bowels. It is not nearly so frequent as 
 mothers suppose. Irritation about the nose or the canal of the 
 ears sometimes induces a cough in a similar way. Enlarged tonsils 
 or elongated palate or throat irritation may also produce a cough. 
 
 THE BREATHING 
 
 The breathing of a young child, particularly if under one year 
 of age and awake, is always slightly irregular. If it becomes very 
 decidedly so, we suspect disease, particularly of the brain. A com- 
 bination of long pauses, lasting half a minute or a minute, with 
 breathing which is at first very faint, gradually becomes more and 
 more deep, and then slowly dies away entirely, goes by the name of 
 " Cheyne-Stokes respiration," and is found in affections of the brain. 
 It is one of the worst of symptoms except in infancy, and even then 
 it is very serious. 
 
 The rate of respiration is increased in fever in proportion to the 
 height of the temperature. It is increased also by pain in rickets, 
 and especially in some affections of the lungs. Sixty respirations a 
 minute are not at all excessive for a child of two years with pneu- 
 monia, and the speed is frequently decidedly greater than this. 
 
 Breathing is often very slow in disease of the brain, particularly 
 tubercular meningitis. Poisoning by opiates produces the same 
 effect. Frequent deep sighing or yawning occurs in affections of the 
 brain, in faintness, or in great exhaustion, and may be a very un- 
 favorable symptom. Breathing entirely through the mouth shows 
 that the nose is completely blocked, while snuffling breathing is the 
 result of a partial catarrhal obstruction. A gurgling in the throat 
 not accompanied by cough may indicate that there is mucus in the 
 back part of it, the result of an inflammation, sometimes slight, 
 sometimes serious. 
 
 " Labored " breathing, in which the chest is pulled up with each 
 breath while the muscles of the neck become tense, the pit of the 
 stomach and the spaces between the ribs sink in, and the edges of 
 the nostrils move in and out, is seen in conditions where the natural 
 ease of respiration is greatly interfered with, as in pneumonia, 
 diphtheria of the larynx, asthma, and the like. Long-drawn, noisy 
 inspirations and expirations are heard in obstruction of the larynx, 
 as from laryngeal diphtheria or spasmodic croup. 
 
THE SICK CHILD 257 
 
 THE PULSE 
 
 The rate of the pulse is subject to such variations in infants that 
 its examination is of less value than it would otherwise be. In 
 early childhood its observation is of more service, although even 
 then deceptive. Slight irregularity is not uncommon. Unusual 
 irregularity is an important symptom in affections of the brain or 
 heart. Fever produces an increase in the pulse rate, the degree of 
 which depends, as a rule, upon the height of the temperature. Slow- 
 ing of the pulse is a very significant symptom, seen particularly in 
 affections of the brain, and sometimes in Bright's disease and jaun- 
 dice. 
 
 THE TEMPERATURE 
 
 The temperature is of all things important to remember in infancy 
 and childhood because fever is easily produced and runs high from 
 slight causes. 
 
 Even slight cold or the presence of constipation or slight dis- 
 turbances of digestion may in babies sometimes produce a 
 temperature of 103 F. or more. We do not speak of fever unless 
 the elevation reaches 100 F. A temperature of 102 or 103 F. con- 
 stitutes moderate fever, while that of 104 or 105 F. is high fever, 
 and above 105 F. very high. A temperature of 107 F. is very dan- 
 gerous, and is usually not recovered from. The danger from fever 
 depends not only upon its height, but upon its duration also. An 
 elevation of 105 F. may be easily borne for a short time, but it 
 becomes alarming if much prolonged. 
 
 THE MOUTH 
 
 The tongue of newborn infants is generally whitish and continues 
 to be so until the saliva becomes plentiful. After this we usually find 
 it coated in disturbances of the stomach and bowels and in nearly 
 any disorder accompanied by fever. In scarlet fever the tongue 
 becomes bright red after a few days, and in measles and whooping 
 cough it is often faintly bluish. In the latter affection an ulcer may 
 sometimes be found directly under the tongue, where the thin mem- 
 brane binds it to the floor of the mouth. In thrush the tongue is 
 covered with white patches like curdled milk. A pale, flabby tongue, 
 marked by the teeth at its edges, indicates debility or impaired diges- 
 tion. In prolonged or very high fever the tongue grows dry, and 
 in some diseases of the stomach or bowels it may look like raw 
 beef, 
 
258 THE MOTHER AND HER CHILD 
 
 Grinding of the teeth is a frequent symptom in infants in whom 
 dentition has commenced. It generally indicates an irritated nervous 
 system. Most often this depends upon some disturbance of diges- 
 tion ; less often upon the presence of worms. The symptom is pres- 
 ent during or preceding a convulsion, and may occur, too, in dis- 
 ease of the brain. In some babies it appears to be only a nervous 
 habit. 
 
 NURSING 
 
 The manner of nursing or swallowing frequently affords impor- 
 tant information. A baby whose nose is much obstructed or who 
 has pneumonia can nurse but for a moment, and then has to let the 
 nipple go in order to breathe more satisfactorily. If it gives a few 
 sucks and then drops the nipple with a cry, we must suspect that the 
 mouth is sore and that nursing is painful. If it swallows with a 
 gurgling noise, often stops to cough, and does as little nursing as 
 possible, we suspect that the throat may be sore. The ceasing to 
 nurse at all, in the case of a very sick baby, is an evidence of great 
 weakness or increasing stupor, and is a most unfavorable symptom. 
 
 THE URINE 
 
 Urine that is high-colored and stains the diaper, or that shows a 
 thick, reddish cloud after standing, may accompany fever or indiges- 
 tion. Sometimes the urine under these conditions is milky when 
 first passed. In some babies a diet containing beef juice or other 
 highly nitrogenous food will produce the reddish cloud, or even 
 actual, red, sandlike particles. A decidedly yellow stain on the 
 diaper occurs when there is jaundice. A faint reddish stain seldom 
 indicates blood. The amount of urine passed is scanty in fever, in 
 diarrhea, and especially in acute Bright's disease. In the latter dis- 
 ease the urine is often of a smoky or even a muddy appearance. 
 The possibility of the occurrence of this symptom after scarlet fever 
 must always be kept in mind, in order that a physician may be sum- 
 moned very quickly, since it is a serious matter. 
 
 THE STOOLS 
 
 We find that the passages are often putty-colored in disorders of 
 the liver, frequently bloody or tarry in appearance in bleeding within 
 the bowel, and liable to be black after taking bismuth, charcoal, or 
 iron, and red after krameria, kino, or haematoxylon. Infants who 
 are receiving more milk than they can digest constantly have whit- 
 ish lumps in their stools, or even entirely formed but almost white 
 
THE SICK CHILD 559 
 
 passages. The presence of a certain amount of greenish coloration 
 of the passages is not infrequent. This is usually an evidence of 
 indigestion, but passages which are yellow when passed and turn to 
 a faint pea green some time later are not an indication of disease. 
 
 WHEN BABY GETS SICK 
 
 When baby shows that he is sick, take his temperature as 
 directed elsewhere, cut down the feeding to at least one half, 
 or, if his temperature is around 102 F. give him nothing but 
 rice water or barley water. If he is constipated give him a 
 cleansing enema, and if hot and feverish a sponge bath may 
 be administered. He should then be put into a bed with light 
 covers and wait further orders which the doctor will give on 
 his arrival. Give the baby no medicine unless ordered to do 
 so by the physician. 
 
 Known to every physician who undertakes the care of chil- 
 dren, is the failure of many well-meaning mothers to call him 
 early. The mother attempts the care of the baby herself, and 
 not until the condition gets beyond her knowledge and wisdom 
 does she seek medical advice. In the early hours of an ap- 
 proaching cold, the beginning of intestinal indigestion, or at 
 the beginning of bronchitis, if the physician can see the child 
 early, prolonged illness may be avoided as well as unnecessary 
 expense and many heart-breaking experiences. 
 
 FEEDING THE SICK BABY 
 
 Feeding the sick baby differs somewhat with the character 
 of the individual disease, but in the outset of any and all dis- 
 eases the intestinal tract should not be overburdened with 
 food. At the approach of any illness, the food should at least 
 be cut down one half; for instance, in the case of a serious 
 acute illness accompanied by fever, not only should the strength 
 of the food be reduced one half, but water should be given 
 plentifully between feedings. It is better never to urge the 
 baby to eat at such times — for the ability to digest food is 
 very much reduced. 
 
 In cases of acute attacks with much vomiting and fever, 
 all milk should be immediately stopped and rice water or bar- 
 
26o THE MOTHER AND HER CHILD 
 
 ley water substituted. When vomiting ceases and the fever 
 approaches normal and food is desired, begin with boiled skim 
 milk in small amounts, well diluted with cereal water, and do 
 not approach the normal amount of milk for twenty-four to 
 forty-eight hours. In this way the weak digestive organs are 
 not overtaxed and they gradually resume their usual work of 
 good digestion. When a baby seems to have no appetite for 
 food, lengthen the intervals from three to four or five hours, 
 for feeding when food is not desired usually aggravates disease 
 disturbances. 
 
 EXAMINING SICK CHILDREN 
 
 And now, above all times, the early seed sowing of teaching 
 the child self-control, teaching him to gargle if he is suffi- 
 ciently old enough, to open his mouth and allow observation 
 without resistance, brings sure results. The great harm of 
 making the doctor and his medicine a threat to obtain obedi- 
 ence also brings its harvest at this time; for the doctor, of all 
 people, ought to be regarded as the child's best friend. When 
 baby is sick, the doctor is needed, his daily visits must not 
 be resisted, his medicines must not be feared — these and such 
 other matters should be made a part of every child's early 
 education. 
 
 Under no circumstances or conditions should we directly 
 falsify to a child. Nothing is accomplished by telling a 
 child it will not hurt when you know that it will hurt, or that 
 the medicine tastes good when you know it is bad-tasting. 
 Every physician can recall unnecessary disturbances in the 
 office because a mother has allowed a child to acquire a wrong 
 mental attitude toward the family physician. 
 
 One mother told her little girl in my office when I wished to 
 make an examination for adenoids which necessitated my put- 
 ting my finger back of the child's uvula, " Now Mary, the doctor 
 won't hurt you at all, it will feel nice." I turned to the little 
 girl and said : " Mary, it will not feel nice, it really won't hurt 
 you, but it will feel uncomfortable." It was a grave mistake 
 to tell her that it would feel nice. The child resisted, and, 
 while the examination was successfully made, the greatest of 
 
THE SICK CHILD 261 
 
 tact had to be used in securing the friendship of the child after 
 the examination. 
 
 It is far better when the throat is to be examined to wrap 
 the child in a shawl or a sheet with his arms placed at his 
 side, and for a member of the family to take him in her lap 
 and hold him securely while the physician quickly makes the 
 observation. And while we appreciate that sickness is not the 
 time to introduce new methods of training, in instances where 
 children have been spoiled, it is far better quietly and firmly 
 to go about the task in a manner that you know can be car- 
 ried through to a successful finish. 
 
 TREATMENT OF SICK CHILDREN 
 
 A sick child should be encouraged to lie in his bed much of 
 the time, and the bed should be kept clean and cool. He should 
 never be set up suddenly or laid back quickly. In the case of 
 a broken leg, all rapid movements should be avoided. A sim- 
 ple story or a soothing lullaby, or the giving of a toy, will 
 often divert attention when some painful movement must be 
 made or some disagreeable task performed. 
 
 Both cleanliness of the body and cleanliness of the mouth 
 are exceedingly necessary in sickness. In all instances of dis- 
 ease or indisposition, the mouth must receive daily care, for 
 stomatitis or gangrene of the mouth often follows neglect. A 
 listerine wash in proportion of one to four, or a magnesia 
 wash, or the addition of a few drops of essence of cinnamon 
 to the mouth wash will do much to prevent such conditions, 
 as well as to relieve them. 
 
 Applications of medicine to the throat may be made without 
 resistance if the tactful nurse watches her time. She should 
 slowly introduce the tongue depressor which may be a flat 
 stick or a spoon, when the application of medicine with a 
 camel's-hair brush is quickly made to the rolled-out throat as the 
 child gags, and if the nurse then quickly diverts his attention 
 to some beautiful story or a picture or a new toy, the treat- 
 ment is soon forgotten. Under no circumstances argue with or 
 scold a sick child. Get everything ready, if possible behind his 
 back or in another room, and then with plenty of help make the 
 
262 THE MOTHER AND HER CHILD 
 
 application or the observation without words, always with 
 gentleness and firmness. 
 
 NURSING RECORDS 
 
 Whether the nurse be the mother, caretaker, practical or 
 professional nurse, a record should always be kept of the con- 
 dition of the patient. The temperature should be reported at 
 different periods designated by the physician. The pulse should 
 be recorded, the amount of urine passed and the time it was 
 passed, the number of bowel movements, all feedings and the 
 general well being of the child — whether it is restless or com- 
 fortable, sleeping or awake, together with the water that he 
 drinks. 
 
 The record may be kept, if necessary, on a piece of common 
 letter paper, and should read something like this: 
 
 March 26, 1916 
 7 a. m. Temperature 102; pulse 132; respiration 40; morn- 
 ing toilet; took 4 ounces of milk; 2 ounces of barley water; 
 
 1 ounce of lime water. 
 
 9 A. m. Enema given ; good bowel movement ; mustard paste 
 applied to chest, front and back, and oil-silk jacket applied; 
 drank boiled water, 4 ounces. 
 
 n a. m. Took the juice of one orange; temperature 103; pulse 
 
 135. 
 12 Noon. Very listless and nervous; temperature 104. Has 
 
 coughed a great deal. Gave mustard paste to chest, front 
 
 and back, and wet-sheet pack. 
 1:30 p. m. Temperature 101.8; 4 ounces of water to drink; 
 
 looks better. 
 3 p. m. Has slept \y 2 hours; temperature 102.5; pulse 134; 
 
 respiration 40; 6 ounces of food given (3 ounces of milk, 
 
 2 ounces of barley water and 1 ounce of lime water). 
 
 A record like this is a great help to the physician, and such 
 a record may be kept by anyone who can read and write. 
 There are printed record blanks which may be procured from 
 any medical supply house and most drug stores. 
 
THE SICK CHILD 263 
 
 BAD-TASTING MEDICINES 
 
 Castor oil has neither a pleasant smell nor taste, and noth- 
 ing is accomplished by telling the child that it does smell good 
 or taste good. If the patient is old enough to drink from a 
 cup, put in a layer of orange juice and then the castor oil and 
 then another layer of orange juice, and in this way it often 
 can be easily taken. Someone has suggested that a piece of ice 
 held in the mouth just before the medicine is taken will often 
 make a bad dose go down without so much forcing. A taste 
 of currant jelly, or a bit of sweet chocolate, or the chewing 
 of a stick of cinnamon is a great adjunct to the administra- 
 tion of bad-tasting medicines. All oily medicines must be 
 kept in a cool place and should always be given in spoons or 
 from medicine glasses that have first been dipped in very cold 
 water. Very often the addition of sugar to bad-tasting medi- 
 cines will in no wise interfere with their action, while it often 
 facilitates the administration of the disagreeable dose. The 
 majority of bad-tasting medicines are now put up in the form 
 of chocolate-flavored candy tablets. 
 
 TEMPERATURES AND PULSE 
 
 The normal temperature of a baby is 98.5 to 99 F. in the 
 rectum. After shaking the mercury of the thermometer down 
 below the 97 mark it is well lubricated with vaseline and then 
 carefully, gently, pushed into the rectum for about an inch and 
 a half or two inches, and left there for three minutes before 
 removing. 
 
 Mothers should exercise self-control in taking the tempera- 
 ture, for nothing is gained by allowing a panicky fear to seize 
 you should the mercury register higher than you anticipated. 
 Notify your physician when the temperature registers above 
 100 F. 
 
 The respirations of a child are fairly regular and rhythmic 
 and occur about forty times per minute during the first month 
 of life and about thirty times per minute during the remainder 
 of the year. From one to two years, twenty-six to twenty- 
 eight is the average. Breathing is somewhat irregular when 
 
264 THE MOTHER AND HER CHILD 
 
 the child is awake and may be a bit slower when asleep. Before 
 the baby is born the fetal pulse is about 150. At birth it ranges 
 from 130 to 140. During the first month the pulse is found 
 to be from 120 to 140. By the sixth month it gets down to 
 120 or 130, and from that on to a year the normal pulse beat 
 of the baby is about 120. The pulse is influenced very much by 
 exercise and is often increased by crying or nursing or any 
 other excitement. 
 
 FEVER 
 
 Children get fever very easily — the digestive disturbance of 
 overeating, constipation, a slight bilious attack — all produce 
 fever which disappears quite as suddenly as it came. The first 
 thing to do under such circumstances is to withhold food, give 
 plenty of water to drink, produce a brisk movement of the 
 bowel by giving a dose of castor oil, give a cleansing enema, 
 and treat the fever as follows: 
 
 After removing all of the clothes from the child, place him 
 in a warm blanket and then prepare a sponge bath which 
 may be equal parts of alcohol and water; expose one portion 
 of the body at a time and apply the water and alcohol first to 
 one arm and then to the other arm, the chest, one leg, the 
 other leg, the back and then the buttocks. Do not dry the part 
 but allow evaporation to take place, and this, accompanied by 
 the cooling of the blood which is brought to the skin by the 
 friction, readily reduces the fever. Another procedure which 
 may be employed if the fever registers high is the wet-sheet 
 pack which is administered as follows: 
 
 Three thicknesses of wool blankets are placed on the bed 
 and a sheet as long as the baby and just enough to wrap 
 around him once, is wrung out of cool water and spread over 
 these blankets. With a hot-water bottle to the feet, the child 
 is then laid down in the wet sheet which is now brought in 
 contact with every portion of his body, then the blankets are 
 quickly brought around, and he is allowed to warm up the 
 sheet — which lowers his temperature. 
 
 Another valuable procedure is the cooling enema. Water 
 the same temperature as that of the body, is allowed to enter 
 
THE SICK CHILD 265 
 
 the bowel and is then quickly cooled down to 90 or 85 F. ; in this 
 manner much heat is taken out of the body and the fever 
 quickly reduced. (For further treatment of fevers see Ap- 
 pendix.) 
 
CHAPTER XXVI 
 BABY'S SICK ROOM 
 
 VISITORS should never be allowed in the sick room dur- 
 ing the height of a disease, and during convalescence not 
 more than one visitor should be allowed at one time, and the 
 visit then should be only two or three minutes in length. The 
 order and the quietness and the system of the sick room 
 should be perfect. Visitors and loitering members of the 
 family do no good and they may do much harm to the recuper- 
 ating nervous system of the child. 
 
 LOCATION OF THE SICK ROOM 
 
 In these days of high rents, we realize that the greater per 
 cent of our readers are living in apartments and homes just 
 big enough conveniently to care for the family during health, 
 and while it would be pleasant and convenient to have a spare 
 room or an attic chamber that could be used in case of illness, 
 it is the exception rather than the rule that the families to 
 whom sickness comes have these extra apartments. When a 
 contagious or an infectious disease comes to the family, it is 
 of great importance that the sick child be isolated, preferably 
 on another floor, from that used by the immediate family. 
 
 Those living in homes, more than likely can fix up a room 
 on the attic floor for the isolation, and those living in apart- 
 ments may put the sick child in one end of the apartment, while 
 they inhabit the other end. One family under my observation 
 not long ago had a child stricken with the measles. In the same 
 apartment there lived a puny baby not quite two years old. 
 Coming as it did in February, the mother of the child was 
 apprehensive, fearing that measles would leave a severe bron- 
 chitis which might mean the death of the already too-delicate 
 
 266 
 
BABY'S SICK ROOM 267 
 
 baby. She was instructed to move the baby's bed to the sun 
 parlor in the front of the flat, while the boy with the measles 
 was put in the parents' room in the rear end of the flat. A 
 sheet was suspended in the middle of the hall leading from the 
 living-room to the bedrooms. Door knobs were disinfected 
 daily, a caretaker was put in charge of the measles patient, the 
 mother very frequently was compelled to go back and adminis- 
 ter a treatment, but each time she donned a large apron and 
 completely covered her hair with a towel, she administered 
 the treatment, took off her wrappings, thoroughly washed 
 her face and hands — disinfected them — and returned to her 
 baby in the front part of the house. 
 
 At night this mother slept on the floor on springs and mattress 
 in the living-room, and to that home the measles came and 
 departed, and the baby did not get them at all, so perfect was 
 the isolation, so vigilant the disinfection, and so scrupulous the 
 care to prevent contamination. So you see from this one 
 instance that it is altogether possible to make isolation complete 
 even on the same floor. But, mind you, the dishes that the lad 
 ate from were all kept in his room. Food was brought to the 
 sheet and there the caretaker held her dishes while the cook 
 poured or lifted the food from her clean dishes to the dishes 
 the caretaker brought from the sick room. 
 
 Whether the sick room is in the attic or whether it be the 
 rear end of an apartment, if the principles of contagion and 
 disinfection are understood I believe it is perfectly possible 
 to isolate even scarlet fever without danger to the other mem- 
 bers of the family. 
 
 NECESSARY FURNISHINGS 
 
 For slight indispositions and trifling disorders, it is not neces- 
 sary to strip the room of its adornment, but it is well to clear 
 off the dresser tops, protect them well with many thicknesses 
 of newspapers covered over by a folded sheet so that alcohol, 
 witch-hazel and other necessaries will not injure the mahogany 
 or oak-top dresser. Whenever the children are sick, rob the 
 room of anything that is going to be in your way. In instances 
 of infectious or contagious diseases, take down all silk or wool 
 
268 THE MOTHER AND HER CHILD 
 
 hangings, replace them by washable curtains or inexpensive 
 ones that can be burned if necessary, and remove valuable 
 paintings and other bric-a-brac that later fumigation will harm 
 or that may gather the dust during the days of illness. 
 
 Just as it is necessary for the man who mines the coal to wear 
 suitable garments, and for the woman who does the scrubbing 
 to dress accordingly, and for the nurse who cares for the case 
 to wear washable clothes — so it is necessary to dress the 
 sick room in garments that are suitable, convenient, and capa- 
 ble of being thoroughly disinfected, fumigated, or even burned 
 if the occasion demands. Hence, expensive rugs should be 
 replaced by rag carpets or no rug at all, while unnecessary 
 articles and garments should be removed from closets, etc. 
 
 Remembering that the little fellow is to remain in this room 
 for possibly two weeks or maybe six weeks, let us put up 
 some bright-colored pictures that he will enjoy, bring in some 
 books and magazines by which he may be entertained, secure 
 a few simple toys that will not tax the brain, but serve as a 
 help to pass away the long hours. There are many paper 
 games that may be had, such as transfer pictures, picture puz- 
 zles, kindergarten papers, drawing pictures, as well as toys that 
 may be put together to fashion new articles. A whole lot of 
 fun can be gotten out of a bunch of burrs that can be stuck 
 together to make men, animals, houses, etc. Scissors and 
 pictures are entertaining as well as paper dolls with their ward- 
 robes. Rubber balloons, or a target gun for the boy of six 
 will be a great source of delight to him; as will a doll with a 
 trunk full of clothes for the little girl during her convalescent 
 days. A tactful nurse and a resourceful mother will think of 
 all the rest that we have not mentioned — which will amuse, 
 entertain and keep happy our convalescent children, help them 
 to forget that they are " shut ins." 
 
 THE NURSERY REFRIGERATOR 
 
 It is wise in instances of the more severe childhood troubles, 
 such as infectious and contagious diseases, to keep as many 
 things in the sick room as possible, and so we remind our 
 reader of the home-made ice box, described elsewhere in this 
 
BABY'S SICK ROOM 269 
 
 book, in which may be kept the fruit juices and the fruits, as 
 well as the milk and the buttermilk. Many medicines, particu- 
 larly the oily medicines, should be kept in this home-made ice 
 box and five cents worth of ice a day will not only make things 
 taste better, especially during the warm months, but will pro- 
 tect the other members of the family, for the family ice box 
 is a big central station which must be protected against infec- 
 tions and carriers of disease. 
 
 In connection with the ice box, we are reminded that it 
 would be a great convenience to have a simple contrivance 
 for heating bouillon, milk, or making a piece of toast, which 
 can be readily done with an electric heater, an alcohol stove, 
 or a small apparatus fitting over the gas jet. 
 
 SICK ROOM DISINFECTANTS 
 
 The most important thing which we are going to mention 
 in this division of the chapter is the disinfection of the door 
 knobs. According to the directions on the poison bottle, place 
 an antiseptic tablet into a small amount of water which will 
 make a solution of 1 to 1000 of bichlorid of mercury, and sev- 
 eral times a day disinfect the door knobs, particularly in the 
 sick end of the house — thoroughly washing and adequately 
 rubbing with a towel moistened in this solution. 
 
 All stools and urine from the sick one will receive atten- 
 tion as directed by the physician. The stools from a typhoid 
 patient should stand for one-half hour in a chamber covered 
 with a layer of lime. 
 
 It is not at all necessary to have vessels containing disinfect- 
 ant substances standing about the room and in the closet. In 
 a room adjoining should be kept all of the dishes used by the 
 sick patient, his tray, half a dozen napkins, knife, fork, spoon, 
 serving dishes, drinking glass, pitcher, etc. All bedding and 
 all linen used by the sick member should be allowed to stand 
 in a solution of disinfectant for several hours when they may 
 be wrung out of the solution, dropped into a bucket and car- 
 ried to the laundry without any danger to other members of the 
 family. 
 
 The nurse is not allowed to leave this room in the garments 
 
2-o THE MOTHER AXD HER CHILD 
 
 that are worn while caring for the sick. She should have her 
 meals in an adjoining room which is also under strict isolation. 
 
 THE MEDICINE CHEST 
 
 The sick room medicine chest should be so placed on the 
 wall that it is outside the reach of the smaller members of the 
 family, for in it should be placed poisons for external use that 
 are capable of producing death if taken internally. Bottles 
 that hold these poisons — such as bichlorid of mercury, lysol, 
 carbolic acid, laudanum, paregoric., belladonna, etc. — should 
 be so different from the other bottles in the medicine chest 
 that if one should reach for them with his eyes shut or in the 
 dark he would at once recognize that he had hold of a poison 
 bottle> This is absolutely necessary. It usually means a bit 
 of extra expense, but when we realize what tragedies may be 
 avoided by such slight expense, it must not be considered. 
 
 Bottles may be procured that have been molded with points 
 of glass projecting from the outside which make them rough to 
 the touch, or they may be covered with a wire mesh or with a 
 wicker covering which may easily be told from the other bot- 
 tles in the case. 
 
 One woman lost her life because the nurse placed two ounces 
 of carbolic acid in the enema instead of two ounces of saline 
 solution. Saline solution is nothing but salt and water, while 
 carbolic acid cost the woman her life, simply because the car- 
 bolic acid was not placed in a specialized poison bottle and the 
 attendant could not read the label in the dark. 
 
 Under no circumstances keep from one year to another the 
 remnants of unused medicine of a former sickness, for medi- 
 cines do not keep well and often lose their strength if kept 
 longer than the physician intended. 
 
 In this medicine chest should be found the following articles : 
 
 A glass graduate marked with fluid drachms (i teaspoon), 
 and fluid ounces (8 teaspoons). 
 A medicine dropper. 
 
 Absorbent cotton. 
 Boric acid. 
 
BABY'S SICK ROOM 271 
 
 Camphorated oil. 
 Castor oil. 
 
 Aromatic spirits of ammonia. 
 Alcohol. 
 Olive oil. 
 Epsom salts. 
 Soda-mint tablets. 
 Vaseline. 
 
 Zinc ointment, together with other medicines the physician 
 orders. 
 Ice bag, hot-water bottle and oiled silk. 
 
 Besides these articles, in the nursery — in readiness for emer- 
 gencies and accidents — should be found the following : 
 
 Gauze bandages of various sizes. 
 Sterile gauze. 
 
 Boric acid crystals and powder. 
 Mustard. 
 
 A pocket case of instruments containing scissors, knife, dress- 
 ing forceps, etc. 
 Syrup of ipecac. 
 Glycerin. 
 
 Tincture of iodine. 
 Package of ordinary baking soda. 
 Peroxid of hydrogen. 
 Absorbent cotton. 
 Needle and thread. 
 Lime water. 
 
 PATENT MEDICINES 
 
 Aside from the giving of castor oil and the application of 
 vaseline to the nose, or of applying boracic acid to the eyes, 
 no medicine should be administered to the baby without com- 
 petent medical advice. There are numerous widely advertised 
 nostrums frequently sold as soothing syrups to be used during 
 the teething or during attacks of diarrhea, or cough spasms, 
 croup, or worms, that contain dangerous drugs and should not 
 
272 THE MOTHER AND HER CHILD 
 
 be given to children. Many well-meaning but ignorant moth- 
 ers are slowly but surely laying the foundations for serious 
 nervous disorders and are often making veritable dope fiends 
 out of their children. Patent medicines are dangerous things 
 in the hands of the people; if we are going to give medicines 
 to our little babies let us at least know what we are giving. 
 Let some conscientious, scientific physician examine the baby 
 and prescribe for its needs. 
 
 If urged to use a patent medicine, examine the label care- 
 fully, for the Federal Food and Drug Act requires the manufac- 
 turer of patent medicines to print plainly on the label of the 
 bottle the name and amount of certain dangerous drugs which 
 it may contain. 
 
 The drugs mentioned in this drug act and which are often 
 used in patent medicine nostrums are, chloral hydrate, cocaine, 
 heroin, chloroform, alpha or beta eucaine, opium, morphin, 
 alcohol, cannabis indica, or any derivative or preparation of 
 any such substance contained therein. 
 
 There are many other drugs sold on the market containing 
 syrups or flavoring materials which may do harm — which may 
 upset the baby's digestion. 
 
 Mothers avoid patent medicines. Consult your physician. 
 Never give a baby any sort of medicine to induce sleep. Unless 
 babies are sick or spoiled or hungry, they will go to sleep of 
 themselves, and even in the days of a high fever a wet-sheet 
 pack seldom ever fails to put the baby to sleep and can do no 
 harm if properly given. 
 
 This may be as good a place as any to mention the dosage 
 of castor oil which is as follows: 
 
 Up to three months, y 2 teaspoon. 
 
 From three to six months, I teaspoon. 
 
 From six to nine months, 1^2 teaspoons. 
 
 From nine to twelve months, 1 dessert spoon (2 teaspoons). 
 
 From twelve months on, 1 to 2 tablespoons. 
 
 AFTER THE SICKNESS IS OVER 
 
 The physician will direct when the disinfectant bath is to be 
 given to the patient previous to his liberation from isolation. 
 
BABY'S SICK ROOM 273 
 
 The different diseases demand different treatment, but, on the 
 whole, it is about as follows: 
 
 The day before the boy is to be allowed to go out among 
 the family once more he receives a soap wash, clean sheet and 
 bedding on the bed, and puts on clean garments. The following 
 morning, his head thoroughly shampooed, his nails manicured, 
 a second soap wash is given followed by a weak bichlorid bath 
 (1 to 10,000 solution) which is followed by an alcohol rub. He 
 is then allowed to go out of the sick room which is now to be 
 thoroughly disinfected and fumigated. 
 
 After the illness is over, the sick room and the adjoining 
 closets and ante rooms must be thoroughly disinfected or fumi- 
 gated. If you are located in a city, the health authorities will 
 do this after an infectious or contagious disease. Away from 
 such conveniences, use the following method : 
 
 Place two ounces of crystals of permanganate of potash in a 
 pan and have a pint bottle of formalin near by. Everything 
 in the room is now exposed, dresser drawers are opened, all 
 bedding, all garments — in fact everything that is in the room 
 — is put in such a position as to be readily exposed to the 
 fumes which are to follow. A line should be stretched across 
 the room over which are thrown the bedding, garments, etc. The 
 cracks of the windows and doors, except the one door of exit, 
 are now sealed up with paper which has been dipped in green 
 soap, and having the paper strips and pan of green soap ready 
 just outside the exit door, the formalin is now poured over the 
 permanganate crystals. Fumes will immediately arise and per- 
 meate every corner, crack and crevice of the sick room. Now 
 quickly make your exit, close the door and seal up key hole 
 and cracks and space under the door with paper dipped in 
 green soap. Leave the room for six hours. After this with 
 a well-moistened cloth to the nose, rush in and throw the win- 
 dows open, hurry out and allow the room to air from twelve to 
 twenty-four hours, after which wash woodwork and painted 
 walls or take paper off and repaper walls ; recalcimine ceilings 
 and closets ; scrub closet shelves and dresser drawers, bedsteads, 
 and other furniture thoroughly. If the mattress is old throw it 
 away, but if not, sun it for several days following the fumigation. 
 
CHAPTER XXVII 
 DIGESTIVE DISORDERS 
 
 IN this chapter we will consider the diseases which commonly 
 occur during infancy and early childhood relative to diges- 
 tion and the alimentary tract. Irregularity of feeding, feed- 
 ing between meals, feeding too much at any given time, as well 
 as feeding the wrong kind of food may cause stomach disturb- 
 ances and intestinal troubles. 
 
 VOMITING 
 
 In a previous chapter, " The Feeding Problem," a common 
 stomach disturbance, vomiting, was gone into quite thoroughly, 
 and in passing to other disorders, we wish to remind the mother 
 that vomiting should always be taken seriously. The interval 
 between meals should usually be lengthened, the time spent in 
 feeding shortened, and it is often necessary to withhold all milk 
 and food of any kind for twelve or eighteen hours, giving only 
 boiled, unsweetened water. Vomiting frequently ushers in some 
 acute disease, and in remote cases, when it is very persistent, 
 it may indicate inflammation of the brain. Complete rest is 
 essential, trotting on the knee, suddenly changing the baby's 
 position, or other quick movements must all be avoided. A 
 physician should see the sick one and determine the cause of the 
 trouble. 
 
 COLIC 
 
 Cases of ordinary colic are usually relieved by heat to the 
 abdomen and feet, drinking hot water in which there has 
 been dissolved a pinch of ordinary baking soda, or a portion 
 of a soda mint tablet, or by the use of the photophore, as pre- 
 viously described. The treatment of such ordinary colic need 
 
 274 
 
DIGESTIVE DISORDERS 275 
 
 not be given further consideration here because it has been 
 described at length in a former chapter; but we do call the 
 attention of the mother to a more serious form of recurring 
 colic which so often accompanies chronic intestinal indigestion, 
 marasmus, and malnutrition. 
 
 In most instances the food is radically at fault and should 
 be reduced to a mixture which can more readily be digested 
 and assimilated by the child. Often whey mixtures, pep- 
 tonized foods, or buttermilk may be indicated. The weight of 
 the baby, the age of the baby, and the color of the stools, 
 must all be taken into account in the preparation of this 
 easily digested food. Weak mixtures should be given at first 
 and then gradually and carefully the quality may be strengthened 
 until the normal formula is again used for the baby. 
 
 Injections into the bowel of water, to which has been added 
 one level teaspoon of soda to the pint, will often give relief in 
 this form of colic. 
 
 CHRONIC INDIGESTION 
 
 While this condition may occur at any time during baby- 
 hood days, it often makes its appearance during the last half 
 of the first year and up to the fifth year. It is accompanied 
 by mucus in the stools, chronic flatulence, constipation or 
 diarrhea, or the alternating of the two, restlessness at night, 
 distention of the abdomen (" pot bellied ") accompanied by pain, 
 a coated tongue with a fetid breath, and loss of appetite. It 
 is a pitiable picture — the weight is usually reduced and the 
 child gives the appearance of being decidedly undernourished. 
 This condition is usually occasioned by errors in diet, whether 
 it be over-feeding or feeding of the wrong element of food, 
 and, since the diet is usually responsible for the condition, in 
 the line of treatment diet is a prime factor. 
 
 All fats must be taken from the food, sugars should be 
 avoided, and the amount of starchy foods, such as flour, pota- 
 toes and bread, should be greatly reduced. Buttermilk, skimmed 
 milk, eggs, green vegetables, and fruit juices should be given. 
 In the older child, if grains are used, they should be well 
 toasted or baked. 
 
276 THE MOTHER AND HER CHILD 
 
 JAUNDICE 
 
 It is altogether common and physiological for the newborn 
 baby to pass through a few days of yellow skin which usually 
 clears up in the second or third week, but it should not recur. 
 Occasionally this yellow tint deepens, the whites of the eyes 
 are yellow, the urine passed leaves a yellow stain on the diaper, 
 while passages from the bowels are white or clay colored. If 
 the child shows symptoms of ill health other than the yellow 
 tint, it should receive medical attention. Older children troubled 
 with jaundice should receive the following treatment: The 
 photophore as described elsewhere should be applied to the 
 liver and abdomen (the liver is on the right side), and this 
 should be followed by the application of what is known as a 
 heating compress, consisting of three layers — a cloth wrung 
 from cold water, a mackintosh, and then two thicknesses of 
 blanket flannel — which are all applied when the skin has been 
 made red by the application of heat. (If the photophore is 
 unavailable, a hot-water bottle may be applied.) The flannel 
 is pinned snugly on the outside as the wet cloth goes next to 
 the skin with the mackintosh between. This should remain on 
 the abdomen for three or four hours, after which the hot appli- 
 cation is again made to the liver and abdomen. The adminis- 
 tration of broken doses of calomel is sometimes indicated in 
 obstinate cases in connection with these applications of heat 
 to the liver. Hot milk or mineral water may be taken with 
 dry toast. In a day or two the color should clear up, the stools 
 should be normal again, and the treatment may be discon- 
 tinued. 
 
 WORMS 
 
 Irritation about the rectum which cannot be otherwise 
 explained is usually suggestive of pinworms. These seatworms 
 or pinworms are very much like little pieces of cotton thread — 
 one-fourth of an inch in length. They grow and thrive in the 
 lower part of the large bowel. Simple and effective treatment is 
 as follows: 
 
 It is well to bathe the parts about the rectum after each 
 bowel movement and often two or three times a day with a 
 
DIGESTIVE DISORDERS 277 
 
 weak antiseptic solution. Itching may be controlled by the 
 application of a disinfectant ointment, or the local applica- 
 tions of ice may serve the same purpose. After a thorough 
 cleansing of the colon by an injection of lukewarm water con- 
 taining a teaspoon of borax to the pint in order to remove 
 the mucus, Doctor Holt suggests that after the discharge of 
 this borated enema, infusions of quassia are very helpful (See 
 Appendix). 
 
 Children suffering from roundworms experience a loss of 
 appetite, varying temperature from above normal to subnormal, 
 with colicky pains in the abdomen on coming to the table and 
 beginning to eat. They are pale and listless, or nervous and 
 irritable. 
 
 Roundworms very much resemble earthworms in shape and 
 color. While their home is in the small intestines they often 
 travel to other parts of the body. They have sometimes 
 crawled into the stomach and have been vomited. The only 
 definite symptom of worms is to find the eggs or the worms 
 themselves in the stool. No worm medicine should ever be 
 given by the mouth without being prescribed by a physician. 
 Cases are on record where well-meaning mothers have killed 
 their children by giving an over dose of worm medicine. 
 
 Tapeworms sometimes trouble children; their segments are 
 found in the stool, and look like small pieces of tape line. The 
 segments are flat and thin, one-fourth inch to one-half inch in 
 width and three-fourths to one inch in length. They are joined 
 together and often their number is so great the worm is many 
 feet in length. The segments grow smaller and smaller as 
 they approach the neck, the head of the worm being a mere 
 point. As the worm is passing from the child it should never 
 be pulled, as the head is easily broken off, and, on remaining 
 in the bowel, it will grow to a full-sized worm. 
 
 Worms come from the eating of half-cooked meats; they 
 enter the stomach as eggs or tiny worms, and pass out into the 
 small intestines, where they begin to grow. They are a com- 
 mon parasite in the human family and should be suspected in 
 all instances where digestive symptoms are masked or do not 
 yield to treatment. 
 
278 THE MOTHER AND HER CHILD 
 
 HOOKWORM DISEASE 
 
 This disease, once seen only in the southern part of the 
 United States, is leaving its former domains as the migrating 
 population is distributing it more or less widely everywhere. 
 Sandy soil and country districts are infected by a tiny worm 
 which thrives in polluted soil and enters the body through the 
 skin of the feet. It also gets into the body through the drinking 
 water or from the eating of uncooked vegetables, such as are 
 used in salads. 
 
 The disease is manifested by " sallow skin, paleness, head- 
 ache, swollen abdomen and sores on the legs." Little swollen 
 places where the worm enters the skin may be seen on the 
 flesh. The condition yields readily to treatment. If a child 
 is discovered scratching his feet (especially in the southern 
 part of this country), he should be taken at once to a physician. 
 
 DISORDERED STOMACH 
 
 At the first symptom of a disordered stomach take all food 
 from the baby and give him rice water prepared by throwing 
 a cupful of well-washed rice into a kettle of boiling water and 
 allowing it to continue to boil for a couple of hours. The 
 water which is strained off is rice water, ready for use after 
 it is cooled. This may be given to the child at the meal hour 
 in the place of his regular food. It should be kept in a glass- 
 covered jar in the ice box. A dose of castor oil, according to 
 the age, should be administered before the feed. The bowels 
 should be washed out and boiled water given freely between 
 the meals of rice water. For a day or two (twenty-four to 
 forty-eight hours), the child should be fed only this rice water, 
 or until the temperature returns to normal and he appears very 
 hungry, at which time milk, which has been boiled for five 
 minutes, may be added to the rice water, first in one-half ounce 
 quantities and gradually increased. Each day a little more 
 milk is added until baby is taking his regular food again. 
 
 Many a death and many acute attacks of summer complaint 
 are avoided by the quick use of castor oil, and by withholding 
 food and stopping the use of milk as soon as the child becomes 
 ill. 
 
DIGESTIVE DISORDERS 279 
 
 STOMATITIS OR THRUSH 
 
 Thrush is evidenced by fretfulness or crying on attempting 
 to nurse. On examination of the mouth it is found to be hot 
 and very tender and covered with little white specks which, 
 if looked at under the microscope, appear to be a fungus 
 growth. If scratched off, the mucous membrane bleeds easily. 
 Thrush often occurs during a fever or in connection with other 
 diseases, and is often due to neglect and lack of cleanliness 
 about the bottles, nipples, etc. Taken in time it is quickly 
 cured. An immediate dose of castor oil or milk of magnesia 
 is indicated, and the use of a mouth wash which will be pre- 
 scribed by the physician. If neglected, it may become ulcerous 
 or gangrenous, which is a very serious condition. Everything 
 pertaining to the feeding, as well as the child's toys, hands, 
 etc., must be kept scrupulously clean. 
 
 CONSTIPATION 
 
 In the chapter, " The Feeding Problem," constipation in 
 bottle-fed babies was discussed. The bowels should move at 
 least once in twenty-four hours. The passages are frequently 
 very hard and leave the body only after a very great effort of 
 straining. This constipation, often continuing until late child- 
 hood, should be corrected in the following manner: 
 
 In early infancy — as early as the fourth month — prune 
 juice may be given as directed elsewhere, while in later 
 months prune pulp or fig pulp, which has been carefully rubbed 
 through a fine-mesh colander, may be given at meal time. By 
 the time the baby is eleven or twelve months old, strained apple 
 sauce may be given. 
 
 We deplore the use of the water enema as a regular daily 
 procedure; in its place we suggest the use of the enema of oil 
 or the introduction into the rectum of a gluten suppository or 
 in obstinate cases a glycerine suppository. Abdominal mas- 
 sage should be daily administered. With a well-oiled hand, 
 begin on the right abdomen and proceed upward to the lower 
 border of the right ribs and across to the left side and down. 
 This should be repeated many times at a regular hour each 
 day. The mother should select an hour for the bowels to move, 
 
280 THE MOTHER' AND HER CHILD 
 
 preferably after the forenoon feeding, and if the child is too 
 small to sit upon the toilet chair, a gluten suppository may be 
 placed into the rectum before the forenoon feed and some time 
 during the middle of the day the bowel movement will be 
 found in the napkin. 
 
 For the older child, before a certain meal each day, a well- 
 vaselined piece of cotton may be inserted in the rectum; this 
 often produces a bowel movement immediately after the meal. 
 Laxative foods, such as bran, stewed figs, stewed prunes, or a 
 raw apple, should be used faithfully — as repeated medication 
 never corrects the difficulty, but usually prolongs it. 
 
 To immediately flush out the bowel, a soapsuds enema or a 
 plain water enema may be allowed to flow into the lower colon, 
 or a glycerine suppository inserted into the rectum will quickly 
 bring a bowel movement. These methods are only of tempo- 
 rary value; a regular habit should be formed, if possible, to 
 bring about a natural, normal bowel movement. When neces- 
 sary to resort to drugs — such remedies as cascara sagrada, 
 milk of magnesia, or syrup of rhubarb, are satisfactory, as 
 well as our old stand-by — castor oil. Regular habits must be 
 insisted upon, and if the mother pays attention to regularity 
 at stool in early childhood very little trouble will be met later 
 on in adolescence and adult life. 
 
 Chronic constipation often produces abnormal conditions 
 about the rectum such as fissures, hemorrhoids, or prolapse, 
 which may be of serious import. 
 
 DIARRHEA 
 
 Diarrhea is a symptom of an acute illness, or it may be asso- 
 ciated with a chronic condition such as chronic intestinal indi- 
 gestion, tuberculosis of the bowel, or may occur alternately with 
 constipation in colitis. It is the most dangerous of all symp- 
 toms that babies develop, and in spite of all the instruction 
 given to mothers at the present time, in spite of all the wel- 
 fare stations in large cities, and in spite of all the efforts put 
 forth by the commissioner of health, with his corps of visiting 
 nurses — even yet, more babies die of diarrhea each summer 
 than from any other single cause. 
 
DIGESTIVE DISORDERS 281 
 
 There are usually just two reasons for diarrhea — uncleanli- 
 ness and bad milk. During the hot summer days flies multiply 
 greatly and all manner of bacteria and germs grow in warm, 
 moist, shadowy places, so that usually before the milk leaves 
 the dairy farm it is seriously contaminated with disease-produc- 
 ing germs. If the milk is not kept at a temperature of 35 or 
 40 F. (which is just above the freezing point), these bacteria, 
 particularly the manure germ, grow at such a rate that by the 
 time the milk gets to the infant it is teeming with bacteria, and 
 diarrhea is the sure result. 
 
 Another form of diarrhea is cholera infantum, where the 
 stools soon become watery and colorless. The vomiting is 
 almost incessant and there is high fever. Fortunately it is a 
 rare disease, but when once seen it is never forgotten. One 
 beautiful baby weighing nearly thirty pounds was reduced to 
 sixteen within forty-eight hours, and when death came he could 
 hardly be recognized because of the wasting from this most 
 dreaded of infant diseases. 
 
 Another form of diarrhea is seen in an acute inflammatory 
 condition of the intestine itself. The stools contain more or 
 less mucus and blood. The bowel movements, which are very 
 frequent, are accompanied by a great deal of pain and strain- 
 ing. This form is often seen in the more severe types of sum- 
 mer dysentery. We wish to impress upon the reader's mind 
 that these diarrheas may all be avoided if the baby's food is 
 clean and free from germs, if the apple or pear is not only 
 washed, but thoroughly scrubbed before paring during the 
 summer months. If all the bottles, nipples, water, toys, etc., 
 are adequately clean, no summer diarrhea, no dysentery, no other 
 infection due to dirt, will attack the baby. Of paramount 
 importance is the pasteurization of milk during the summer 
 months, as mentioned elsewhere. 
 
 TREATMENT OF DIARRHEA 
 
 Simple diarrhea in the older child of two or three years 
 is treated as follows: Take away all solid foods. Give a big 
 does of castor oil, thoroughly wash out the bowel by warm 
 water containing a level teaspoon of salt and a level teaspoon 
 
282 THE MOTHER AND HER CHILD 
 
 of baking soda to the pint, and put the child to bed in 
 a quiet room. Boil all milk for ten minutes and thicken it 
 with flour that has been browned in the oven; feed this to 
 the child at five-hour intervals. After each bowel movement, 
 no matter how often they come, the colon should be washed 
 out with the salt and soda enema as before mentioned. 
 
 Bear in mind that the child is losing liquids, and so, after 
 the bowels have moved, boiled water should be given by 
 mouth, or a cupful of water can often be retained if it is intro- 
 duced into the rectum slowly under very low pressure. Twenty- 
 four or forty hours should clear up a case of simple diarrhea, 
 and on returning to food it should be dry toast and boiled 
 milk. For the younger baby, withhold all milk and give barley 
 water or rice water for the first twenty-four hours, returning 
 to milk very gradually and slowly. 
 
 For the more severe types, such as the dysentery containing 
 mucus and blood, everything that has been done for the simple 
 diarrhea should be done; the baby should be kept very quiet, 
 while castor oil should be promptly administered. Food is 
 withheld and the bowels are carefully irrigated after each 
 movement with the salt and soda solutions. After the bowels 
 have moved from the castor oil, then bismuth subnitrate, which 
 has been dissolved in two ounces of water, should be given — 
 one or two teaspoons every three hours. This will naturally 
 turn the bowel movements dark. 
 
 Under no circumstances should any other medicines be given 
 without the physician's knowledge, as it is at such times as 
 this that many " would-be friends " advise laudanum, pare- 
 goric, and other opiates. The skin must be kept warm, and 
 fluids must replace those that have been carried off in the 
 many stools. Water may be given by an enema, by water 
 drinking, and in such rare cases as cholera infantum, when 
 water cannot be retained on the stomach, it often becomes neces- 
 sary to inject it under the skin (hypodermoclysis) so that it 
 may go at once to the wasted tissues and perhaps save the 
 baby's life. 
 
 Give the baby ten days or two weeks to return to normal 
 condition, and under no circumstances hurry the feeding of 
 
DIGESTIVE DISORDERS 283 
 
 milk, as a second attack may occur much more readily than 
 the first; may more profoundly overcome the baby and result 
 in death. 
 
 RUPTURE 
 
 A protrusion of a loop or portion of intestine through a 
 weakened abdominal muscle — which grows larger when baby 
 cries and smaller when he is lying down in a relaxed condi- 
 tion — is known as rupture or hernia, and is of common occur- 
 rence in infancy. It is often seen at the navel and sometimes 
 in the groin as early as the second week. 
 
 Hernia is always dangerous and should never be neglected. 
 The physician will protect the navel by a special support with 
 adhesive plaster which is carefully renewed twice a week, and 
 if worn for several months usually entirely corrects the con- 
 dition. A comfortable truss made from skeins of white yarn 
 will amply protect a groin hernia. The condition should 
 always be taken seriously and receive immediate treatment. 
 
 PROLAPSE OF THE BOWEL 
 
 Occasionally, as the result of severe straining in consti- 
 pation, the rectum protrudes sometimes one-half inch, and in 
 rare instances two or three inches. The placing of a young 
 child upon a toilet chair and insisting upon severe straining 
 sometimes results in such a protrusion of the rectum. This 
 may be avoided by the application of vaseline to the rectum or 
 by the use of the gluten or glycerine suppositories which cause 
 the hardened masses to make their way out easily. Someone 
 has suggested that if the buttocks are supported by a board 
 placed over the toilet seat with a two-inch opening so that 
 severe straining of the rectal muscles is impossible, the pro- 
 lapse of the rectum will not recur. 
 
 The moment the mother observes the slightest protrusion 
 of the rectum she should quickly put it back and have the child 
 lie down and move the bowel in the diaper. Very severe cases 
 require a physician's attention, but if prompt and quick meas- 
 ures are taken on the first appearance it may be quickly cor- 
 rected and serious consequences be avoided. 
 
284 THE MOTHER AND HER CHILD 
 
 In this connection we might mention a condition which some- 
 times babies are born with — the absence of the rectal opening. 
 If the baby's bowels do not move for the first two days, sur- 
 gical interference is more than likely necessary. Often the 
 external opening alone is missing. Sometimes there is a com- 
 plete closure or atresia of the lower part of the colon. 
 
 BLEEDING FROM THE NAVEL 
 
 There should be no hemorrhage from the umbilical stump 
 after it has been properly tied, but occasionally a bit of blood 
 is found upon the dressing and a second tying of the cord 
 stump is necessary. The cord drops off in eight or ten days, 
 and the umbilicus that is left may be moist or it may bleed 
 slightly; if such is the case, great care should be exercised in 
 bathing this ulcer that has been left behind. It simply should be 
 touched with alcohol, a bit of boric acid powder applied, and a 
 small piece of sterile gauze be placed over it. In the course of 
 two or three days it will entirely heal. Care should always be 
 exercised in washing the umbilicus. Extensive hemorrhage 
 from this portion of the body is rare, but it does happen occa- 
 sionally and is a severe condition which demands surgical atten- 
 tion. 
 
 If the umbilicus remains moist and foul smelling, general 
 blood poisoning of the infant may easily follow. Thorough 
 dusting with boric acid powder, with possibly a little oxide of 
 zinc, will usually effect a cure promptly, but should the con- 
 dition continue, which it does only in rare instances, the doctor 
 may have to cauterize it. 
 
CHAPTER XXVIII 
 CONTAGIOUS DISEASES 
 
 NEVER under any circumstances knowingly expose a child 
 to any of the so-called " childhood diseases." The old 
 method of " have the child get them as quickly as possible and 
 get over them," has laid the foundation for many chronic dis- 
 orders later in life. For instance, eye troubles and running 
 ears are often the sequelae of measles; chronic coughs, tuber- 
 culosis and bronchitis frequently follow in the wake of whoop- 
 ing cough; heart disorders follow diphtheria, while kidney dis- 
 ease often follows in the course of scarlet fever. 
 
 CATCHING DISEASE 
 
 Under all circumstances keep the children away from these 
 dangerous childhood diseases. When a contagious disease 
 breaks out in a school and the little fellow has, along with the 
 other pupils, been exposed to it, begin at once systematically 
 to keep the nose and throat very clean with such well-known 
 sprays as the champhor-menthol-albolene spray, which should 
 be used in the nose morning, noon, and night. Throat gargles, 
 such as listerine, or equal parts of alcohol and water, help to 
 keep the throat in condition to resist the microbic invasion. 
 
 During this anxious time of patient waiting the bowels should 
 move every day and the food should be cut down at least a 
 third. In other words, moderate eating and a clean bowel 
 tract go a long way toward keeping a child well and preparing 
 him for an attack of disease. The skin at this time should 
 be kept well bathed and free from the accumulated skin secre- 
 tions which clog up the sweat glands and otherwise lower the 
 vitality. 
 
 Stuffy, close rooms, where the ventilation is poor, not only 
 
 285 
 
286 THE MOTHER AND HER CHILD 
 
 harbor disease germs, but also lower the vitality of the child. 
 Never take your child into a household where there is any form 
 of sickness, for it may turn out to be a contagious disease — 
 no matter how it began, it must be remembered that many 
 contagious diseases, in their earlier stages, much resemble a 
 simple cold. 
 
 Measles come on rather gradually, and one might suspect 
 that the child was simply suffering from a severe cold in the 
 head. 
 
 Scarlet fever usually begins with a sore throat, while chicken- 
 pox has very few initial symptoms; usually the first thing 
 noted is the rash itself. Diphtheria begins with a sore throat, 
 while whooping cough begins very insidiously. 
 
 The most important thing is to keep children away from 
 people who are sick, and if a contagious or infectious disease 
 is prevalent in the neighborhood discourage the mingling of 
 the children in hot, illy ventilated rooms. Put a stop to " par- 
 ties " and all similar gatherings. Let the little folks have 
 good books, plenty of toys, in a well-ventilated room, and the 
 more they keep to themselves at this particular time the better 
 they are off. 
 
 THE SPREAD OF CONTAGION 
 
 It is possible to " stamp out " any known disease if only 
 proper cooperation takes place and certain sanitary regulations 
 are maintained. It is within the memory of most of our readers 
 when yellow fever was put to flight and the cause of malaria 
 discovered. We learned to screen our camps and no longer 
 did our soldiers contract the fever; while the simple covering 
 of stagnant pools with oil, together with proper screenage, 
 stopped the ravages of malaria. 
 
 Likewise, many of the woeful tragedies of infant summer 
 diarrhea and dysenteries have been tracked to the so-called 
 " innocent house fly." We have all learned — only recently — 
 that if we move the manure pile once in seven days the hatch- 
 ing of the maggots may be prevented, and so millions, yes 
 trillions, of these carriers of disease may never be born. 
 
 If there is one sweet morsel above another for this fly pest 
 
CONTAGIOUS DISEASES 2S7 
 
 it is tubercular sputum or feces, and from these feasts they 
 go directly to walk over baby's hands, crawl over his cheek, 
 and wash their feet in his milk. Proper screenage will prevent 
 such contamination of food, such opportunities for carrying 
 disease. 
 
 Sunshine, hot water, soap, and fresh air, are the best ordi- 
 nary every-day disinfectants. It is possible so to conduct the 
 treatment of a contagious or infectious disease that no other 
 member of the family may contract it. A few simple but very 
 important hints are: 
 
 1. Door knobs are one of the very greatest avenues of con- 
 tagion — disinfect them. 
 
 2. Cleanse the hands both before and after attending to the 
 sick; first, scrub with stiff brush, soap and water, then dip in 
 alcohol. 
 
 3. An epidemic of sore eyes may be stopped by absolute 
 " hand disinfection " and using separate towels. 
 
 4. Do not go visiting when you have a " common cold." 
 
 5. Kissing is one of the best ways of spreading many dis- 
 eases. 
 
 6. In cases of contagious and infectious diseases completely 
 cover all excretions from the body with lime. 
 
 7. Country homes would be as healthy as city homes if the 
 privies and stables were screened. 
 
 8. In the country, the well water should be boiled ; one 
 infected well may be the cause of the death of a score of 
 beautiful children. 
 
 INCUBATION PERIODS 
 
 The incubation period of scarlet fever is from one to seven 
 days. 
 
 Measles, ten to twenty days. 
 Whooping cough, from one to two weeks. 
 Chicken-pox, fourteen to sixteen days. 
 German measles, seven to twenty-one days. 
 Diphtheria, any time from one to twelve days. 
 Mumps, from one week to three weeks. 
 
288 THE MOTHER AND HER CHILD 
 
 Of all the diseases, measles and chicken-pox are probably the 
 most contagious. In scarlet fever and diphtheria, close contact 
 is necessary for exposure, while whooping cough can actually 
 be contracted in the open air, young babies being particularly 
 susceptible. 
 
 TYPHOID FEVER 
 
 Typhoid fever is a disease of the small intestine. Typhoid 
 germs accumulate in the little lymph nodes of the small intes- 
 tines and that is the reason why we often have so many hemor- 
 rhages from the bowel — actual ulcerations take place — and if 
 an ulcer is situated in the neighborhood of a blood vessel hemor- 
 rhage may result. 
 
 Typhoid fever begins rather insidiously with a slight debility 
 and loss of appetite, but if a temperature record is kept the 
 fever will be found to rise from one-half to a degree higher 
 each day. A steady climb in the temperature curve is noted 
 until the end of the first week, when it remains for a week, 
 possibly 103 or 104 F. After one week it begins slowly to 
 decrease and, if all goes well, the early part of the fourth week 
 usually finds the temperature about normal. It is exceedingly 
 important that the child be kept in bed during the entire course 
 of the disease. The bed pan must be used at each bowel move- 
 ment or urination. 
 
 First Week Treatment. During this week the child may feel 
 quite well, but he should be kept in bed and sustaining treat- 
 ments begun — such as wet-sheet packs and cold frictions to 
 the skin (during which time there should always be external 
 heat to the feet). The diet must be full and nourishing, but 
 all pastries and " knicknacks " should be avoided. Abundance 
 of fresh fruit that has been well washed before paring, eggs, 
 pasteurized milk, baked potatoes, and toasted bread may be 
 taken at regular periods — with an interval of not less than 
 five hours beween meals. 
 
 The bowels should be opened in the beginning of the disease 
 with a liberal dose of castor oil, after which daily colonic irri- 
 gations should be employed. These enemas should be given 
 at least once a day, the temperature being about that of the 
 
CONTAGIOUS DISEASES 289 
 
 body, with a smaller terminal enema about five degrees cooler 
 at the close of each bowel cleansing. 
 
 Second Week Treatment. The normal temperature at this 
 time is no longer 98.6, it is 101.5 F. This fever is essential to 
 the curative and defensive processes of the body; and while 
 we do not care to have the fever fall below 101.5, at the same 
 time nothing is to be gained by allowing the fever to go up 
 much above 102.5 or 103 degrees F. And so, during the second 
 week, while the disease is at its height, we make frequent use 
 of the wet-sheet pack, always remembering that the extremi- 
 ties must be kept warm and never permitting the skin to become 
 blue or mottled while the cold treatment is being administered. 
 Since the real disease is localized in the small intestine, we will 
 now describe a very important treatment for the diseased bowel 
 — and one which is also very useful in combating high tem- 
 perature. 
 
 The Cooling Enema. The temperature of this enema begins 
 one degree higher than that of the body (supposing the body 
 temperature to be 103, the temperature of the enema would 
 start at 104 F.). This is allowed to flow into the colon and out 
 again, under low pressure, without disturbing the patient, by 
 means of a glass tube connection (See Fig. 15). The tempera- 
 ture is quickly brought down to 100, then to 98, then to 90, 
 usually finishing up at 80 or 85 F. The water is allowed to enter 
 the rectum slowly through a soft rubber catheter (not a hard 
 rectal point), and as it comes out it will be noted that the water 
 is very warm, sometimes registering 105, and it is needless to add 
 that if the water goes in at 80 and comes out at 105 F., much 
 heat has been taken from the body; and so, of all the treat- 
 ments we have to suggest for typhoid fever, the one just men- 
 tioned is possibly the most important. When it is necessary 
 to keep up this enema for an hour or two, the cool water may 
 cramp the bowels, but this may be entirely obviated by applying 
 hot compresses to the abdomen. 
 
 Another treatment of great importance in this second week 
 is the cold abdominal compress. Much fever is occasioned in 
 the abdomen because it is the seat of disease, and the much 
 dreaded hemorrhages which often cause the death of the 
 
290 THE MOTHER AND HER CHILD 
 
 Fig. 15. The Cooling Enema 
 
CONTAGIOUS DISEASES 291 
 
 patient are usually avoided by the use of abdominal com- 
 presses — wrung out of water at 55 F. — the temperature of 
 ordinary well water — and changed every twenty minutes. 
 
 I recall one mother in my dispensary practice who was so 
 poor she could not afford a nurse, her only helper being a son 
 twelve years old. A nurse went to the house twice each day 
 and taught this lad of twelve years to give his mother the 
 cooling colonic irrigation; he was also taught to warm up the 
 abdomen by a hot application and afterwards to apply the cold 
 compresses. The mother made a good recovery. 
 
 During this second week the diet should be sustaining. It 
 should consist of boiled milk, eggs, fresh fruit and fresh fruit 
 juices, dextrinized grains (hard toast, toasted corn flakes, 
 shredded wheat biscuits, etc.). The mouth should be kept 
 scrupulously clean, for in all the infectious and contagious dis- 
 eases there is always the possibility of gangrene in the mouth 
 if it is neglected. 
 
 Third Week Treatment. This is the week we look for hem- 
 orrhage from the bowel unless the abdomen has been well 
 treated during the second week; and even so, the cool com- 
 presses to the abdomen will be continued well into the third 
 week — also the daily or semi-daily enema. The skin is kept, 
 in good condition with soap washing and friction baths, and a 
 fairly liberal diet is maintained. During the whole course of 
 the disease the skin is never allowed to get blue or mottled, 
 being quickly restored to the normal red color by the mustard 
 sheet bath, the short hot-blanket pack, or the dry-blanket pack 
 with hot-water bottles. Under no circumstances let the child 
 leave the room or his bed for at least another week. 
 
 MUMPS 
 
 Infants are rarely affected with mumps. It is a disease of 
 the salivary glands and (as a rule) is usually preceded by pain 
 between the ear and the angle of the jaw, accompanied in a 
 short time by swelling and temperature. It is distinctly con- 
 tagious even during the incubation period. There is much ten- 
 derness on pressure, and chewing is difficult and may be impos- 
 sible. It usually occurs on the face and only one side may be 
 
292 THE MOTHER AND HER CHILD 
 
 affected. The bowels should be kept open, the mouth should 
 be kept clean, and the side of the face should be protected by 
 a layer of cotton held in place by bandages. 
 
 Hot fomentations may be applied if the pain is severe. The 
 electric light bulb on an extension cord, that was mentioned 
 in connection with earache, is very comforting in this con- 
 dition. 
 
 Isolation should be maintained for ten days or two weeks 
 after all symptoms have disappeared. 
 
 SCARLET FEVER 
 
 Scarlet fever is one of childhood's most dreaded diseases 
 because of, first, its long quarantine; second, its terrible possi- 
 bilities of contagion; and, third, its sequelae. 
 
 Absolute quarantine is necessary until ten days after the last 
 signs of desquamation have disappeared. 
 
 This disease is always alarming because of the possibilities 
 of its sequelae — the danger of pneumonia, inflammation of 
 the ears, abscesses of the glands of the neck, and nephritis 
 (inflammation of the kidneys). 
 
 Scarlet fever is highly contagious at any time during its 
 onset and course. Among the first symptoms of the disease 
 are sore throat, swollen glands, fever, etc. Vomiting on a 
 street car or at the movie may spread the disease to more 
 than one child who might otherwise have escaped. One child 
 who may have only a very light form of the disease may give 
 it to another child in the most severe form. Any such group 
 of classic symptoms — vomiting, fever, rapid pulse, and sore 
 throat — should cause any parent immediately to isolate the 
 little sufferer for several days — awaiting the " rash " — which 
 usually puts in its appearance after three or four days of 
 increasing temperature. 
 
 This rash has an appearance " all of its own," unlike any 
 other. Because the fine " meal-like " red points are in such 
 close proximity, the skin assumes a smooth " lobster red " 
 color that is never to be forgotten. After three days of increas- 
 ing redness, the color begins slowly to fade, and after four 
 or five days of this fading a peculiar peeling takes place, whose 
 
CONTAGIOUS DISEASES 293 
 
 scales vary in size from a small fleck to casts of the whole of 
 the soles of the feet and the palms of the hands. 
 
 During the height of the disease, the throat is very red, 
 the tonsils are not only inflamed, but covered over with white 
 patches, the head aches and the tongue possesses a peculiar coat- 
 ing through which peep the red points of the swollen papillae, 
 presenting the classic " strawberry tongue " of scarlet fever. 
 
 After ten days the fever disappears and the " real sick " 
 stage of the disease is in the past. 
 
 Each morning of the ten previous days a small dose of Epsom 
 salts is usually administered and the itching, which so often 
 accompanies the rash, is relieved by carbolized-water sponge 
 baths. 
 
 The nose, throat, and ears receive daily care — sprays to the 
 nose and gargles to the throat, as well as special swabbing to 
 the tonsils. 
 
 The physician in charge of the case will note the urinary 
 findings, guard the heart and kidneys, prevent the spreading of 
 the scales of desquamation by frequent rubbing of the skin with 
 oil, and otherwise work for the future well-being of the 
 patient. 
 
 MEASLES 
 
 Measles, one of the most common diseases of childhood, is 
 not to be regarded lightly, for very often its sequelae — run- 
 ning ears, weak eyes, and bronchial coughs — may prove very 
 serious and troublesome. Tuberculosis of the lungs not infre- 
 quently follows in the wake of measles. The early symptoms 
 of measles are so mild that often the child is out of doors, at 
 school, or about his usual play, until the second or third day 
 of the fever. He was supposed merely to be suffering from 
 a simple " cold in the head." 
 
 On the third or fourth day the patient begins heavy sneez- 
 ing and wears a stupid expression; and it is then that the 
 mother ascertains that his temperature is perhaps 101 to 102 F. 
 He is put to bed and the next day the rash usually appears. The 
 rash is peculiar to itself, not usually mistaken for anything else, 
 being a purplish red, slightly elevated, flattened papule, about 
 
294 THE MOTHER AND HER CHILD 
 
 the size of a split pea. The coughing, which is very annoying, 
 usually remains until about the seventh or eighth day — at 
 which time the fever also disappears. 
 
 The bowels must be kept open ; a daily bath be given — in 
 which has been dissolved a small amount of bicarbonate of 
 soda (simple baking soda) — after which an oil rub should 
 be administered. The nose should be frequently sprayed with 
 three per cent camphor-menthol-alboline spray, while the throat 
 is gargled with equal parts of alcohol and water. The feet 
 should be kept warm by external heat, while the physician in 
 charge may order additional attention to the chest, such as a 
 pneumonia jacket, etc. 
 
 Care should be taken to guard against " catching cold," for 
 bronchitis or pneumonia is quite likely to develop in many cases 
 of measles. The eyes should be protected by goggles and the 
 room should be darkened; under no circumstances should the 
 little patient be allowed to read. Carelessness in this respect 
 may mean weakened eyesight all the rest of his life. Until two 
 weeks after the rash has disappeared, the little fellow should 
 be kept by himself, for the desquamation keeps up almost con- 
 tinuously during this time. 
 
 The food during the course of the disease is a liquid and soft 
 diet. Children should never be allowed to go to a party or 
 gathering with a cold in the head ; the mothers of a group of 
 small children will never forget the time that one certain 
 mother allowed her little fellow to attend a party with " simply 
 a cold in the head." He laughed, talked, and sneezed during 
 the afternoon and when he went home the rash appeared that 
 night, while eight of the ten exposed children came down with 
 measles during the next two weeks. 
 
 CHICKENPOX 
 
 The incubation period of chickenpox is from ten to seven- 
 teen days. It is a mild disease, with a troublesome rash con- 
 sisting of widely scattered pimples appearing over the scalp, 
 face, and body. These pimples soon became vesicles (small 
 blisters), -which in turn quickly become pustular, afterwards 
 drying up with heavy crust formation. Severe itching which 
 
CONTAGIOUS DISEASES 295 
 
 attends these pustules may be greatly allayed by either the 
 daily carbolic-acid-water bath or a baking-soda bath. The itch- 
 ing must be relieved by proper measures, for if the crust is 
 removed from the top of the blebs by scratching, a scar usually 
 results. The bowels should be kept open, the diet should be soft. 
 Rigidly isolate, for chickenpox is highly contagious. 
 
 SMALLPOX 
 
 This disease occurs oftenest during the cold season. It spares 
 no one unless vaccinated, attacking children and adults alike. 
 The early symptoms are : headache, pain in the back, high fever, 
 vomiting, and general lassitude. In many respects these resem- 
 ble the symptoms of the grippe, while on the third day the 
 eruption appears. The pimples are hard and feel like shot under 
 the skin. Within a day or two these shotlike pimples have 
 grown and pushed themselves beyond the skin into little conical 
 vesicles which soon turn to pus. By the eighth or ninth day 
 crusts are formed over the vesicle, beginning to fall off about 
 the fifteenth day. 
 
 Patients are quarantined usually eight weeks and when a case 
 of smallpox in the home breaks out everyone in the family 
 should be revaccinated. The strictest isolation is important from 
 the first of the disease. 
 
 We will not enter into the treatment of smallpox, for medical 
 aid is sought at once and usually the patient is removed to 
 a special isolation hospital. 
 
 VACCINATION 
 
 The history of the change brought about in the Philippines 
 since vaccination has been introduced is an argument of itself 
 which ought to convince the most skeptical of the value of 
 vaccination. By all means, every child in a fair degree of health 
 should be vaccinated. It is wise to vaccinate babies before the 
 teething period — from the third to the sixth month. Babies 
 with any skin trouble or suffering from malnutrition, but not 
 living in a smallpox district, should be vaccinated during the 
 second year. In young babies, under six months, the leg Is the 
 proper place to receive the vaccination. 
 
296 THE MOTHER AND HER CHILD 
 
 If proper surgical cleanliness is practiced and ample protec- 
 tion is afforded in after dressing, vaccination need not be a tax- 
 ing process. The child suffers from general lassitude — a little 
 drowsiness with loss of appetite and a small amount of fever — 
 but this passes off in a reasonable length of time, especially if 
 he is not overfed and his bowels are looked after. On the sec- 
 ond or third day after vaccination a red papule appears which 
 soon grows larger, and, after five or six days, it becomes filled 
 with a watery fluid. By the tenth day it has the appearance of 
 a pustule about the size of a ten-cent piece, surrounded by a 
 red areola about three inches in diameter. At the end of two 
 weeks the pustule has dried down to a good crust or scab, in 
 another week it falls off, leaving a pitted white scar. 
 
 If the vaccination does not take, it should be repeated after 
 an interval of two months. 
 
 DIPHTHERIA 
 
 Diphtheria is a disease much dreaded during childhood and 
 adolescence. It may attack any age — even little babies are 
 susceptible. It begins with a general feeling of heavy, drowsy 
 lassitude with a sore throat. White spots appear on the tonsils 
 which may resemble a simple follicular tonsillitis, while in a 
 short time white patches spread over the throat and tonsils. 
 
 It is not at all uncommon for this membrane to attack the 
 nose, producing a bloody, pustular discharge; and when it does 
 attack the nose, it is none the less contagious and must be re- 
 garded just as seriously. A physician is called at once, and, 
 not only to the child, but to the other members of the family, 
 antitoxin is immediately administered. The disease runs a regu- 
 lar course and its most dangerous complication is the membrane 
 which forms in the larynx and threatens to suffocate the child 
 unless prompt intubation is performed — the slipping of a silver 
 tube in the larynx to prevent suffocation and death. The early 
 use of antitoxin greatly lessens all these serious complications. 
 
 Care must be exercised to prevent sudden heart failure; and 
 this is done by raising the child to an upright position with the 
 utmost care; while you insist upon him lying quietly upon his 
 back or his side, long after the disease has left his throat. While 
 
CONTAGIOUS DISEASES 297 
 
 the throat or nose is the seat of disease, the toxins from these 
 most dreaded diphtheritic microbes spread through the lymph 
 channels and the blood vessels to the .heart itself — so weaken- 
 ing that organ that it sometimes suddenly fails, or becomes more 
 or less crippled for life. These serious results are to be pre- 
 vented by the science of good nursing and the prompt use of 
 antitoxin. In these days the " Schick test " may be administered 
 for the purpose of ascertaining whether one is susceptible to 
 contracting diphtheria. 
 
 A physician is always in charge of diphtheria, and he will 
 supply directions for the bowels, the diet, and the sprays for the 
 nose and throat, and the general well-being of the suffering 
 child. Isolation and quarantine should continue for two weeks, 
 and in bad cases three weeks, after the membrane has disap- 
 peared from the throat. 
 
 WHOOPING COUGH 
 
 A child suffering from a continuous cough, particularly if it 
 is accompanied by a whoop or a condition which is so often 
 seen in children who cough — not able to stop ■ — should not be 
 taken to church, nor to the movies, nor allowed to go to school ; 
 neither should he be allowed to leave his own yard. The aver- 
 age duration of the disease is usually six weeks. The child 
 should have an abundance of fresh air, should spend much of 
 his time out of doors, and while in the house should avoid dust 
 of every kind ; at night he should not be exposed to drafts. Call 
 the physician early in the case and he may attempt to thwart 
 the progress of the disease by certain administrations of vaccine 
 medication. 
 
 In very bad cases, where a young child cannot catch his breath 
 and gets blue in the face — which, fortunately, is uncommon — 
 he should be slapped in the face with a towel wet in cold water ; 
 or, he may be lifted into a tub of warm water, then quickly in 
 cold water, then back into the warm, etc. Hygienic measures 
 should prevail, such as keeping the bowels open, the skin clean, 
 and the use of the usual throat gargles and nasal sprays. Do 
 not be misguided by the old-time thought that whooping cough 
 must run its course; for, if medical aid is promptly secured, the 
 
298 THE MOTHER AND HER CHILD 
 
 disease may often be cut short and the severe paroxysms greatly 
 lessened. 
 
 EYE INFECTIONS 
 
 Not long ago while in North Dakota near Canada, we took a 
 trip one day just over the border to visit several villages of Rus- 
 sian peasants. We found the boys and girls of nearly the entire 
 village suffering from trachoma — a dangerous, infectious dis- 
 ease of the eyes which spreads alarmingly from one child to 
 another. 
 
 We saw the disease in all of its varying degrees among the 
 children. Some of them had swollen, reddened lids. A dis- 
 charge of pus was coming from the eyes of others, and they 
 could not look toward a light or the sun. This disease is spread 
 in a hundred different ways — through the common use of wash 
 basins, towels, handkerchiefs, tools, toys, door knobs, gates, etc., 
 and that is the reason why these isolated villages of foreign 
 people who could neither read nor write the English language 
 were nearly all so sorely afflicted. 
 
 The ordinary condition of " catching cold in the eye " (." pink 
 eye ") is just as infectious as the trachoma which we have men- 
 tioned, although it is more of an acute disorder and nothing like 
 so serious. 
 
 In all such cases a physician is to be called immediately, iso- 
 late the patient, and give strict attention to carrying out the 
 doctor's orders. 
 
 Another form of inflammation of the eye which was men- 
 tioned in a previous chapter, is the inflammation of the eye of 
 the newborn. 
 
 In most civilized districts at the present, especially where the 
 cases are attended by a physician, the eyes of all newborn 
 babies are treated with either argyrol or silver nitrate. Just as 
 soon as defective sight is discovered in the child the eyes should 
 be examined at once and proper glasses fitted. While the glim- 
 mer and shimmer of moving pictures may seriously interfere 
 with the child's vision, on the other hand, this very thing often 
 discovers the defect in the eyesight earlier than it would other- 
 wise be found out. 
 
CONTAGIOUS DISEASES 299 
 
 RUNNING EARS 
 
 Inflammation of the ears was fully covered in our discussion 
 of adenoids and tonsils, but we would like to add at this time 
 that under no circumstances should a running ear be regarded 
 lightly. A chronic mastoiditis (inflammation of the middle ear) 
 often follows measles, scarlet fever, adenoid infection, and in- 
 flammation of the tonsils. The attention of a specialist should be 
 called to it and his instructions most carefully carried out; for, 
 when we have a sudden stopping of the discharge from the ear 
 with high fever and pain behind the ear, sometimes an operation 
 is imperative or the child may be lost. 
 
CHAPTER XXIX 
 RESPIRATORY DISEASES 
 
 NEXT to digestive disturbances, babies suffer more fre- 
 quently from respiratory disorders — colds, bronchitis, and 
 pneumonia. In fact, during very early infancy, pneumonia 
 heads the list of infant deaths, only to be displaced a few months 
 later by that most dreaded summer disease — diarrhea. 
 
 Little tiny babies are so helpless — they are so dependent upon 
 their seniors for life itself — that our responsibility is indeed 
 great. We should put forth our best endeavor to avoid and pre- 
 vent common colds. Among all the common maladies that afflict 
 the human race " colds " probably head the list ; and, in the case 
 of babies and the younger children, the common colds often go 
 on into coughs, croup, bronchitis, and even pneumonia. 
 
 WHY BABIES CATCH COLD 
 
 1. Someone has brought the infection to him. 
 
 2. Somebody coughed in his face. 
 
 3. Germ-laden hands have handled the baby. 
 
 4. He has drunk from an " infected " glass. 
 
 5. There was not enough moisture in the air. 
 
 6. Somebody wiped his face with an infected towel. 
 
 7. Baby was allowed to play on the cold floor. 
 
 8. Baby's lowered vitality could not stand the combined strain 
 of overeating and clogged up bowels. 
 
 9. Baby was kissed in the mouth by a " cold-germ " carrier. 
 
 10. Baby was dressed too warmly — and then taken out. 
 
 11. Somebody carelessly breathed in baby's face, 
 
 12. He slept in a stuffy room. 
 
 300 
 
RESPIRATORY DISEASES 301 
 
 13. His extremities got chilled. 
 
 14. Baby has adenoids or diseased tonsils. 
 
 Babies should not be allowed to sit or play on cold, drafty 
 floors. They may play on mother's bed whose open side is 
 protected with high-back chairs, or they may play in their own 
 bed whose raised sides are sheltered by blankets. 
 
 It is possible for a mother so to disinfect her hands, and so 
 garb herself with clean, washable garments, that, although she 
 may be suffering from an acute cold, she may continue to care 
 for her baby and the baby need not contract the cold. 
 
 CORYZA COLD IN THE HEAD 
 
 This most annoying ailment, a cold in the head, is particularly 
 hard on babies because the obstruction of the nasal passages not 
 only makes breathing difficult, but renders nursing well-nigh im- 
 possible. 
 
 The throat end of the eustachium tube (the ear tube) is found 
 in the upper and back part of the throat, just behind the nose. 
 The infection of the cold extends from both the nose and throat 
 and there results a spreading inflammatory process on through 
 these ear tubes into the middle ear itself. Now if this tube 
 swells so much that it entirely closes, as so often happens in 
 cases of " cold in the head " as well as in constant irritation 
 from adenoids, then may follow a vast train of difficulties — 
 earache, mastoiditis, etc. — with the result that the tiny bones 
 in the middle ear which vibrate so exquisitely may become 
 ankylosed (stiffened) and deafness often follow. Everything 
 known must be done to prevent baby's catching " cold in the 
 head." If the sinuses become infected it may also lead to 
 serious consequences. 
 
 When the nose becomes clogged it may be opened up by re- 
 peatedly disinfecting the inside of the nose with oily sprays such 
 as simple albolene or camphorated-albolene spray. 
 
 The bowels should be quickly opened by castor oil, and the 
 feedings should be cut down at least two-thirds or one-half. 
 
 Public drinking cups should always be avoided and kissing the 
 baby be tabooed. 
 
302 THE MOTHER AND HER CHILD 
 
 GRIPPE 
 
 The treatment of influenza in infancy and childhood is to avoid 
 contact with an older person suffering with the grippe. Ordi- 
 narily, the so-called " grippe " is a common, mixed infection — 
 not true influenza. Coryza and cough are the chief respiratory 
 symptoms which attend these widespread epidemics. Often 
 vomiting and diarrhea are seen in the young sufferers. 
 
 In cases of grippe put the child to bed and call the doctor. In 
 the case of the older children, the treatment and care to be rec- 
 ommended has been fully outlined by the author in the little 
 work entitled The Cause and Cure of Colds. 
 
 Complications from the grippe are very frequent in children 
 — such as severe diarrhea, enlarged glands of the neck, running 
 ears, bronchitis, pneumonia, and sometimes tuberculosis. 
 
 Every effort should be put forth to isolate and quarantine the 
 first member of the family to be stricken with grippe so that the 
 remaining members may, if possible, escape an uncomfortable 
 and unhappy siege. 
 
 SORE THROAT 
 
 The danger of permanent deafness which so often follows a 
 sore throat as well as a cold in the head, should cause every 
 mother or caretaker earnestly to begin treatment at the very first 
 sign of a sore throat. When a little baby gulps or cries on swal- 
 lowing, a sore throat should always be suspected and remedial 
 measures promptly instituted. 
 
 A most convenient article with which to examine an infant's 
 throat is a small pocket flashlight. The pillars of the throat or 
 the tonsils or both may be much inflamed, and since tonsillitis, 
 diphtheria, and scarlet fever all begin with a sore throat, it is 
 wise early to seek medical counsel in order that the differential 
 diagnosis may be promptly made. We urge the mother, as a 
 rule, not to attempt to diagnose severe cases of sore throat. 
 Send for the physician. 
 
 Tonsillitis is a severe form of sore throat which, fortunately, 
 rarely troubles tiny infants; but for every sore throat, while 
 waiting for medical help to arrive, lay your plans to empty the 
 
RESPIRATORY DISEASES 3°3 
 
 bowels, diminish the quantity of the food, swab or spray the 
 throat, and later closely follow the physician's advice concerning 
 the general treatment of the child. 
 
 ADENOIDS 
 
 Adenoid growths appear as grape-like lymphoid formations 
 located in the upper and posterior-nasal pharynx. These ade- 
 noids secrete a very toxic, thickened fluid, which slowly makes 
 its way down along the back wall of the throat, and reddens and 
 inflames first the anterior and posterior pillars of the throat and 
 then often inflames and enlarges the tonsils. 
 
 Adenoids not only obstruct the respiratory passage way to the 
 throat and lungs, but they also exert a harmful influence on the 
 general physical and mental development of the child. 
 
 It is nothing less than criminal for heedless parents to allow 
 adenoid growths to remain in the child's post-nasal pharynx. 
 The little fellow's face is disfigured, more or less for life, his 
 mentality dulled, while he is compelled to breathe through his 
 mouth. 
 
 An almost miraculous change often follows the complete re- 
 moval of these obstructive adenoids — the child takes a renewed 
 interest in everything about him. More oxygen finds its way to 
 the tissues, his face takes on better color, he gains in weight, 
 in fact, there appears to be a complete rejuvenation mentally 
 and physically. 
 
 The signs or symptoms of adenoids are mouth breathing, rest- 
 lessness at night, snoring, recurring colds, nasal discharge, swell- 
 ing of the glands of the neck, poor nutrition, loss of appetite, 
 bed wetting, impaired hearing, lack of attention, and mental 
 dullness. The removal of adenoids is neither a serious or diffi- 
 cult procedure, and they may safely be removed at any age. 
 
 DISEASED TONSILS 
 
 Tonsils which remain permanently enlarged and show signs 
 of disease and debilitation — filled crypts — may be removed as 
 early as the fourth or fifth year, if necessary. If proper treat- 
 ment does not improve the tonsils as the child grows older, their 
 removal should seriously be considered. The tonsils may serve 
 
304 THE MOTHER AND HER CHILD 
 
 some special secretory or defensive function during the first few 
 years of life and we think best, therefore, not to advise their 
 removal — except in extreme cases — until the child is at least 
 four or five years old. 
 
 When it is necessary to attack the tonsils, they should be 
 thoroughly dissected out — not merely burned or clipped off. 
 If they are properly removed, the danger of heart trouble, 
 rheumatism, and many other infections may be considered as 
 greatly lessened. 
 
 After five years of age the normal tonsils should begin to 
 shrink, and at about the beginning of adolescence they should 
 be no larger than a small lima bean, hidden almost completely 
 out of sight behind the pillars of the throat. While healthy ton- 
 sils may serve some useful purpose even in the adult, it is almost 
 universally conceded that the thoroughly bad and diseased tonsil 
 is utterly useless to the body — only an open gateway for the 
 entrance of infection. 
 
 BRONCHITIS 
 
 A very common disorder of early infancy and childhood is 
 bronchitis — an inflammation of the bronchial tubes — 'accom- 
 panied by severe coughing. Its tendency to pass into pneumonia 
 renders it a disease for skilled hands to treat — a disorder hardly 
 safe for even the well-meaning mother to undertake to manage 
 without medical advice and help. And since bronchitis is usually 
 accompanied by alarming symptoms of high fever, weakened 
 heart, embarrassed breathing, mottled or blue skin, green stools, 
 troublesome cough, disturbed sleep, " stopped up nose," and 
 " choked up throat," it is of utmost importance not only to 
 seek medical aid early, but also that the mother, herself, should 
 have definite ideas concerning the proper manner of doing the 
 following things in the line of treatment: 
 
 1. Making and applying a mustard paste. 
 
 2. The fashioning of an oil-silk jacket. 
 
 3. Improvising a steam tent. 
 
 4. Flushing out the colon, and a score of other things which 
 the watchful doctor may want given any moment. 
 
RESPIRATORY DISEASES 305 
 
 Mustard Pastes are prepared by mixing one part of mustard 
 and six parts of flour in warm water and applying to the chest 
 between two pieces of thin muslin. It is left on just seven 
 minutes and then talcum powder is thickly sprinkled on the 
 moist, reddened skin; this powder quickly absorbs all the mois- 
 ture and leaves the skin in a good condition — ready for another 
 paste in three hours if it is so ordered. 
 
 The Oil-Silk Jacket, or pneumonia jacket, consists of three 
 layers — the inside of cheesecloth, an inner thin sheet of cot- 
 ton wadding, and an outside layer of oil silk (procurable at any 
 drug store). It should open on the shoulder and under the arm 
 on the same side. It is worn constantly (change for fresh 
 cheesecloth and cotton every day) during the inflammatory 
 stage; it is removed only during the mustard pastes. 
 
 A Steam Tent may be prepared by placing a sheet over the 
 infant's crib and allowing steam to enter from a large paper 
 funnel placed in the nose of a tea kettle of boiling water kept 
 hot on a small stove of some sort. 
 
 The mattress and bedding are covered with rubber sheeting 
 and the infant's clothes protected from moisture. The baby 
 should remain in this steamy atmosphere ten minutes at a time. 
 
 Another method is to hold baby in arms near the large end 
 of a big funnel placed in a tea kettle on the gas stove or range, 
 and then have an assistant help hold a sheet tent over both the 
 mother and babe. Or the baby carriage may be placed over a 
 small tub of water into which are dropped several hot bricks. 
 A sheet canopy spread over the carriage holds the steam in and 
 baby reaps the benefits of the warm moisture. 
 
 Colonic Flushing is necessary when green stools accompany 
 bronchitis. A well-lubricated end of a large Davidson's syringe 
 is inserted into the rectum, and with the hips of the baby brought 
 to the edge of a basin (the heels held in the hands of the assist- 
 ant), water is forced into the rectum. Not more than one ordi- 
 nary cup of water should be introduced at any one time. After 
 expulsion, another may be gently injected. 
 
 The diet in bronchitis is always reduced so that no extra 
 work will be thrown on the already overtaxed constitution of 
 the child. 
 
306 THE MOTHER AND HER CHILD 
 
 'Absolute rest is necessary and perfect quiet should prevail. 
 The humidity of the room should not be lower than 50 at any 
 time, while the air should be moderately cool and fresh. 
 
 Numerous other details which may be necessary in the man- 
 agement of bronchitis will be directed by the physicians and 
 nurses in charge of the case. 
 
 SPASMODIC CROUP 
 
 It is believed that children with enlarged tonsils and adenoids 
 are much more subject to croup than others. Although very 
 sudden in its onset and very alarming, spasmodic croup, for- 
 tunately, is seldom dangerous. A little child goes to bed in 
 apparently normal condition and wakes up suddenly with a 
 coarse metallic cough, difficult breathing, and with a distressed 
 expression on the face. 
 
 Alternate hot and cold compresses should be applied to the 
 throat — first the hot cloths (wrung from very hot water) being 
 applied over the throat, which should he covered with a single 
 thickness of dry flannel. Then after three minutes of the hot 
 cloths a very cold cloth is applied to the skin itself for one half 
 minute; then more of the hot compress, followed again by the 
 short cold, until five such changes have been made. A bronchitis 
 tent should be quickly improvised so that the child can be 
 " steamed." 
 
 Vomiting must be produced by kerosene (three or four drops 
 on sugar), alum and molasses, or ipecac (ten drops every fifteen 
 minutes). Some remedy must be administered continuously 
 until free vomiting occurs. A good dose of castor oil should be 
 given after the spasm. Suitable treatment should be adminis- 
 tered through the day to prevent a recurrence of the attack the 
 next night. 
 
 The general vital resistance should be raised by outdoor life, 
 improved circulation, good food; adenoids if present, should 
 be removed. 
 
 Medical advice should be sought in every case of severe croup, 
 for membraneous croup usually is indicative of diphtheria, and 
 the diagnosis is important, as on it hangs the determination of 
 the administration of antitoxin. 
 
RESPIRATORY DISEASES 307 
 
 PNEUMONIA 
 
 Pneumonia is always a serious disease. It is accompanied by 
 high fever, painful, very short cough, and rapid breathing with 
 a moving in and out of the edges of the nose as well as the 
 spaces between the ribs. The possibilities of complications are 
 always great — the dangers are many — so that the combined 
 watchfulness of both the mother and a proficient trained nurse 
 are required; not to mention the skill of the physician. 
 
 The steam tent, the mustard paste, the oil-silk jacket and the 
 colonic flushing (described earlier in this chapter) may all be 
 asked for by the physician in his untiring efforts to prevent dan- 
 gerous complications during the course of the disease. 
 
 Plenty of moderately cool, fresh air (without drafts) is of 
 great benefit. Never allow blue finger tips, or cold ear tips to 
 exist; send at once for the doctor and administer a hot bath, or 
 wrap in a sheet dipped in hot mustard water while awaiting his 
 arrival. No mother should think of attempting to carry her 
 baby through an attack of bronchitis or pneumonia without the 
 best medical help available. 
 
CHAPTER XXX 
 THE NERVOUS CHILD 
 
 WHILE each child possesses an individuality all its own, 
 nevertheless, there are certain general principles of 
 psychologic conduct and family discipline which are more or 
 less applicable to all children. The so-called nervous child, in 
 addition to the usual methods of child culture, stands in need 
 of special attention as concerns its early discipline and training. 
 This chapter will, therefore, be devoted to special suggestions 
 with regard to the management and training of those children 
 who are by heredity predisposed to nervousness, over-excitabil- 
 ity, and who possess but a minimum of self-control. 
 
 HEREDITARY NERVOUSNESS 
 
 The so-called nervous child — all things equal — is the child 
 who is born into the world with an unbalanced or inefficiently 
 controlled nervous system; and while it is all too true that the 
 common nursery methods of " spoiling the child " are often 
 equally to blame with heredity for the production of an erratic 
 disposition and an uncontrolled temper, nevertheless, it is now 
 generally recognized that the foundation of the difficulties of 
 the nervous child reaches back into its immediate and remote 
 ancestral heredity. 
 
 I no longer doubt but that many of these babies with a bad 
 nervous heredity, who are born predisposed to Saint Vitus' 
 dance, bad temper, chronic worry, neurasthenia, and hysteria 
 could be spared much of their early troubles and later miseries 
 by prompt and proper methods of early nursery discipline. 
 
 These nervous babies are born into the world with an ab- 
 normal lack of self-control. Their " inhibition control " over 
 the natural and spontaneous tendency of the nervous system to 
 
 308 
 
THE NERVOUS CHILD 309 
 
 manifest its inherent impulses and passing whims is decidedly 
 deficient. The child is unduly sensitive, whines, hollers, or flies 
 into a violent rage when its will is crossed in the least degree. 
 Such a child sometimes keeps its mother living in constant terror 
 because, when its will is crossed in any particular, it will scream 
 and hold its breath until it turns black in the face and some- 
 times actually goes into a convulsion. 
 
 In dealing with these unfortunate little ones, fathers and 
 mothers, while they should be firm and persistent in their meth- 
 ods of correction, should also be kind and patient; fully recog- 
 nizing that whatever undesirable traits the little ones manifest 
 they have come by honestly — these naughty tendencies being 
 the result either of heredity or spoiling, for both of which the 
 parents stand responsible. 
 
 EARLY TRAINING 
 
 One of the very first things that a child, especially the nervous 
 child, should learn is that crying and other angerful manifesta- 
 tions accomplish absolutely nothing. The greatest part of the 
 successful training of the nervous child should take place before 
 it is three and one-half years of age. It should early learn to 
 lie quietly in its little bed and be entirely happy without receiv- 
 ing any attention or having any fuss made over it. It should 
 not become the center of a circle of admiring and indulgent 
 family friends and caretakers who will succeed in effectually 
 destroying what little degree of self-control it may be fortunate 
 enough to possess. 
 
 When the little one is discovered to be nervous, fretful, im- 
 patient, and easily irritated early in the morning, it should be 
 left alone in its bed or in the nursery until it quiets down. If 
 it has a good, healthy crying spell, leave it alone. Let it early 
 get used to living with itself — teach the little fellow to get 
 along with the world as it is — and you will do a great deal 
 toward preventing a host of neurasthenic miseries and a flood 
 of hysterical sorrows later on in life. 
 
 You must not expect to train the nervous child by the simple 
 and easy methods which are successful in the case of a normal 
 child ; that is, you cannot repeat a simple discipline two or three 
 
310 THE MOTHER AND HER CHILD 
 
 times and have the child learn the lesson. In the case of the 
 high-strung nervous child it requires " line upon line and pre- 
 cept upon precept ; " for, whereas a normal child will respond to 
 a certain discipline after it is repeated a half dozen times, the 
 nervous child will require the persistent repetition of such a 
 discipline from twenty-five to one hundred times before the 
 lesson sinks into his consciousness sufficiently to enable 
 him to gain control of his erratic and unbalanced nervous 
 mechanism. 
 
 SPOILING THE CHILD 
 
 As bad as all spoiling methods are in child culture, they are 
 decidedly disastrous — almost fatal — in the case of the nervous 
 child ; and yet it is these delicate, sensitive, cute little things that 
 are the very ones who are most frequently the worst spoiled. 
 Nervous children simply must not be played with all the time. 
 They must be by themselves a great deal, at least this is true 
 in their earlier years. 
 
 The nervous baby must early learn absolute respect for au- 
 thority, so that what it lacks in its own nervous control may be 
 partially made up for by parental suggestion and discipline. Of 
 course, as suggested in a later chapter, the more ideal methods 
 of suggestion, education, and persuasion should be employed in 
 your efforts to secure obedience and promote self-control; but, 
 when through either the deep-rooted incorrigibility of a child, 
 or the inefficiency of the parent's efforts in the employment of 
 suggestion — no matter what the cause of the failure of your 
 ideal methods to control temper, stop crying, or otherwise put 
 down the juvenile rebellion, whether the child has been spoiled 
 on account of company, sickness or ^through your carelessness — 
 when you cannot effectively and immediately enforce your will 
 any other way, do not hesitate to punish; spank promptly and 
 vigorously and spank repeatedly if necessary to accomplish your 
 purpose. You must not fail in the case of the nervous child to 
 accomplish exactly what you start out to do. 
 
 When the little fellow wakes up in the night and cries, see 
 if he needs anything and administer to him. If you have pre- 
 viously tried the method of letting him " cry it out," which is 
 
THE NERVOUS CHILD 311 
 
 usually entirely sufficient in the case of a normal child, and if 
 such treatment does not seem to cure him, then speak to him 
 firmly, give him to understand that he must stop crying, and 
 if he does not, turn him over and administer a good spanking — 
 and repeat if necessary to get results. In dealing with a nervous 
 child we must follow the directions on the bottle of the old- 
 fashioned liniment " rub in until relief is obtained." 
 
 No " spoiling practices " should be countenanced in the case 
 of nervous children. They should be taught to sleep undis- 
 turbed in a room in the presence of usual noises. They should 
 not be allowed to grow up with a sleeping-room always darkened 
 by day and a light to sleep by at night. They should be taught 
 to sleep on without being disturbed even if someone does enter 
 the room; they should be taught to sleep normally without hav- 
 ing to quiet and hush the whole neighborhood. 
 
 PLAYMATES 
 
 The early play of nervous children should be carefully super- 
 vised and organized. Under no circumstance should they be 
 allowed exclusively to play with children younger than them- 
 selves. They must not be allowed to dictate and control their 
 playmates; it is far better that they should play at least a part 
 of the time with older children who will force them to occupy 
 subordinate roles in their affairs of play ; in this way much may 
 be accomplished toward preventing the development of a selfish, 
 headstrong, and intolerant attitude. When the nervous child 
 is miffed or peeved at play and wants to quit because he cannot 
 have his way, see to it that he quickly takes his place back in the 
 ranks of his playfellows, and thus early teach him how to 
 react to defeat and disappointment. The nervous child must 
 not be allowed to grow up with a disposition that will in some 
 later crisis cause him to " get mad and quit." 
 
 If the nervous baby has older brothers and sisters, see to it 
 that he does not, through pet and peeve and other manifestations 
 of temper, control the family and thus dictate the trend of all 
 the children's play. Early train him to be manly, to play fair, 
 and when his feelings are hurt or things do not go just to his 
 liking, teach him, in the language of the street, to be " game." 
 
312 THE MOTHER AND HER CHILD 
 
 It is equally important that the little girls be taught in the same 
 way how to take disappointment and defeat without murmur or 
 complaint. 
 
 TEACHING SELF-CONTROL 
 
 When nervous children grow up, especially if their parents 
 are well to do, and they are not forced to work for a living, 
 they are prone to develop into erratic, neurasthenic, and hys- 
 terical women, and worrying, inefficient, and nervous men ; and 
 in later years they throng the doctor's offices with both their 
 real and imaginary complaints. These patients always feel that 
 they are different from other people, that something terrible is 
 the matter with them or that something awful is about to hap- 
 pen to them. Their brains constantly swarm with fears and 
 premonitions of disease, disaster, and despair, while their other- 
 wise brilliant intellects are confused and handicapped because of 
 these " spoiled " and " hereditary " nervous disturbances — with 
 the result that both their happiness and usefulness in life is 
 largely destroyed. 
 
 The fundamental abnormal characteristic of that great group 
 of nerve-patients who throng the doctor's office is sensitiveness, 
 suggestibility, and lack of self-control. Sensitiveness is nothing 
 more or less than a refined form of selfishness, while lack of 
 self-control is merely the combined end-product of heredity and 
 childhood spoiling. I am a great believer in, and practitioner 
 of, modern methods of psychological child culture, but let me 
 say to the fond parent who has a nervous child, when you have 
 failed to teach the child self-control by suggestive methods, do 
 not hesitate to punish, for of all cases it is doubly true of the 
 nervous child that if you " spare the rod " you are sure to " spoil 
 the child." 
 
 Let me urge parents to secure this self-control and enforce 
 this discipline before the child is three or four years of age; 
 correct the child at a time when your purpose can be accom- 
 plished without leaving in his subconscious mind so many vivid 
 memories of these personal and, sometimes, more or less brutal 
 physical encounters. Every year you put off winning the dis- 
 ciplinary fight with your offspring, you enormously increase the 
 
THE NERVOUS CHILD 313 
 
 danger and likelihood of alienating his affections and otherwise 
 destroying that beautiful and sympathetic relationship which 
 should always exist between a child and his parents. In other 
 words, the older the child, the less the good you accomplish by 
 discipline and the more the personal resentment toward the 
 parent is aroused on the part of the child. 
 
 CRIME AND INTEMPERANCE 
 
 While it is generally admitted that feeble-mindedness lies at 
 the foundation of most crime, we must also recognize that 
 failure on the part of parents to teach their children self-control 
 is also responsible for many otherwise fairly normal youths 
 falling into crime and intemperance. The parents of a nervous 
 child must recognize that they will in all probability be subject 
 to special danger along these lines as they grow up. The nerv- 
 ous child, as it grows up, is quite likely to be erratic, emotional, 
 indecisive, and otherwise easily influenced by his associates and 
 environment. 
 
 Nervous children are more highly suggestible than others, and 
 if they have not been taught to control their appetites and de- 
 sires, their wants and passions, they are going to form an 
 especially susceptible class of society from which may be re- 
 cruited high-class criminals, dipsomaniacs, and other unfortu- 
 nates. 
 
 It is true that any spoiled child, however normal its heredity, 
 may turn out bad in these respects if it is not properly trained ; 
 but what we are trying to accomplish here is to emphasize to 
 parents that the nervous child is doubly prone to go wrong and 
 suffer much sorrow in after life if he is not early and effectively 
 taught self-control. 
 
 UNSPOILING THE CHILD 
 
 If the child of nervous tendencies forms the habit of crying, 
 sulking, or otherwise misbehaving when it is denied its desires, 
 or when something it wants done is not immediately attended 
 to, it will be found an excellent plan simply to stand still and let 
 the little fellow have it out with himself, in the meanwhile 
 kindly reminding him to say, " please mamma," " please papa," 
 
314 THE MOTHER AND HER CHILD 
 
 etc. I well remember one nervous little girl who would yell 
 at the top of her voice and become black in the face the moment 
 she wanted a door opened or anything else. A few weeks of 
 patience and firmness on the part of the mother entirely cured 
 her of this unbecoming trait. 
 
 As a rule, it will be found best not to argue with the nervous 
 child. The moment your commands are not heeded, when you 
 have admonished the child once or twice without effect, take 
 him quickly to the crib or the nursery and there leave him alone, 
 isolated, until he is in a state of mind to manifest a kindly spirit 
 and an obedient disposition. It is an excellent plan quietly and 
 quickly to deprive such children of their pleasures temporarily, 
 in order to produce thoughtfulness ; and these methods are often 
 more efficacious than the infliction of varying degrees of pain 
 under the guise of punishment. 
 
 Nervous children must be taught to go to sleep by themselves. 
 They are not to be rocked or allowed to hold the hand of the 
 mother or the caretaker. The nervous baby should not be en- 
 couraged to exhibit its cuteness for the delectation of the family 
 or the amusement of strangers and visitors. He should be 
 especially trained in early and regular habits, taking particular 
 pains to see that bed wetting and similar bad habits are early 
 overcome; otherwise, he may drag along through early life and 
 become the cause of great embarrassment both to himself and 
 his parents. 
 
 The control of these nervous habits is somewhat like the man- 
 agement of the slipping of the wheels of a locomotive when the 
 track is wet and slippery. The little folks ofttimes endeavor to 
 apply the brakes, but they are minus the sand which keeps the 
 wheels from slipping. The parent, with his well-planned dis- 
 cipline, is able to supply this essential element, and thus the child 
 is enabled to gain a sufficient amount of self-control to prevent 
 him making a continuous spectacle of himself. 
 
 When nervous children do not walk or talk early, let them 
 alone. Of course, if later on it is discovered that they are mani- 
 festly backward children, something must be done about it; but 
 if the nervous child is encouraged to talk too soon there is great 
 danger of his developing into a stutterer or a stammerer. 
 
THE NERVOUS CHILD 315 
 
 PREVENTING HYSTERIA 
 
 Every year we have pass through our hands men and women, 
 especially women, who possess beautiful characters, who have 
 noble intellects, and who have high aims and holy ambitions in 
 life, but whose careers have been well-nigh ruined, almost shat- 
 tered, because of the hysterical tendency which ever accom- 
 panies them, and which, just as soon as the stress and strain 
 of life reaches a certain degree of intensity, unfailingly pro- 
 duces its characteristic breakdown; the patient is seized with 
 confusion, is overcome by feeling, indulges in an emotional 
 sprawl, is flooded with terrible apprehensions and distracting 
 sensations, may even go into a convulsive fit, and, in extreme 
 cases, even become unconscious and rigidly stiff. 
 
 Now, in the vast majority of cases, if this nervous patient, 
 when a baby, had been thoroughly disciplined and taught proper 
 self-control before it was four years of age, it would have 
 developed into quite a model little citizen ; and while through- 
 out life it would have borne more or less of a hysteria 
 stigma, nevertheless it would have possessed a sufficient amount 
 of self-control to have gotten along with dignity and success ; 
 in fact, the possibilities are so tremendous, the situation 
 is so terrible in the case of these nervous babies, that we might 
 almost say that, in the majority of such, success and fail- 
 ure in life will be largely determined by the early and effective 
 application of these methods of preventive discipline. 
 
 I was recently consulted by a patient whose nervous system 
 was in a deplorable state, who had lost almost complete mental 
 control of herself, and who really presented a pathetic spectacle 
 as she told of the fears and worries that enthralled her. In an 
 effort to get to the bottom of this patient's heredity I had a 
 conference with her father, and I learned that this woman, in 
 her childhood days, had been constantly humored — allowed to 
 have everything she wanted. She was a delicate and sensitive 
 little thing and the parents could not bear to hear her cry, it 
 made her sick, it gave her convulsions, it produced sleepless 
 nights, it destroyed her appetite, and so she grew up in this 
 pampered way. The father recognized the greatness of his mis- 
 
316 THE MOTHER AND HER CHILD 
 
 take and he told me with tears in his eyes how, when the ring- 
 ing of the school bell disturbed his little girl baby, he saw the 
 school directors and had them stop ringing the bell, and he even 
 stopped the ringing of the church bells. He was an influential 
 citizen and could even stop the blowing of the whistles if it dis- 
 turbed his precious little daughter. 
 
 And so this woman has grown up with this nervous system 
 naturally weakened by heredity and further weakened by " spoil- 
 ing " ; and fortunate indeed she will be if off and on the most 
 of her life she is not seeking the advice of a physician in her 
 efforts to gain that self-control which her parents could have 
 so easily put in her possession at the time she was three or four 
 years of age, if they had only spent a few hours then, instead 
 of the many months and years that subsequently have been de- 
 voted to medical attention. 
 
 METHODS OF DISCIPLINE 
 
 We run into many snags when we undertake to discipline the 
 nervous baby. The first is that it will sometimes cry so hard 
 that it will get black in the face and may even have a convul- 
 sion ; occasionally a small blood vessel may be ruptured on some 
 part of the body, usually the face. When you see the little one 
 approaching this point, turn it over and administer a sound 
 spanking and it will instantly catch its breath. This will not 
 have to be repeated many times until that particular difficulty 
 will be largely under control. 
 
 It will be discovered when you undertake to break a bad 
 habit in the case of a spoiled child who is of a nervous tempera- 
 ment, that your discipline interferes with the child's appetite and 
 nutrition. The delicate little creature who has perhaps already 
 given you no end of trouble regarding its feeding, will begin to 
 lose in weight, and even the doctor often becomes so alarmed 
 that he advises against all further methods of discipline. We 
 think this is usually a mistake. Both the nutrition and discipline 
 should be kept in mind and carried harmoniously through to a 
 successful finish. It will be necessary during such troublous 
 times to conserve both the physical and nervous strength of the 
 child; it should not be allowed to run about and over-play, as 
 
THE NERVOUS CHILD 317 
 
 such high strung children often do. It should be given a reason- 
 able amount of physical exercise, and two or three times a day 
 should have short periods of complete isolation in the nursery, 
 where it may quietly play with its blocks and toys, sing and 
 croon or talk as the case may be, but should be left entirely 
 alone. 
 
 Wise efforts should be put forth to keep the feeding up to the 
 proper number of calories, and to see, if the child does not gain 
 during this disciplinary struggle, that at least it does not lose; 
 and I give it as my experience that I have yet to see a case in 
 which both the child's nutrition and discipline cannot be effi- 
 ciently maintained at one and the same time, though it does 
 sometimes require adroit scientific and artistic management. But 
 the game we are playing is worth the effort — the battle must be 
 fought — and it can be fought with the least suffering and sor- 
 rowing the earlier the conflict is waged to a successful issue. 
 
 I am decidedly opposed to allowing these young nervous chil- 
 dren to over-play and thus wear themselves out unduly. This 
 over exhaustion sometimes renders the training of the child 
 much more difficult, as it is a well-known fact that we are all 
 much more irritable and lacking in self-control when we are 
 tired, more especially when we are over-tired and fatigued. 
 
 Let me emphasize the importance and value of proper periods 
 of isolation — complete rest and partial physical relaxation. 
 You can take a child who has gotten up wrong in the morning, 
 whose nerves are running away with him, who is irritable, 
 crying at everything that happens, who even rejects the food 
 prepared for him, and who, when spoken to and commanded to 
 stop crying, yells all the louder — I say you can take such a 
 little one back to its crib, place it in the bed and smilingly walk- 
 out of the room. After a transient outburst of crying, within 
 a very few minutes you can return to find a perfect little angel, 
 winsome and smiling, happy and satisfied, presenting an entirely 
 different picture from the little culprit so recently incarcerated 
 as a punishment for his unseemly conduct. 
 
 But let me repeat that while such methods of discipline often 
 work like magic on normal children, they must be repeated again 
 and again in the case of one who is nervous in order to establish 
 
318 THE MOTHER AND HER CHILD 
 
 new association groups in the brain and to form new habit 
 
 grooves in his developing nervous system. 
 
 RESPECT FOR AUTHORITY 
 
 There are just two things the nervous child must grow up to 
 respect; one is authority and the other is the rights and privi- 
 leges of his associates. The nervous child needs early to learn 
 to reach a conclusion and to render a decision — to render a 
 decision without equivocation — to move forward in obedience 
 to that decision without quibbling and without question; that is 
 the thing the nervous man and woman must learn in connec- 
 tion with the later conquest of their own nerves ; and a founda- 
 tion for such a mastery of one's unruly nerves is best laid early 
 in life — by teaching the child prompt and unquestioning obedi- 
 ence to parental commands. At the same time, endeavor so to 
 raise the child that it acquires the faculty of quickly and agree- 
 ably adapting itself to its environment, at the same time cheer- 
 fully recognizing the rights of its fellows. 
 
 It is a crime against the nervous child to allow it to hesitate, 
 to debate, or to falter about any matter that pertains to the 
 execution of parental commands. Let your rule be — speak 
 once, then spank. Never for a moment countenance anything 
 resembling dilatoriness or procrastination, let the child grow up 
 to recognize these as its greatest dangers, never to be tolerated 
 for one moment. 
 
 FALSE SYMPATHY 
 
 We are aware that many good people in perusing this chapter 
 will think that some of the advice here given is both cruel and 
 hard hearted ; but we can safely venture the opinion that those 
 who have reared many children, at least if they have had some 
 nervous little ones, will be able to discern the meaning and sig- 
 nificance of most of our suggestions. Sympathy is a beautiful 
 and human trait and we want nothing in this chapter in any way 
 to interfere with that characteristic sympathy of a parent for 
 its offspring — the proverbial " as a father pitieth his children " 
 — nevertheless, there is a great deal of sympathy that is utterly 
 false, that is of the nature of a disastrous compromise, for the 
 
THE NERVOUS CHILD 319 
 
 time being making it easy for both parent and child, but making 
 things unutterably more difficult later on in life when both 
 (or perhaps the child alone) must face the calamitous con- 
 sequences of this failure early to inculcate the principles of self- 
 control and self-mastery on the mind and character of the 
 nervous child. 
 
 We so often hear " mother love " eulogized. It is a wonder- 
 ful and self-denying human trait; but, as a physician, I have 
 been led to believe that " mother loyalty " is of almost equal or 
 even greater value. All mothers love their children more or 
 less, but only a few mothers possess that superb loyalty which 
 is able to rise above human sympathy and maternal love, which 
 qualifies the mother to stand smilingly by the side of the crib 
 and watch her little one in a fit of anger — yelling at the top of 
 its voice — and yet never touch the child, allow the little fellow 
 to come to himself, to wake up to the fact that all his yelling, 
 his emotion, his anger, and his resentment are absolutely power- 
 less to move his mother. Thus has the mother — by her loyalty 
 to the little fellow — taught him a new lesson in self-control, 
 and thus has she added one more strong link in the chain of 
 character which parent and child are forging day by day, and 
 which finally must determine both the child's temporal and 
 eternal destiny. 
 
 SYSTEM AND ORDER 
 
 System and order are desirable acquisitions for ail children, 
 but they are absolutely indispensable to the successful rearing of 
 the nervous child, who should be taught to have a place for 
 everything and everything in its place. When he enters the 
 house his clothes must not be thoughtlessly thrown about. Every 
 garment must be put in its proper place. These little folks must 
 be taught a systematic and regular way of doing things. 
 
 Nervous children must not be allowed to procrastinate. They 
 must not be allowed to put off until tomorrow anything which 
 can be done today. They must be taught how to keep the work- 
 ing decks of life clear — caught right up to the minute. They 
 should be taught proper methods of analysis — how to go to the 
 bottom of things — how to render a decision, execute it, and 
 
320 THE MOTHER AND HER CHILD 
 
 then move forward quickly to the next task of life. When they 
 come home from school with home work to do it would be best, 
 as a rule, first to do the school work before engaging in play. 
 In fact, all the methods which are needful for the proper dis- 
 cipline of the ordinary child are more than doubly needful for 
 the training of the nervous child ; while more than fourfold per- 
 sistence is needed on the part of parents to make them really 
 effective. 
 
 EMOTIONAL RUNAWAYS 
 
 Whether the child be two years of age or ten years of age, 
 when the parent discovers that the nervous system is " losing 
 its head," that the child is embarking on a nervous runaway, or 
 that it is about to indulge in an emotional sprawl, it is best to 
 interfere suddenly and spectacularly. Lay a firm hand on him 
 and bring things to a sudden stop. Speak to him calmly and 
 deliberately, but firmly. Set him on a chair, put him in the bed, 
 or take him to a room and isolate him. 
 
 In the case of the older children, tell them a story of the 
 horse which becomes frightened, loses self-control, and tears 
 off down the highway, wrecking the vehicle and throwing out its 
 occupants. Explain to them that many of the mistakes of life 
 are made during the times of these emotional runaways, these 
 passing spells of lost self-control. Tell the little folks that you 
 have perfect confidence in them if they will only take time to stop 
 and think before they talk or act. Explain to them that since 
 you saw that they were rapidly approaching a foolish climax 
 you thought it was your duty to call a halt, to stop them long 
 enough to enable them to collect their wits and indulge in some 
 sober thinking. 
 
 Personally, we have found it to be a good plan not to be 
 too arbitrary with the little folks, like putting them on a chair 
 and saying, " You must sit there one hour by the clock." They 
 usually begin to indulge in resentful thoughts and a situation 
 is often produced akin to that of the stern father who felt 
 compelled to go back and thrash his boy three different times 
 during his hour on the chair, because of what he was satisfied 
 was going through the boy's mind. No, that is not usually the 
 
THE NERVOUS CHILD 321 
 
 best way. Put them on the chair with an indeterminate sen- 
 tence. I prefer to carry it out something like this : " Now, 
 son, this will never do; you are running away with yourself. 
 Stop for a moment and think. Now I am going to ask you to 
 sit clown in that chair there and think this over quietly. I 
 will be in the next room. Whenever you think you have got 
 control of yourself and have thought this thing out so you can 
 talk with me, you may get up from the chair and come into 
 the room to me." Sometimes five minutes, sometimes fifteen 
 minutes, and the little fellow will walk in and talk to you in 
 a very satisfactory manner. He will give you his viewpoint 
 and you will be able to adjust the matter in a spirit of con- 
 ference which will be satisfactory to both parent and child, 
 without doing the least violence to the responsibility of the one 
 or the individuality of the other. 
 
 Very little is to be accomplished, when the child starts to 
 indulge in an emotional runaway, if the parent contracts the 
 same spirit, begins to talk fast and loud, to gesticulate wildly, 
 grabs the child, begins to slap and shake it — that is merely an 
 exhibition on the part of the parent of the very same weakness 
 he is trying to correct in his offspring. I am afraid it is entirely 
 too true that for every time you shake one demon out of a 
 child in anger, you shake in seven worse devils. When all 
 other methods fail and you must resort to punishment, do it 
 with kindness, deliberation, and dignity. Never punish a 
 child in haste and anger. 
 
 THE FINAL REWARD 
 
 The advice offered in this chapter is not mere theory. It 
 has been successfully used by many parents in the manage- 
 ment of their nervous children, and while all principles of 
 child culture must be carefully wrought out and made applica- 
 ble to the particular child in question, nevertheless, the methods 
 of repeated and firm discipline herein set forth will enable 
 you to take many a child who has been born into this world 
 almost neurologically bankrupt, and, by this training and disci- 
 pline, enable him in adult life to draw such dividends of self- 
 control and self-mastery; as will far exceed the outward results 
 
322 THE MOTHER AND HER CHILD 
 
 obtained in the case of many children who are born with sound 
 nervous systems, but who were early spoiled and allowed to 
 grow up without that discipline which is so essential to later 
 self-control and dignity of character. 
 
CHAPTER XXXI 
 NERVOUS DISEASES 
 
 IN this chapter we shall consider a number of the more com- 
 mon diseases which are associated with the nervous sys- 
 tem of the child. Some of these so-called nervous diseases 
 are hereditary or congenital, while others are the result of infec- 
 tion and environment. 
 
 SLEEPLESSNESS — INSOMNIA 
 
 There are many conditions which cause sleeplessness or 
 insomnia in a child aside from disturbance of the mental state 
 or nervous system. For instance, late romping, too hearty and 
 too late a dinner, lack of outdoor life during the day, illy 
 ventilated sleeping rooms, too much bedding, too little bedding 
 which causes cold extremities, too much sleep during the day, 
 too much excitement (movies or receptions), intestinal indiges- 
 tion which is associated with accumulation of gas, and consti- 
 pation — any or all of these are causes of sleeplessness. Some 
 peculiarly nervous children — those with an hereditary strain 
 of nervousness — are easily upset or disturbed by any of the 
 conditions above mentioned. 
 
 The treatment of insomnia consists, first, in finding the 
 cause and removing it. Children with a nervous tendency 
 should be let alone as nearly as possible, and just allowed to 
 grow up as the little lambs and calves grow up. They should 
 be fed, watered, kept clean and dry, and allowed to live their 
 lives undisturbed and without excitement. 
 
 The medicinal remedies on the market for insomnia are all 
 harmful if used too long or in excess, and we most earnestly 
 urge the mother not to seek drug-store information concerning 
 remedies for sleeplessness. The neutral bath is beneficial in 
 
 323 
 
324 THE MOTHER AND HER CHILD 
 
 ninety per cent of these cases. It is administered as follows: 
 Enough water is allowed to run into the bath tub to cover the 
 child. The temperature should be 99 to 100 F. It should be 
 taken accurately — and should be maintained. Bath tub ther- 
 mometers may be purchased at any drug store. The restless 
 child, after the bowels have been freely moved, is placed in 
 the water, and, without whispering, talking, or laughing, he 
 remains there for at least twenty minutes, after which he is 
 carefully lifted out, wrapped in a sheet and very gently dried 
 off with soothing strokes and placed at once into his night 
 clothes. As before said, ninety per cent of restless children 
 will go at once to sleep after such a treatment. 
 
 Another method of treating sleeplessness is by the wet-sheet 
 pack. Three single woolen blankets are placed on the bed 
 and a sheet large enough to wrap the child in is wrung from 
 warm water, about 100 F. The child is stripped and this sheet 
 is brought in contact with every portion of his body, quickly 
 followed by bringing the flannel blankets about him and he is 
 allowed to remain there for twenty minutes — if he does not 
 fall asleep before the lapse of that time. With witch-hazel 
 or alcohol, the body is sponged off, night clothes are put on 
 and a restful night usually follows. If fresh air is lacking, open 
 the windows. If there is too much bedding, remove some of it. 
 Talcum powder the sweaty back and neck and make the child 
 perfectly comfortable. Give a small drink of water and turn 
 out the light. 
 
 NIGHT TERRORS 
 
 Night terrors are probably due to some digestive disturbance, 
 with a coexisting highly nervous temperament. They often- 
 times, in older children, follow the reading of thrilling stories 
 or a visit to an exciting moving-picture show. The child goes 
 to sleep and gets along nicely for two or three hours and then 
 suddenly jumps up out of bed and rushes to its mother with 
 little or no explanation for the act. In his dreams the thoughts 
 and the imaginations of his waking moments are all con- 
 founded and alarming. 
 
 We recall one little fellow who constantly feared big, black 
 
NERVOUS DISEASES 325 
 
 birds coming in the window and attacking him — he had been 
 reading about Sinbad the Sailor and his experiences with the 
 big bird. He so feared this big, black bird that he could not 
 go to sleep. For a number of nights he did not have the cour- 
 age to tell his parents that it was the fear of the big bird that 
 kept him from going to sleep, but finally he confided in his 
 mother and told her of his fear. The mother and father both 
 entered into a conversation with him through an open door 
 which connected the two rooms, after the lights were out ; they 
 laughed and talked about the big bird, they openly talked of it 
 and allowed their imagination to work with the child's imagina- 
 tion in planning how he could combat with the bird, should it 
 really come, asking him how big it really was and what color 
 he thought its eyes were and how big an object he thought 
 its feet could carry. They all three planned a fairy story they 
 might write which would rival the fairy stories of the Arabian 
 Nights. In a very short time — possibly a week or ten days — 
 the little fellow felt quite equal to these imaginary assaults, 
 his fears were quieted and his slumbers were no more disturbed 
 by visions of the big, black bird. 
 
 Everything should be done to relieve the stomach and intes- 
 tines of laborious work during the sleeping hours, hence let the 
 evening meal be light and eaten early enough to be out of the 
 way, as far as digestion is concerned, by bed time. 
 
 NERVOUSNESS 
 
 During the formative period of the nervous system — the 
 first few years — under no circumstances should the children 
 be played with late at night, when they are tired and sleepy, 
 or hungry, for it is at such times that the nervous system is 
 so easily excited and irritated. When the baby is to be played 
 with, if at all, it should be in the morning or after the mid-day 
 nap. Rest and peaceful surroundings are of paramount impor- 
 tance to the nervous child, and he should be left alone to amuse 
 himself several hours each day. It is a deplorable fact that 
 the nervous child — the very one that should be left alone — 
 is the very child that usually receives the most attention, the 
 very one who is most petted, indulged, and pacified; all of 
 
326 THE MOTHER AND HER CHILD 
 
 which only tends to increase his lack of self-control and to 
 multiply the future sorrows of his well-meaning but indulgent 
 parents. 
 
 HEADACHE 
 
 Headache attacks old and young alike, and the young infant 
 that is unable to tell us he has a headache manifests it by roll- 
 ing the head from side to side, putting his hand to his head, 
 or by wrinkling up his brow. Headaches may be occasioned by 
 disorders of the brain and spinal column, such as meningitis. 
 It nearly always accompanies fever, and is often a result of 
 constipation, intestinal indigestion, overeating, as well as eating 
 the wrong kind of food. 
 
 The treatment of headache in children (aside from removing 
 any known cause) consists of a hot foot bath, a brief mustard 
 paste to the back of the neck, a light diet — sometimes nothing 
 but water — and the administration of a laxative. 
 
 CONVULSIONS — SPASMS 
 
 In the very young, convulsions are easily produced. That 
 which will produce but a headache in an adult will often pro- 
 duce a convulsion in the child. Aside from diseases of the 
 nervous system such as epilepsy, etc., convulsions frequently 
 accompany gas on the bowels, intestinal indigestion, disordered 
 dentition, an acute illness, intestinal parasites (worms), irrita- 
 tion about the genitals such as the need of circumcision, an 
 adherent clitoris, adenoids and enlarged tonsils, inflammation 
 of the ears, and poor nutrition of any sort such as rickets. 
 
 The convulsion picture is a stiffening of the body — some- 
 times arching backwards — rolling or staring of the eye-balls, 
 blueness of the skin, a drooling mouth (often foamy mucus at 
 the mouth), clinched hands, biting the teeth — if there are 
 teeth — and even biting the tongue. There is at first a suc- 
 cession of quick, jerking, convulsive movements of the body 
 which in a few moments grow less and less violent and finally 
 cease. The child begins to cry and then soon goes off into a 
 deep sleep, while the body seems more heavy and logy than 
 usual. In extreme cases, the child relaxes but for a moment 
 
NERVOUS DISEASES 327 
 
 of time, when he goes off into another convulsion, sometimes 
 going from one fit into another until death relieves him. 
 
 Treatment for convulsions must be instituted at once. Do 
 not wait entirely to undress the child — pull off his shoes, place 
 him at once into a good warm bath, temperature about 100 
 to 102 F. An ice cap should be placed to his head (cracked 
 ice done up in a towel), and while in the bath or immediately 
 upon taking him out, give a warm soapsuds enema. The bath 
 that the child is placed in should be always tested with the 
 bared elbow. A half cupful of mustard may be added to the 
 bath. Just as soon as the child is able to swallow, give a tea- 
 spoon of syrup of ipecac. Enema after enema should be 
 given until the water comes back clear. Undue excitement 
 after the bath only predisposes to repeated attacks, and while 
 the mother may be very happy that the child is himself again, 
 under no circumstances should she caress and fondle him. 
 Put the little one to bed and allow his nervous system to calm 
 down; let him rest quietly and undisturbed. 
 
 NERVOUS TWITCHINGS 
 
 Habit spasms or " tics " are common in childhood, and are 
 caused by an over irritability of the nerves supplying certain 
 groups of muscles. It is not at all uncommon to see a child 
 nervously blink the eyes, twitch the nasal muscles, shrug the 
 shoulders, constantly open and close the hand, and execute a 
 score of other minor habit-spasms; which, day by day, wear 
 deeper and deeper paths into his nervous system as a result 
 of their constant repetition. These minor habit-spasms of 
 childhood are but telltales of an unstable nervous system, of 
 a nervous heredity lacking poise and balance; and, mind you, 
 if this nervous system is studied, treated, and properly harnessed 
 with self-understanding and self-control, much may be accom- 
 plished; the habit may be more or less completely eradicated. If 
 left to itself, unchecked, the habit deepens the " spasm-groove," 
 and the " energy-leaks " grow bigger and bigger until finally, 
 in later, adult life, all that is necessary to convert such per- 
 sons into first-class neurasthenics or hysterics is some bad 
 news, a few worries, or a sudden shock. 
 
328 THE MOTHER AND HER CHILD 
 
 By all means study to nip all childhood twitchings in the 
 bud ; remembering all the while that childhood — the formative 
 period for the nervous system of the child — presents the 
 golden opportunity to prevent and abort the more grave neu- 
 roses of later life. There may be a special contraction of 
 one or more muscles of the eyeball which produces either a 
 " cross-eye," when the contraction is convergent, or a turning 
 of one eye outward when the contraction is divergent. It is 
 not possible for the mother to correct this condition. The 
 one important thing for her to do is to take the child to a 
 skilled ophthalmologist early in his life, that treatment may be 
 instituted for the correction of the difficulty. 
 
 RETENTION OF URINE 
 
 Not an unusual condition during childhood is a temporary 
 retention of urine. It may follow an attack of colic or accom- 
 pany any acute illness. Increase the water drinking, and, after 
 seven or eight hours, hot cloths should be applied over the 
 bladder; a large enema (enema bag should be hung low) should 
 also be given, retaining as much as is possible. These simple 
 measures usually relieve the condition. If retention follows 
 circumcision, due to swelling of the parts, the surgeon should 
 be notified. 
 
 BED WETTING 
 
 Nocturnal enuresis (bed wetting) usually is found to " run 
 in families." It is seldom the case to find that both the father 
 and the mother escaped bed wetting during childhood when 
 the child is sorely afflicted. 
 
 Early bad habits may be the prime factor in this distressing 
 and humiliating difficulty. A little child that has been com- 
 pelled to lie in wet diapers for hours at a time gradually 
 becomes accustomed to " being wet," and the desire to urinate 
 is not under the keen control of a will that has been trained 
 by untiring patience to " sit on a chair " at regular intervals 
 throughout the day. This lack of training in a child who 
 possesses an unstable nervous system, creates the proper 
 environment for the habit of bed wetting — which often 
 
NERVOUS DISEASES 329 
 
 marches steadily on until puberty. In the treatment of bed 
 wetting give attention to the following: 
 
 1. The urine should be thoroughly examined. 
 
 2. The size of the bladder should be determined. 
 
 3. The last meal of the day should not be after four o'clock 
 in the afternoon. 
 
 4. All during the day, in young children, systematic training 
 should be begun — put the child on the chair every hour, then 
 every hour and a half, then every two hours. Let the work 
 be done most painstakingly and much will be accomplished 
 toward training the bladder to " hold its contents " during the 
 night. For a time it will be necessary to set an alarm clock 
 to ring every three hours during the night, that the bladder may 
 be relieved at regular intervals. 
 
 5. No liquids whatever are allowed after four p. m.; even the 
 four o'clock meal should be very light. 
 
 6. In older children the habit is often broken by appealing 
 to the pride — by requesting or demanding the child to rinse 
 out the bed linen and hang it up to dry himself. 
 
 Usually at puberty the trouble ends, and while no amount of 
 whipping will correct the difficulty, the promise of rewards, an 
 appeal to the pride, correction of dietetic errors, the establish- 
 ment of regular times to empty the bladder, the removal of all 
 reflex causes such as adenoids, need of circumcision, worms, 
 etc. — these combined influences — will bring results in the 
 end, if they are faithfully and intelligently applied. 
 
 MENINGITIS 
 
 Cerebro-spinal meningitis is not highly contagious. Children 
 old enough to complain of symptoms usually first complain of 
 an intense headache with frequent vomiting and very high 
 fever. Great prostration is seen, the pulse is weak, the respi- 
 rations are irregular, the child may have convulsions, or it may 
 have chills and fever, and rigidity of the body may be present. 
 The position of the child is very characteristic. It does not 
 want to lie on its back but usually rests on one side, with the 
 spine more or less arched. It is a very serious disease and 
 demands the early attention of a physician. Some cases are 
 
330 THE MOTHER AND HER CHILD 
 
 very mild and others are exceedingly grave. If the physician 
 is secured early, and special remedies administered that are 
 known today, many of the children may be saved. 
 
 INFANTILE PARALYSIS 
 
 Infantile paralysis is a serious disease of the spinal cord 
 which comes on very suddenly and is associated with vomiting, 
 pain in the legs, and a high temperature. After these symptoms 
 have lasted a day or two the paralysis is discovered. There 
 may be convulsions. The paralysis is progressive, and the 
 wasting of the muscles increases until by the end of a couple 
 of months one limb is considerably shorter than the other. 
 Sometimes the baby goes to bed at night in apparent good 
 health and wakes up in the morning paralyzed. 
 
 In this disease the attention of the best physician in your 
 community should be called to the case at once, for there are 
 being developed in our large research laboratories special vac- 
 cines for this condition as well as for spinal meningitis. But 
 what is done must be done very, very early, so let there be no 
 delay in calling in medical counsel. 
 
 There are other forms of spinal paralysis which, associated 
 with tuberculosis of the spine and other spinal diseases, result 
 in loss of power to one or more groups of muscles. The only 
 treatment that can be given in the home is to keep all of the 
 paralytic portions of the body very warm by external heat, 
 care being taken to avoid burning, and secure medical advice. 
 Often, later in the course of the disease, by the aid of crutches 
 and braces, the child can be taught to go to school and to get 
 around the house about his little duties. 
 
 The slight facial paralysis which is so often seen in babies 
 that have been delivered with forceps, usually clears up in a 
 few days or at the latest in a few weeks or months. 
 
 SAINT VITUS' DANCE 
 
 Saint Vitus' dance (chorea) is a peculiar disorder seen in 
 nervous children, and which usually clears up in a few weeks 
 or months under proper treatment. It is characterized by 
 irregular jerkings pretty much all over the body, so that the 
 
NERVOUS DISEASES 331 
 
 child staggers as he walks, drops his food at the table, and exe- 
 cutes many other noticeably abnormal movements. The child 
 should be taken out of school at once and removed from 
 association with children who might make sport of him or 
 otherwise annoy him and thus increase these irregular jerkings. 
 He should at once be put under the direction of competent 
 medical authority. Simple food, colon hygiene, more or less 
 complete rest, and freedom from annoying circumstances, will 
 usually bring about a speedy recovery. 
 
 CONGENITAL DISORDERS 
 
 Water on the Brain is characterized by an enlarged head 
 due to an increased accumulation of fluid within the cranium. 
 While the face remains small the head greatly increases in size 
 so that oftentimes it must be braced while the child is com- 
 pelled to remain in a wheel chair. The mentality is usually 
 fairly normal, but the enormous weight of the head compels 
 the life-long occupancy of a wheel chair. 
 
 Deaf-Mutism. The child born deaf pays no attention what- 
 ever to sounds. An intellectual expression is seen on his face 
 and by six months he is able to do all that a normal baby can 
 do with the exception of hearing. The child should early be 
 taken to an ear specialist in the endeavor, if possible, to correct 
 the defect of hearing. Such little ones who are destined to a 
 life without sound, should be given every opportunity to learn 
 to read the lips and to secure a good education — to be taught, 
 a vocation where eyesight is of more value than hearing. 
 Special institutions are in existence today which can take 
 these deaf mutes when small and so teach them to make audi- 
 ble sounds that they can make themselves understood — at 
 least partially. Lip reading is a wonderful improvement over 
 the deaf and dumb alphabet, and should be taught early. 
 
 Congenital Blindness. Perhaps not until the child is six 
 months old can the observer distinguish between blindness and 
 idiocy. The blind child of course will not fix his eyes upon any 
 object; but the general lassitude and the inability to hold up 
 its head, while seen in idiocy, is not present in blindness. 
 
 Feeble Mindedness. A baby that is born with a weak mind 
 
332 THE MOTHER AND HER CHILD 
 
 is found to be very backward in all the normal developmental 
 attainments of the growing child. A normal baby holds up 
 its head at four months and should be able to sit erect at six 
 months. The weak-minded baby will not do this, and often as 
 late as two years it will not make any attempt to walk or to talk. 
 There is an unnatural expression — a vacant look — to the 
 face, while there is often much dribbling at the mouth. 
 
 Early Training should be Instituted. It is necessary to call 
 the attention of a physician to these facts, that the parents 
 may be instructed in regard to the early training which is so 
 essential in all these weak-minded little folk. In our opinion 
 it is best to remove these children early to special institutions, 
 where their education can be superintended by those thoroughly 
 accomplished and accustomed to dealing with this class. There 
 are varying grades of feeble mindedness — the backward child 
 who requires a longer time to learn things, and the child who is 
 slow at school and possibly cannot get through more than the 
 fourth or fifth grade — but as soon as weak mindedness is 
 discovered, it is best to transfer the child to some special insti- 
 tution. 
 
CHAPTER XXXII 
 
 SKIN TROUBLES 
 
 ONE of the earliest skin troubles that the average normal 
 child suffers from is prickly heat — a tiny, red-pointed 
 rash always accompanied by sweating and usually resulting 
 from over-dressing, stuffy rooms, and other conditions that 
 make the child too warm. Prickly heat produces more or less 
 discomfort but usually little or no itching. Ordinarily, a sponge 
 bath followed by the application of talcum powder is sufficient 
 to give relief in mild cases; but severe or neglected cases should 
 be treated by means of bran baths, a cupful of bran being tied 
 up in a gauze bag and suspended in water until the water 
 assumes a milky color. Soda baths, two tablespoons to a gallon 
 of water, are also very soothing. A baby should never receive 
 any friction with a towel after such baths, but should be rolled 
 up in a clean linen towel and simply patted dry. 
 
 CHAFING 
 
 Great care should be exercised in the choice of baby's soaps. 
 Among a number of soaps that might be mentioned castile soap 
 is, perhaps, as good as any. Frequent sponging is required to 
 wash off the irritating perspiration ; cool clothing, plenty of tal- 
 cum powder, a dose of calcined magnesia, and a regulated 
 diet are necessary to clear up the trouble. 
 
 Chafed skin, particularly between the buttocks or in other 
 folds and creases, should be kept free from soap. Either the 
 starch or bran bath may be tried, while olive oil should be 
 frequently and lightly rubbed over the chafed part. A bit of 
 sterile cotton placed between the folds to prevent friction is 
 often all that is necessary to correct the difficulty. 
 
 Dandruff or milk crust which is often seen on young babies' 
 
 333 
 
334 THE MOTHER AND HER CHILD 
 
 scalps has been described in detail elsewhere. It should early 
 receive the vaseline rub at night which will often loosen up 
 the hardened crusts. It may be gently removed in the morn- 
 ing with soap and water unless the case has gone on to great 
 severity. In such neglected cases the mother should not under- 
 take to correct the difficulty alone. Taken early, when the 
 scalp is covered with tiny flakes known as milk crust, it can 
 be quickly relieved. 
 
 VULVOVAGINITIS 
 
 Vulvovaginitis is a very contagious disease, and before the 
 days of hospital asepsis, which is so perfectly maintained today 
 in our large institutions, this disease used to go right through a 
 children's ward because of carelessness in the handling of soiled 
 diapers, etc. The sign of this disease is a yellow-white vaginal 
 discharge, while the surrounding skin covering the inside of 
 the thighs and buttocks may be very much reddened. The 
 baby should be taken at once to the physician at the first appear- 
 ance of these symptoms. Only rigid isolation can possibly pre- 
 vent other children from getting it — essentials are separate 
 towels, wash towels, soap (in the case of the older children), 
 and, in the case of the baby, separate diapers and rigid scrub- 
 "bing of the attendant's hands — in this way only can this infec- 
 tion be held in check. The infected child should sleep by her- 
 self, and utmost care must be exercised in preventing her fin- 
 gers from first touching the itching vulva and then placing them 
 to the eyes or to the mother's eyes. A vulva pad must be worn 
 as long as the disease lasts. The physician will give you the 
 proper medicines to be used in these cases, and if no physician 
 is within reach, you are perfectly safe in dropping into the 
 spread apart vulva a few drops of twenty-per-cent argyrol and 
 then applying the vulva pad. After each treatment the hands 
 of the mother or nurse must be most rigidly cleansed. 
 
 ECZEMA 
 
 Eczema is a very troublesome disease, particularly in infants ; 
 there are so many forms of it that there is neither time nor 
 space in this volume to describe them individually. This dis- 
 
SKIN TROUBLES 335 
 
 ease may be produced in children by either internal or 
 external causes — from friction on the skin, from coarse, rough 
 woolen clothes, or from starched garments, or from lace or 
 starched bonnet strings which rub into the folds of the skin. 
 Irritating soap, the contact of soiled diapers, cheap toilet pow- 
 ders, and discharges from the nose and ears may also be respon- 
 sible for the disease. The particular internal causes are over- 
 feeding, digestive disturbances, the too early use of starches 
 which create fermentation in the intestinal tract. In the most 
 frequent form of eczema the skin becomes red and then there 
 appear tiny vesicles (water blisters) which soon rupture and 
 " weep." This fluid which oozes from these tiny, ruptured 
 vesicles, in connection with the perspiration and exfoliation 
 of old skin, forms heavy crusts upon the face which are both 
 unsightly and annoying. 
 
 Another form of eczema is simply a very badly chafed con- 
 dition accompanied by intense itching, and commonly known 
 as " dry eczema." A very disagreeable form is the pustular 
 variety. One poor little sufferer that was once brought to us 
 had so many pustules on his head that one could not put a 
 ten cent piece on his scalp without touching a pustule. The 
 treatment of these cases, in order to be effective and leave the 
 child's head in normal condition, must be administered with 
 the utmost patience every day for weeks. A doctor's help is 
 always required in combating this sort of skin trouble. If 
 the cause is external, then the clothes should be changed. All 
 irritation should be removed — the clothing must not be allowed 
 to scratch the skin. The child must not scratch himself. If 
 necessary, little splints may be placed on the inside of his arms 
 to prevent his bending the elbows if the eczema is on the face, 
 while the little sleeves may be pinned to the side of the dress 
 to resist the movement of the arms. 
 
 ECZEMA TREATMENT 
 
 The diet should be most carefully looked into. The nursing- 
 mother will earnestly look into every article of food she her- 
 self is eating, and carefully avoid all -foods that produce fer- 
 mentation or decomposition. The mother's urine should be 
 
336 THE MOTHER AND HER CHILD 
 
 examined and its acidity noted; if it is above normal she 
 should take some alkalines such as ordinary baking soda or cal- 
 cined magnesia. If it is a bottle-fed baby, any form of flour 
 should be removed from the food and the quantity of the milk 
 reduced. All this, of course, is done under the direction of the 
 physician. Repeated doses of castor oil may be given. 
 
 The name of the medicinal agents that have been used in the 
 treatment of eczema, is legion. Perhaps one of the most widely 
 used is the early varnishing of the affected skin with ichthyol 
 (one part ichthyol, one part distilled water), which is swabbed 
 on after the skin has been cleansed with olive oil. Allow this 
 to almost dry, and then sprinkle on talcum powder which 
 smooths over the dry varnish of ichthyol. This is worn every 
 night and during the day, in bad cases, even when the eczema 
 is on the face. It is renewed each day, and is preceded by 
 the olive-oil bath. No water or soap is ever used in eczema. 
 Fortunately, the Eskimo has taught us that the skin really can 
 be cleansed with oil as well as with water. In the appendix 
 will be found two prescriptions, number one and number two, 
 that have proved very beneficial in some of the most severe 
 forms of eczema. 
 
 HIVES AND FRECKLES 
 
 Hives, a crop of little raised red papules closely resembling 
 lesions caused by the sting of a mosquito, may make their 
 appearance upon the skin of the child, remain a few hours, and 
 then disappear. Hives are usually due to digestive disturbances 
 and may be caused by such foods as strawberries, nuts, pas- 
 tries, pineapple, certain sea foods, mushrooms, etc. A good 
 cathartic, the taking of alkalines, such as baking soda or cal- 
 cined magnesia, with a bran or starch bath, or possibly a soda 
 bath, will usually correct the difficulty. The same treatment 
 may be used in nettle rash or prickly heat. 
 
 Freckles seem to run in families. Broad-brimmed hats or 
 sunbonnets may be worn, but under no circumstance should a 
 little girl be bidden to remain in the house and shun the beau- 
 tiful, sunshiny outdoors just because she freckles easily. Do 
 not apply any lotions to the freckled face without medical 
 
SKIN TROUBLES 337 
 
 advice, for great harm may be done the tender skin of the 
 child. 
 
 RINGWORM 
 
 Often upon the scalps of young children may be seen circles 
 — rather, patches — which are slightly rough to the touch, and 
 which cause the hair to fall out and the spots to remain bald. 
 They are known as ringworms of the scalp. The affection may 
 likewise appear on the body or the face, presenting a ring of 
 reddened skin with a scaly border. Ringworm on the scalp is 
 hard to treat and medical help should be secured, for, in spite 
 of all that can be done, the disease often runs its course, leav- 
 ing round bald spots over the head. Ringworm of the face, taken 
 early, is helped by carefully painting with tincture of iodine. The 
 mother should constantly bear in mind that ringworm is a 
 " catching " disease, so that all handkerchiefs, towels, and 
 clothes are to be kept separate. The disease known as mange 
 which so often attacks dogs, is nothing more than ringworm, 
 and children often contract the disease from dogs. Ringworm, 
 whether it be on children or dogs, may be greatly helped by 
 the use of tincture of iodine and other appropriate remedies. 
 
 BOILS 
 
 The much poulticing of boils has done an untold amount of 
 mischief. Many children and adults are in their graves today 
 because of improper treatment of boils. Blood poisoning which 
 so often follows the careless poulticing, as well as the uncleanly 
 opening of boils, can all be avoided. Before touching a boil, 
 the surrounding skin should be thoroughly washed with sterile 
 cotton and laundry soap and then disinfected with alcohol. 
 Then, with a scalpel or a surgeon's knife which has been either 
 boiled for twenty minutes or allowed to remain in pure car- 
 bolic acid two minutes and then in alcohol two minutes, it should 
 be thoroughly opened down to the core so that the pus may 
 come out. It is very much better for the trained hands of a 
 physician to do this than for any member of the family to 
 undertake such an operation — where the danger of blood poi- 
 soning is always present. The only treatment of skin eruptions 
 
338 THE MOTHER AND HER CHILD 
 
 containing pus which is justifiable for the home folks to under- 
 take is to simply paint them with iodine. Under no circum- 
 stance should poultices be used. 
 
 FEVER BLISTERS 
 
 It is not at all uncommon for small children to develop a 
 group of fever blisters on the lips when suffering with any 
 disease, or experiencing a high fever. Even a simple cold or 
 a spell of indigestion may be accompanied by fever blisters. 
 They appear not only on the lips but also on the edges of the 
 nose and may even be seen on the chin. 
 
 Early in their first appearance they may be treated with 
 spirits of camphor or plain alcohol, which sometimes tends to 
 abort them; but they usually run their course, and when they 
 are fully developed they may be treated with zinc oxide, sim- 
 ple borated vaseline, or ichthyol. 
 
 WARTS 
 
 Very often children's hands are disfigured by warts. They 
 appear suddenly, develop rapidly, and many times disappear 
 just about as suddenly as they appeared. Every child suffer- 
 ing from warts usually passes through the stage of charms 
 and lingoes which are popularly used to remove these disagree- 
 able growths. We hardly see any efficacy in " bean-ie, bean-ie 
 take this wart away," or any particular virtue in stealing 
 mother's dishcloth, cutting it up into as many pieces as there 
 are warts on the hand and rubbing each wart with a separate 
 piece of the cloth; but you will find people in every town or 
 village who will assure you that their warts were driven away 
 by one of these charms or lingoes. Warts are either better 
 left alone or removed by a physician with the high-frequency 
 spark or some other reliable method. 
 
 BIRTHMARKS 
 
 A red or purplish patch on the skin is the result, as men- 
 tioned in an earlier chapter, of an embryological accident in 
 which one or more embryonic cells slipped out of place in the 
 early days of skin formation. These accidental markings may 
 
SKIN TROUBLES 339 
 
 occur on the face, the scalp, or on any other portion of the 
 body, and they should be let alone, unless they show a tendency 
 to grow, when it may prove best to give them proper surgical 
 attention. 
 
 A mole is also a birthmark, and if found upon the neck or 
 shoulders where it is likely to disfigure, it may be removed by 
 the high-frequency spark, or by surgery, in the same way as 
 warts. Never tamper with moles. Leave them alone or turn 
 them over to the surgeon. 
 
 ERYSIPELAS 
 
 Erysipelas is a much-dreaded disease which is the result of 
 infection with the blood-poisoning germ — streptococcus. It 
 usually occurs about a wound, and is due to infection by this 
 microbe. If it follows circumcision, it is due, of course, to 
 infection, and may be very serious, even causing death. It 
 attacks persons of any age and is oftenest seen on the face. In 
 appearance, the skin is a bright and shiny red, with a definite 
 line of demarcation slightly raised at the edges because of the 
 swollen tissues underneath. On pressure, the redness disap- 
 pears but reappears immediately upon relieving the pressure. 
 The inflammation, pain, and fever often continues a number of 
 days, during which the child should be isolated from all other 
 members of the family. The bowels should be freely opened, 
 and the diet should be liquid and soft; while local treatment is 
 cared for by the physician who should always be called. Should 
 erysipelas develop on a very young baby it is very important 
 that he should be removed at once from the mother. As stated 
 before, the disease is produced by the blood-poisoning germ 
 which is very much to be avoided in any and all stages of 
 obstetrics. One attack in no way renders the patients immune. 
 They may have repeated attacks of erysipelas. The treatments 
 should be started early and kept up most rigidly. 
 
 SCABIES AND LICE 
 
 In thickly settled districts among the poor and uneducated, 
 where filth and untidiness reign, the " itch " is a very promi- 
 nent disease. It is caused by the itch mite, a parasite which 
 
340 THE MOTHER AND HER CHILD 
 
 burrows underneath the skin leaving behind its eggs in little 
 irregularly shaped, bluish tinted ridges. Such a profound 
 itching is set up by this burrowing and depositing of eggs that 
 the child cannot resist scratching, and all taken together pro- 
 duces the typical itch-rash. The common site for this rash is 
 on the sides and between the fingers and toes ; on arm pits and 
 buttocks of the child, as well as at the waistline. The treat- 
 ment is usually beyond home remedies. A physician should 
 have charge of the case who will conduct a line of treatment 
 which, if diligently followed, will rid the body of this scourge 
 within a week or ten days. 
 
 Along with the itch are often found parasites of the head, 
 or lice (pediculi). It is not at all infrequent to find them in 
 the heads of uncared for children; but if a much-cared- for 
 child is brought in contact with an infected head he will prob- 
 ably " catch " the infection. A most intense and disagreeable 
 itching is set up at once. The treatment consists in getting 
 the head clean by the use of a very fine comb, thus endeavor- 
 ing to remove the adult parasites as well as the eggs or " nits." 
 However, great care should be taken to avoid injuring the 
 scalp. Perhaps the simplest and most effective treatment 
 known is the kerosene bath which should be applied at night, 
 the hair being done up in a bandage until morning, when the 
 kerosene is washed off with soap and water and then the hair 
 given a vigorous vinegar shampoo in order to destroy the 
 " nits." Tincture of larkspur, or an ointment made from the 
 seeds, may also be used. It is applied several days in succes- 
 sion and then washed out. 
 
CHAPTER XXXIII 
 DEFORMITIES AND CHRONIC DISORDERS 
 
 REFERENCE has already been made to certain accidents 
 of embryology during the very early days or weeks of the 
 formative period of the embryo. Common illustrations of such 
 deforming developmental accidents are harelip, cleft palate, 
 and club foot. 
 
 HARELIP AND CLEFT PALATE 
 
 In the case of a partial or complete failure of the two sides 
 of the face to come together in the median line, a deformity 
 results which is known as harelip — a partial or complete cleft 
 of the upper lip. It may be a single or a double cleft, expos- 
 ing the teeth, or the cleft may even extend up into the nose. 
 This deformity may seriously interfere with nursing, making 
 it necessary to resort to feeding with a medicine dropper and 
 later a spoon. The success of the operation for the relief of 
 harelip, which should usually be performed during the early 
 months of life, is often very remarkable. 
 
 Should this failure to unite be in the deeper structures of 
 the head, then cleft palate is the result. This, too, may be par- 
 tial or complete: partial as seen in a cleft of the soft palate 
 only; and complete, when the hard palate also is involved. In 
 such an instance it is the floor of the nose that is defective; 
 hence the nose and mouth are one cavity. 
 
 A specially devised apparatus which assists the child in nurs- 
 ing may be found on the market, for nursing is well-nigh 
 impossible without the closure of the roof of the mouth. The 
 operation for cleft palate is usually successful when performed 
 at the proper time and by competent hands. 
 
 In tongue-tie the weblike membrane underneath is attached 
 
 341 
 
342 THE MOTHER AND HER CHILD 
 
 too far forward, so that the child is quite unable to protrude 
 his tongue, and this condition greatly interferes with sucking. 
 The operation for the relief of this condition is slight, and 
 should be performed as soon as the defect is discovered. 
 
 DEFORMED HANDS AND FEET 
 
 Occasionally there is a webbing of one or more fingers of the 
 hand, and there are sometimes seen too many fingers or a dou- 
 ble thumb. It is needless to allow such a deformity to continue ; 
 the operation for relief is often remarkably successful and 
 should be performed very early. 
 
 Clubfoot results when short tendons or contracted tendons 
 pull the toes inward or outward with raising of the heel. Treat- 
 ment must be instituted early; braces or splints are applied; 
 and untiring efforts are put forth in massage and other lines to 
 prevent a lifelong handicap of clubfoot. 
 
 An inward rotating of the legs presents the deformity of 
 pigeon-toe. The normal foot naturally inclines toward " point- 
 ing in," and such a condition should not be discouraged. Many 
 flat feet (broken arch) are due to shoe lasts which compel 
 the toes to slant " out," and the bunions which so often follow 
 such mistreatment may be exceedingly painful. 
 
 By all means place shoes on the pigeon-toed child that pos- 
 sess straight lasts with flexible arches, and which admit of the 
 exercise of many muscles of the foot which otherwise remain 
 inactive. 
 
 As the child grows older the toenails thicken, and often in 
 their trimming they are cut so closely at the corners that some- 
 times a condition results known as ingrowing nails. Such are 
 very painful and must receive special attention. First of all, 
 the nail is cut squarely, and after scraping it thin the corner 
 is lifted and cotton so placed under it that the nail's downward 
 and inward growth is stopped. 
 
 SPINAL CURVATURE 
 
 Curvature of the spine is more common than is usually 
 thought. The most frequent variety of it is the lateral 
 curvature. One shoulder is lower than the other, and the hips 
 
DEFORMITIES AND CHRONIC DISORDERS 343 
 
 are therefore uneven. Rickets, during infancy, is the most 
 common cause of spinal curvature. 
 
 Improper sitting at school — sitting on the edge of the seat 
 — or carrying heavy loads are often contributing factors to the 
 production of lateral curvatures. Only the muscles and liga- 
 ments enter into this deformity, hence the treatment should 
 be started early and should consist of: 
 
 1. Stretching exercises. 
 
 2. Hanging from the rounds of a ladder securely fastened to 
 the wall. 
 
 3. Certain applications of hot fomentations to the spinal mus- 
 cles for their relaxation. 
 
 4. Firm cushion placed under one or other of the hips to 
 encourage the re-establishment of muscular poise. 
 
 5. Special supervision of the case. 
 
 pott's disease 
 
 Pott's disease, or tuberculosis of the bone, often results in 
 an angular spinal deformity. This curvature, unlike the lateral 
 curvature, is a sequela of an actual disease of the bones. It is 
 always very serious and demands early treatment from skilled 
 hands. Early in the disease there is a peculiar stiff, tottering 
 gait. The little child holds the spine rigidly, and in picking up 
 objects from the floor bends the knees instead of the spine. If 
 the trouble is in the upper spine, the shoulders are held high 
 and the head is stiffly poised, it is never rotated; in looking 
 about the entire body turns. 
 
 Medical aid should be secured early. The X ray not only 
 locates the difficulty but also determines the extent of the 
 process. If the spine be put to perfect rest, outdoor life begun, 
 a diet rich in fats established, the results are often wonder- 
 fully successful. 
 
 Another tubercular condition is seen in the much dreaded 
 hip-joint disease which parents should always be on the look- 
 out for. The earliest symptoms are crying out in the night 
 suddenly, unnatural standing on one leg (to relieve the strain 
 on the diseased hip) and so-called " growing pains." Call in 
 a physician very early and institute proper treatment. A pos- 
 
344 THE MOTHER AND HER CHILD 
 
 terior curvature of the spine is often associated with a bad 
 case of rickets. It is of temporary duration, and usually clears 
 up when the symptoms of rickets have been eradicated. It 
 involves only the back muscles — not the vertebral bones, 
 
 The young mother is often very much concerned over the 
 misshapen head of the child as a result of a prolonged labor; 
 and it does seem quite miraculous to see a head, more nearly 
 resembling an egg than anything else, become beautifully 
 round and shapely by the end of two or three days. 
 
 Protruding ears may be encouraged to lie more flatly by the 
 wearing of a specialized bonnet at night. When the babies are 
 too young to turn themselves they should be turned first to one 
 side and then the other, while care should always be exercised 
 in properly straightening out a curled under ear or an over- 
 lapping ear. 
 
 RHEUMATISM 
 
 While we so often regard rheumatism an adult disease, never- 
 theless, children do suffer its aches and pains as well as the 
 fever which so often attends the inflammatory type. The so- 
 called " growing pains " are often of rheumatic origin. 
 
 Diseased tonsils not only are often — very often — the ave- 
 nue of entry of infectious microorganisms that cause one type 
 of rheumatism, but many forms of valvular heart disease are 
 also directly traceable to these same diseased tonsils. The 
 treatment consists in giving proper attention to the tonsils, 
 even removal if necessary — and if the child is old enough. All 
 other possible causes should be located and removed; the child 
 should have absolute rest in bed with brisk cathartics and a 
 liquid diet (no meat broths). The diet should consist more 
 of alkalinizing foods as shown in the special table in the appen- 
 dix. Medicinal alkalines are often given when the urine shows 
 a very high acid reaction. 
 
 SCURVY 
 
 Scurvy, seen in children who subsist on " prepared foods," 
 is manifested by tender legs and swollen gums which have a 
 tendency to bleed easily. Pallor, loss of appetite, and insomnia 
 
DEFORMITIES AND CHRONIC DISORDERS 345 
 
 accompany the condition. The treatment of scurvy is change 
 of diet from " patent foods " to fresh cow's milk, with the 
 addition of orange juice, daily. In older children the food must 
 be very nutritious; out of door life, salt glows, friction baths 
 (see appendix), and the taking of large amounts of fats are 
 all essential to the cure. 
 
 ADENITIS — ENLARGED GLANDS 
 
 Enlarged glands, or what our grandmothers used to call 
 " kernels " in the throat are often the result of inflammation in 
 the mouth or throat, and occur in connection with many of 
 the childhood diseases, notably diphtheria, scarlet fever, and 
 scarlatina. 
 
 Glands appearing in the back of the neck may be occasioned 
 by pediculli (lice), ring worm, or eczema, while those seen in 
 the neck just back and below the ears may come from mas- 
 toiditis (inflammation of the middle ear) or adenoids. 
 
 Glands felt under the arm enlarge because of trouble or 
 infection in the breast, hand, or arm ; while glands in the groin 
 are usually due to some infection of the feet, legs, or abdomen. 
 
 These glands usually disappear when the general health and 
 well-being of the child is improved by: 
 
 i. Outdoor life. 
 
 2. Morning dry-friction rub to the skin. 
 
 3. Good liberal diet, including plenty of fats. 
 
 4. No feeding between meals. 
 
 5. The salt glow and general tonic treatment (see appendix). 
 
 6. The oil rub at night. 
 
 RICKETS 
 
 Rickets (a disease of the bones) often follows in the wake 
 of faulty feeding and unhygienic surroundings. The bones 
 lack a proper amount of lime salts and other elements. Devel- 
 opment in general, especially that of the bones, is greatly inter- 
 fered with. 
 
 Bowlegs, prominent square brow, enlarged perspiring head, 
 weakness, and often tenderness of the flesh, are notable 
 signs of the disease. The treatment varies little from that 
 
346 THE MOTHER AND HER CHILD 
 
 of scurvy, and will be provided in detail by the attending 
 
 physician. 
 
 MALARIA 
 
 Children often suffer from malarial parasites. Sudden rise 
 of fever on regular days (sometimes daily, every two days or 
 every three days) should demand a careful medical examina- 
 tion including the examination of the blood where the offend- 
 ing organism is seen in the red blood cells. We recently saw 
 a little girl who happened to have an earache and was about 
 to be operated on for ear trouble, when examination of the 
 blood revealed the fact that she was suffering from malaria. 
 
 TUBERCULOSIS 
 
 In the routine examination of adult patients, the X ray 
 observations of the lungs often reveal deposits of lime salts 
 which tell the story of a successful fight against tuberculosis 
 (Fig. 16). And while it may seem surprising, we believe 
 beyond a doubt that most of us have had some varying degree 
 of tuberculosis while young — the unrecognized battle has 
 been fought — and these small monuments of lime salts alone 
 remain to tell the interesting story. 
 
 The pity of it is that whole armies of little folks fall in this 
 struggle against disease, for it is one of the common and fatal 
 diseases of childhood. Fresh-air schools, playgrounds, and 
 free school lunches are saving hundreds of children from 
 the ravages of this disease each year. 
 
 Tuberculosis is strictly a house disease, hence the little 
 tubercular patient must seek outdoor life. All avoidable expo- 
 sure to the disease must be denounced, and public sentiment 
 must continue to be aroused to the hygienic betterment of the 
 tenement districts and basement homes. The sanitary drinking 
 cup and the bubble fountain must be encouraged, as must also 
 the proper ventilation of all places where crowds assemble, be 
 it the schoolroom, the theater, or the church. 
 
 SYPHILIS 
 
 While tuberculosis is known as the " great white plague," 
 syphilis and gonorrhea constitute the " great black plague," 
 
Fig. 16. X ray Showing Tuberculosis of the Lung 
 
DEFORMITIES AND CHRONIC DISORDERS 347 
 
 which seen in the little folks is pitiable indeed, leading us to 
 realize that surely " the children's teeth have been set on 
 edge " because of the careless eating of sour grapes by the 
 parents. Syphilitic parents who have not been properly treated, 
 should think many times before they take upon themselves the 
 awful responsibility of bringing into the world a tainted child. 
 Proper mercurial treatment should be instituted at once not 
 only for the child but also in the case of both parents. 
 
CHAPTER XXXIV 
 ACCIDENTS AND EMERGENCIES 
 
 IN this chapter we wish to instruct the mother or the care- 
 taker in doing the one thing needful for every one of the 
 more common household accidents and emergencies while wait- 
 ing for the doctor. 
 
 In every household there should be found an accident and 
 emergency " kit " of necessary paraphernalia for the quick 
 application of the one necessary medicine, dressing, etc. This 
 " kit " should contain baking soda for burns, bandages and 
 sterile gauze for cuts or tears, together with adhesive plaster, 
 needle and thread, etc. 
 
 INSECT BITES AND STINGS 
 
 Far greater harm is often done the skin by the subsequent 
 scratching of the insect bite with dirty finger nails than by the 
 bite iself; and so it is very important that we remember to 
 allay quickly the intense itching by the application of ammonia 
 water or camphor. Almost instantly the itching is stopped, 
 and the added " scratching " irritation to the already injured 
 skin is thus avoided. 
 
 By the aid of a magnifying glass, and often by the naked 
 eye, we may detect the stinger which has been left behind by 
 the greedy guest, and which should be removed by a pair of 
 tweezers. Ice-water compresses will stop the swelling and even 
 an old-fashioned mud dressing, which was used and appreci- 
 ated by our great grandmothers, is a thing not to be despised. 
 
 If the much admired shrubbery be removed one hundred feet 
 away from the porch, mosquitoes would trouble the household 
 less. It has been demonstrated in many localities that clearing 
 away the near-by clumps of shrubbery permits the family to 
 
 348 
 
ACCIDENTS AND EMERGENCIES 349 
 
 sit on unscreened porches unharmed. Mosquitoes multiply 
 rapidly in stagnant pools of water, but if oil is poured over 
 these stagnant waters the increase of mosquitoes is abated, and 
 their total extinction is not unheard of in swampy districts 
 receiving such care. 
 
 Whenever baby is out of doors where mosquitoes, flies, or 
 other insects are to be found, he should be properly protected 
 from such pests by mosquito netting stretched over a frame 
 eighteen inches above his face, for we can think of nothing 
 more uncomfortable than a mosquito netting dragging over a 
 sweaty baby's face. The fact that mosquitoes, flies, roaches, 
 and other insects are carriers of tuberculosis, infantile paraly- 
 sis, typhoid fever, cholera, yellow fever and malaria, as well 
 as a host of minor ailments, should make us the more anxious 
 for either their extermination or the protection of our chil- 
 dren from their greedy bites and stings. 
 
 DOG BITES AND SNAKE BITES 
 
 Dogs, cats, rats, or mice bite at any time of the year, and 
 provision should always be made for ample protection against 
 such accidents. 
 
 Such a wound should always be squeezed or sucked until it 
 has bled freely, and then be cauterized by a red-hot iron or 
 touched with an applicator that has been dipped in sulphuric 
 acid or nitric acid. A subsequent dressing of Balsam Peru is 
 healing. The dog should be watched, and if it shows signs of 
 hydrophobia the bitten child should be promptly taken to the 
 nearest Pasteur Institute for treatment. 
 
 In the case of snake bites the same sucking and cauterizing 
 treatment is indicated, with the additional tying of a hand- 
 kerchief or cord a few inches above the wound to stay the prog- 
 ress of the blood and to keep the poison out of the general 
 circulation. A solution of twenty-per-cent permanganate of 
 potash should be used to wash the wound. 
 
 The popular administration of large draughts of whiskey is 
 of no benefit, for the secondary depressant effect of alcohol 
 increases the body's poison burden, and those who survive do 
 so in spite of the whiskey, and not because of it. 
 
350 THE MOTHER AND HER CHILD 
 
 SWALLOWING FOREIGN BODIES 
 
 Small articles such as buttons, safety pins, thimbles, coins, 
 etc., are often swallowed by little folks, and if they lodge in 
 the throat and the child struggles for his breath the treatment 
 is as follows: grasp him by the heels and turn him upside 
 down while a helper briskly slaps him on the back. The for- 
 eign body generally flies across the room. If it is lodged high 
 up in the throat it may often be dislodged by the thumb and 
 finger. If it cannot be reached and it will not go down, lose 
 no time in seeking an X-ray laboratory where its exact loca- 
 tion may quickly be discovered and proper measures instituted 
 for its removal. 
 
 A troublesome fish bone is easily dislodged by swallowing 
 a half-chewed piece of bread which carries it down to the 
 stomach. Cathartics and purgatives are not to be given; in due 
 time the object will appear in the stool. In all instances it is well 
 to locate its exact position by the X ray — that there may be 
 assurance that it will do no harm. 
 
 It is surprising what large objects can be swallowed. One 
 old gentleman swallowed his false teeth, and a six months old 
 baby swallowed, or at least had lodged in its throat, a silver 
 dollar. 
 
 All detachable parts should be removed from toys that are 
 given to babies, such as the whistle from rubber animals, the 
 button eyes of wool kittens and dogs, and other such remova- 
 ble parts. 
 
 FOREIGN BODIES IN THE EYE 
 
 To begin with, do not get " panicky," but carefully, pains- 
 takingly, and patiently do the following: 
 
 1. Rub the well eye until the tears flow plentifully in both 
 eyes. 
 
 2. Blow the nose on the injured eye side, closing the other 
 side. This often encourages the tears to wash the foreign 
 speck down through the tear duct, into the nose and out into 
 the handkerchief (in case the child is old enough to follow such 
 instruction). If the foreign body be sharp, as a piece of steel 
 or flint is likely to be, it may be driven right into the eyeball. 
 
ACCIDENTS AND EMERGENCIES 351 
 
 Seek a physician who will drop medicine into the eye to deaden 
 the pain and then if it cannot be gently rubbed off the eyeball, 
 a magnet will promptly remove it. 
 
 An eye bath of warm boracic acid is always comforting 
 and never does harm, so that may be given while waiting for 
 the doctor to come, if the object seems to be beyond the reach 
 of family help. 
 
 If an alkaline, such as lime, be blown into the eye it is very 
 painful, but much relief may be obtained by gently pouring 
 into the eye, by means of a medicine dropper or eye cup, warm 
 water to which has been added a little vinegar or lemon juice. 
 Likewise, acid in the eye produces much pain. In this instance, 
 an eye bath of a weak soda solution is indicated. 
 
 FOREIGN BODIES IN EAR AND NOSE 
 
 Insects that have crawled into the ear may be suffocated by 
 dropping sweet oil or castor oil into the ear, which, after twenty 
 minutes, should be washed out by gentle syringing with warm 
 water from a fountain syringe, hung one foot above the child's 
 head. 
 
 Peas, beans, shoe buttons, or beads are sometimes put into 
 the ear and nose by adventurous or experimenting children. 
 
 The shoe button or bead will not swell as does the pea or the 
 bean, and may often be safely washed out. If it is causing 
 no pain and will not drop out in case of the ear, or will not be 
 easily blown out in case of the nose, see your physician at once. 
 He has in his possession just the necessary instruments for 
 its immediate removal. 
 
 Peas and beans swell, and consequently cause greater dis- 
 comfort the longer they are in; do not poke at any foreign 
 body lodged either in the nose or the ear, for the ear drum may 
 thus be injured, while in the former case it may be pushed 
 into one of the accessory sinuses. 
 
 EARACHE 
 
 One of the most comforting and highly effectual forms of 
 heat for an aching ear is a four-candle-power carbon electric 
 light on an extension cord that permits the light to come in dose 
 
352 THE MOTHER AND HER CHILD 
 
 contact with the ear. A shade is made from a piece of stiff 
 letter paper that fits the socket snugly and flares out to a three 
 inch opening, which should extend below the point of the bulb 
 one inch. This shade holds all the heat and light and directs it 
 into the aching ear. 
 
 In every well-ordered household there will be found a 
 three-per-cent solution of carbolic acid and glycerine of 
 which one drop should be put into the aching ear, and then the 
 external heat, mentioned above, should be applied. A bag of 
 warm salt, a hot water bag, or a warm plate will provide exter- 
 nal heat if an electric light is not available. Do not put lauda- 
 num or other remedies into the ear, other than are herein sug- 
 gested, without your physician's knowledge. 
 
 Earache is always serious, and since it is usually indicative 
 of trouble which, if left untreated, may cause deafness, it 
 demands thorough treatment from skilled hands. 
 
 Running ears invariably need medical attention and should 
 never be neglected. 
 
 NOSEBLEED 
 
 If the nose bleeds whenever it is cleansed, more than likely 
 there is an ulcer on the septum which will continue to bleed if 
 left untreated. The physician should heal the ulcer, and the 
 child should be taught always to vaseline the nostril before 
 cleansing it. 
 
 In case of persistent nosebleed, put the child to bed with the 
 head elevated. Pressure should be put on the blood vessels 
 going to the nose by placing two fingers firmly on the outer 
 angles of the nose on the upper lip, while a helper may put 
 firm pressure at the root of the nose at the inner angle of each 
 eye. An ice bag may be placed at the back of the neck, and 
 another piece of ice held on the forehead at the root of the 
 nose. If these measures do not stop the flow of blood a few 
 drops of adrenalin may be put into the nose and repeated in 
 five minutes if necessary. As the bleeding begins to stop, as 
 well as during the bleeding, all blowing of the nose is forbid- 
 den as it will only cause the bleeding to start afresh. It some- 
 times helps to hold a piece of ice in the hands. 
 
ACCIDENTS AND EMERGENCIES 353 
 
 CUTS AND TEARS 
 
 A cut with smooth edges, if deep, should be allowed to bleed 
 freely, should be washed in boracic acid solution, and its edges 
 held together by a stitch which is usually put in by a physician ; 
 but if treatment is to be given at home, the hands of the nurse 
 must be thoroughly washed and the thread and needle boiled 
 for twenty minutes. If the physician has been sent for, make 
 firm pressure over the wound by bandaging tightly with a 
 dressing of sterile gauze dipped in boracic acid solution. 
 
 In case of a slight cut, make it bleed freely, then wash in 
 boracic-acid solution and apply sterile gauze held in place by 
 a binder. If no odor or pain follows, let alone for two or 
 three days, when a new dressing is applied. 
 
 A physician should be called in case of ragged wounds or 
 tears, as such usually leave bad scars. Cleanse carefully, leav- 
 ing no dirt in the wound, cause it to bleed, if possible, and apply 
 a sterile gauze compress wet in boracic-acid solution, bandaged 
 on as directed above. Zinc ointment may be applied to sur- 
 faces that have been skinned. All dressings on dirty wounds 
 should be changed daily. 
 
 Blood poisoning may readily follow a wound, hence the utmost 
 cleanliness should prevail. The hands of the attendant, the 
 dressings, the surrounding skin, must all be clean. The bowels 
 should be kept open, and under-feeding rather than over-feed- 
 ing is indicated. 
 
 If a needle be needed to open a sore or boil, always disinfect 
 the part and surrounding area by painting with tincture of 
 iodine, and heat the needle to red heat through a flame before 
 it touches the sore. 
 
 In case of cuts or wounds of the eyeball apply a compress 
 of sterile gauze wet in boracic acid, held on by a bandage, and 
 go immediately to a good eye specialist. 
 
 PUNCTURED WOUNDS AND SLIVERS 
 
 Wounds made by pins, needles, fishhooks, tacks, and splinters 
 are always very painful and great care must be exercised to 
 force bleeding freely, which helps to wash out infection, as 
 
354 THE MOTHER AND HER CHILD 
 
 more than likely microbes entered with the instrument or 
 sliver when the wound was made. 
 
 Fishhooks are exceedingly troublesome, as they often occa- 
 sion the enlarging of the wound to get them out, especially if 
 they have gone in beyond the barb. 
 
 Slivers are easily broken off, so great care is needed in their 
 removal. A pair of tweezers is convenient for seizing the 
 protruding portion, while all side movements are avoided lest 
 it break off in the flesh, in which case it may be gotten out 
 with a needle that has been sterilized in a flame. 
 
 All puncture wounds should be dressed with the wet, sterile 
 compress, covered over with wax paper and bandaged loosely; 
 this encourages cleanliness and favors healing. 
 
 BRUISES 
 
 If left untreated, bruises swell, become highly discolored, 
 and in the process of healing pass through the dark blue, green, 
 and yellow stages. The treatment is as follows : Apply hot and 
 cold alternately — the heat should be as hot as can be borne 
 and left on very hot for three minutes, then ice water com- 
 presses should be applied for one minute, then hot again — these 
 changes should continue for an hour, and if carried out imme- 
 diately after the injury all discolorations and most of the swell- 
 ing may be avoided. Witch-hazel compresses are comforting. 
 If discoloration has taken place, the application of hot com- 
 presses will often hasten its disappearance. 
 
 FRACTURES AND DISLOCATIONS 
 
 While there is very little a member of the family or a non- 
 medical friend can do in case of a fracture, and while it is 
 unwise to offer suggestions relative to the setting of bones, yet 
 it is highly important that both the family and friends know 
 how properly to support a broken leg while carrying a disabled 
 person into the house or to near-by medical aid. 
 
 For instance, in the case of a fractured leg below the knee, 
 if a couple of flat boards three inches wide be tied about the 
 leg with two pocket handkerchiefs, the ends of the fractured 
 bone will not rub against each other and the pain will be 
 
ACCIDENTS AND EMERGENCIES 355 
 
 much less in carrying. In this way all danger of causing the 
 broken bones to protrude and thus " compounding " the fracture 
 is also avoided. And also, if there is no near-by ambulance, 
 a good emergency stretcher may be improvised out of two or 
 three buttoned vests with two poles, rakes, or brooms run 
 through the armholes — one vest under the shoulders and one 
 under the hips and still another under the fracture. An injured 
 person may in this way be carried for miles quite comfortably. 
 
 Two people may fashion a seat out of their four hands on 
 which the disabled child may sit with his arms about the necks 
 of his two friends. If the fractured end of the bone penetrates 
 the flesh it is then known as a compound fracture and the 
 utmost cleanliness must prevail — as in dressing other wounds. 
 An X ray laboratory should always be sought, where con- 
 venient, to ascertain if the ends of the bones are in good 
 position. 
 
 In dislocations, the bone has slipped out of place at the joint. 
 Medical aid should be called to replace the bone, while hot 
 applications may be used in the meantime. 
 
 SPRAINS 
 
 All sprains (a twist or straining of a joint) should promptly 
 be put into a very hot bath and held there for thirty minutes. 
 If this is impossible, then a rubber tube or a handkerchief is 
 tied snugly between the sprain and the trunk of the body. Almost 
 instantly the pain, which is often intense and severe, is very much 
 lessened. The hot-water bath is very hot, and the joint should be 
 very red on taking it out. Immediately following the bath the 
 injured joint is wrapped in a very cold wet compress, which 
 is next completely covered by silk, gutta-percha, mackintosh, 
 or many thicknesses of newspaper — anything that will hold 
 all the heat in — as the cold compress is quickly heated up. 
 Lastly, a bandage of heavy flannel completely covers the whole 
 — compress, impervious covering, etc. 
 
 The joint is now elevated for three hours, when it is again 
 immersed in a very hot bath and then again the cold compress 
 is applied. This is continued every three hours, except during 
 sleep, for two days, after which it may be done morning and 
 
356 THE MOTHER AND HER CHILD 
 
 evening. Massage is now administered every three hours, first 
 four inches below the injury then four inches above it, while 
 in a day or so the joint itself may be gently rubbed with well- 
 oiled hands. By the end of one week the patient begins to use 
 the injured member. 
 
 In the case of a sprained ankle a properly applied adhesive 
 strap bandage will give no end of relief and support. Various 
 liniments may be applied, but usually the good obtained is from 
 the thorough rubbing which always accompanies their use 
 according to directions. 
 
 Sprains treated as above directed will often liberate the 
 child in one-third the usual time generally allotted for its 
 healing. 
 
 FROST BITES AND CHILBLAINS 
 
 Keep the child who has frozen some part of his body in a 
 cool room, and rub the frost-bitten part with snow or ice water, 
 or wrap it up in cold water compresses. 
 
 The return to heat must be slow indeed, else much pain may 
 be experienced; blisters followed by discoloration, and even 
 mortification, may set in. You may be surprised some morning 
 on awakening to find your child's hand twice its normal size 
 and very red, because it was out from under the cover a good 
 share of the night exposed to Jack Frost. Do not bring it to 
 heat quickly but immerse it in cold water, gradually and slowly 
 raising the temperature of the bath until it is warm and com- 
 fortable. 
 
 The intense itching and burning of a chilblain may often be 
 relieved by painting with iodine or triple chloride of iron (Mon- 
 sel's solution). Soap liniment has also been suggested, as 
 well as alternate applications of hot and cold water. Chilblains 
 are troublesome, painful, and their yearly recurrence is often 
 very annoying. 
 
 SWALLOWING POISONS 
 
 Poisons of an acid nature, such as hydrochloric, sulphuric, 
 nitric, or oxalic acids, are neutralized by alkalines, such as 
 magnesia, chalk, soda, and soap, followed by soothing drinks 
 or sweet oil. 
 
ACCIDENTS AND EMERGENCIES 357 
 
 Remember that carbolic acid is not an acid, and is not anti- 
 doted with alkalines. The swallowing of carbolic acid should 
 be quickly followed by diluted alcohol, and if this drug is not 
 ready at hand many of the numerous alcoholic patent medicines 
 will do just as well. Epsom salts should be given in abundance. 
 
 Poisons of an alkaline nature, such as lye, washing soda, 
 ammonia, etc., are antidoted with vinegar or lemon juice, fol- 
 lowed by soothing drinks or sweet oil. 
 
 A complete table of poisons and their antidotes will be found 
 in the appendix. 
 
 Poison ivy, as soon as detected, should be treated as follows : 
 Thoroughly scrub the affected part with tincture of green 
 soap and hot water, which often prevents the trouble develop- 
 ing. Clean pieces of gauze may be wrung out of lime water 
 and placed over the inflamed and much swollen surface, keeping 
 them very wet. At night an ointment of zinc oxide may be 
 applied over a painting of " black wash " (to be obtained at 
 drug stores). Poison (trifoliolate, or three-leaved) ivy re- 
 sembles Virginia Creeper, and all nurses and caretakers should 
 be able to recognize it. 
 
 Another treatment for poison ivy which is said to be very 
 efficient is as follows: Moisten a bit of cotton with a ten-per- 
 cent solution of carbolic acid and apply to the affected area — 
 then immediately (about one-half minute) wipe off this carbolic 
 acid with another piece of cotton saturated with alcohol. 
 
 Matches, roach powders, fly poisons, washing fluids, lye, paris 
 green, antiseptic tablets, and pieces of green paper, should all 
 be kept out of the child's reach; and, in case of accidental 
 swallowing of any of them, the physician should be sent for at 
 once, and with the message " Come ! " should be given the name 
 of the poison swallowed — if it is known. 
 
 After the antidote is given, soothing drinks are usually admin- 
 istered, such as raw white of egg, milk, flaxseed tea, slippery 
 elm, etc. 
 
 Complete rest in bed is always essential, and external heat is 
 necessary for the body chills easily as the child grows weak. 
 
 Toothache may be temporarily relieved by applying an ice 
 bag below the jaw, thus diminishing the flow of blood to the 
 
358 THE MOTHER AND HER CHILD 
 
 tooth, and a hot-water bottle to the cheek, which causes the skin 
 vessels to fill with blood, thus relieving the tension in the 
 vessels of the tooth. 
 
 If there is a cavity, a small piece of cotton moistened with 
 oil of cloves and packed well into it may give much relief. 
 
 Children and adults should make a bi-annual pilgrimage to 
 the dentist, who seeks out beginning cavities, early treatment 
 of which will prevent these dreadful aches and later ill health. 
 
 BURNS 
 
 Burns and scalds are not at all uncommon with children, whose 
 eagerness to explore and desire to investigate often leads them 
 into trouble. 
 
 1. The simple reddening of the skin — slight burns and sun- 
 burn — simply needs protecting oil, or equal parts of oil and 
 lime water, and is to be covered with sterile gauze. 
 
 2. The burns which destroy the outer layer of the skin, pro- 
 ducing a blister, are treated much as a wound would be treated. 
 The blister, if larger than a half dollar, should be opened near 
 the edge with a needle which has been passed through a flame. 
 The serum should be pressed out and the parts protected by 
 a piece of gutta-percha that has been disinfected with some 
 antiseptic solution ; this covering keeps the dressings from stick- 
 ing, thus avoiding the destruction of the new-forming tissues. 
 
 3. When the tissues are injured in the more severe burns, 
 the surrounding flesh is carefully disinfected with boracic-acid 
 solution, and the same dressing applied as described for the 
 " blister burns." Balsam Peru is a healing balm for burns of 
 this classification. 
 
 If a child's clothes catch on fire he is instantly to be thrown 
 on the floor and any heavy woolen fabric, such as a curtain, 
 table spread, blanket, or rug, is to be thrown over him (begin- 
 ning at the neck) and the flames thus smothered. The clothing 
 is now cut off, and if more than one-third of the body is burned 
 the child should be taken to the hospital for constant care; 
 and if more than one-half of the body is injured recovery is 
 doubtful. Great care should be taken in keeping the unburned 
 portion of the body warm, as there is a great tendency for the 
 
ACCIDENTS AND EMERGENCIES 359 
 
 child to become very cold as he weakens from both the nervous 
 shock and from the absorption of toxins. 
 
 Acid chemical burns are treated with baking soda, except 
 in the case of carbolic acid (misnamed), which is treated with 
 alcohol ; alkaline chemical burns are dressed in vinegar or lemon 
 juice compresses. 
 
 Methods for restoring the drowned should be understood by 
 every man, woman, and youth. These methods are more fully 
 taken up in works devoted to emergencies and will not be dis- 
 cussed in detail at this time. 
 
 FAINTING 
 
 Consciousness is quickly restored to the fainting child by 
 lowering the head — laying him flat on the floor — while an 
 assistant raises the legs perpendicularly. Cold dashes of water 
 may be slapped on the chest with a towel, while the face is 
 bathed or sprinkled with cold water. Consciousness is usually 
 quickly restored by the above suggestions, in connection with 
 plenty of fresh air. 
 
 A sudden blow on the head occasionally results in a severe 
 condition known as concussion of the brain. There is a partial 
 or complete loss of consciousness lasting from a few moments 
 to an hour or two. Pallor of the skin and a sense of bewilder- 
 ment accompany concussion of the brain. 
 
 Rest, quiet, and darkness should prevail until the physician 
 arrives and makes an examination. External heat to the 
 extremities may be applied, but no stimulants are to be adminis- 
 tered until so ordered by the physician. 
 
 It is wise to seek medical advice in the case of odd or unusual 
 behavior after a fall on the head. 
 
CHAPTER XXXV 
 DIET AXD NUTRITION 
 
 MOST interesting is the study of the food as it passes 
 through the processes of digestion, absorption, assimila- 
 tion, and oxidation — all definite and important parts of the 
 great cycle through which everything we eat passes on its way 
 from the table to the tissues. Elimination is the last step in 
 nutrition, and is the process by which the body rids itself of the 
 broken down cells and other poisonous and useless wastes. 
 These various phases of bodily nutrition may be expressed in 
 a single term — metabolism. 
 
 What we eat and how much we eat must be carefully planned, 
 for our body temple is really made of what we eat. If you 
 were erecting a beautiful mansion you would not think of 
 allowing cheap, trashy, and inferior building materials to enter 
 into the construction of your home. Xeither should you permit 
 unfit and inferior materials to become a part of the daily dietary 
 of your little boy or girl, thus to become a part of their bodily 
 structure. 
 
 ASSIMILATION OF FOOD 
 
 Following the process of digestion in the stomach and intes- 
 tine, the nutritive food elements are absorbed through the wall 
 of the bowel by the wonderfully adapted little villus, and dis- 
 tributed by various routes to the uttermost parts of the body. 
 The sugars (all starches are changed into sugar) are carried 
 in the portal blood stream to the liver, where they are actually 
 stored away in the form of glycogen which, in a most intelligent 
 manner, is dealt out to the body from hour to hour as it is 
 needed for fuel. If all the sugar, after a hearty meal, were 
 poured into the circulation at once, the blood stream would 
 
 360 
 
DIET AND NUTRITION 361 
 
 be overwhelmed and the kidneys would be forced to excrete 
 it in the urine. This unnecessary waste is avoided by the liver's 
 storing sugar after each meal and dealing it out to the body as 
 required. 
 
 Likewise, the proteins also pass through the liver on their 
 way to the body. Just what action the liver exerts upon pro- 
 teins is not wholly known at the present writing. The digested 
 fats are absorbed at once by the lacteals, the beginning of 
 the intestinal lymphatic system, by which they are carried to the 
 large veins at the root of the neck and there emptied into the 
 blood stream. We have now traced our various food elements 
 through the processes of digestion and absorption in the ali- 
 mentary tract, some going through the liver, and others through 
 the lymphatic system, until they circulate in the blood stream 
 itself. 
 
 It is from these food substances, circulating in the blood 
 stream, that the various cells of the body must assimilate into 
 themselves such portions as they require for purposes of heat 
 and energy and for the repair of their cell substance. This 
 specialized work of cell assimilation converts the dissolved 
 watery food in the blood into solid tissues, exactly reversing 
 the process of digestion. 
 
 With a most profound intelligence, each of these body cells 
 and tissues, bone and nerve fiber, muscle and organ, selects 
 from the blood stream just its supply or portion of the food 
 elements requisite to its upbuilding and maintenance. The 
 mysteries of assimilation are effected by means of chemical sub- 
 stances called " enzymes," similar to those found in the digest- 
 ive organs, but acting in an entirely different manner, in that 
 they build up solids out of liquids instead of converting solids 
 into liquids. 
 
 ELIMINATION OF BODY WASTES 
 
 Metabolism consists of a twofold role — an upbuilding and a 
 tearing down process. After the food is all digested, absorbed, 
 and assimilated, having become a part of the bodily organ, bone, 
 muscle, and nerve fiber, then begins the work of tearing it down 
 — of liberating its heat and energy — to be followed by its 
 
362 THE MOTHER AND HER CHILD 
 
 elimination from the body through the sweat glands, uriniferous 
 tubules of the kidneys, etc. The carbohydrates (starches and 
 sugars), together with the fats, are completely burned up in 
 the body and are then eliminated in the form of water (thrown 
 off through the sweat) and carbonic acid gas given up by the 
 lungs. 
 
 The proteins, or nitrogenous foods, are not so completely 
 burned up in the body. The ashes which result from their com- 
 bustion are not simple substances like the water and C0 2 of 
 the carbohydrates. This protein ash is represented by a number 
 of complicated substances, some of which are solid (protein 
 clinkers), which accumulate in the body and help to bring about 
 many diseases, such as gout, headache, fatigue, bilious- 
 ness, etc. 
 
 These protein ashes and clinkers are further acted upon — 
 split up and sifted — by the liver, and are finally eliminated 
 by the kidneys in the form of urea, uric acid, etc. The body 
 being unable to store up protein, is often greatly embarrassed 
 when one eats more of this substance than is daily required 
 to replenish the waste of the body, for it must all be immedi- 
 ately split up in the system, and the over-abundant and irritat- 
 ing ashes must be carried off by the eliminating organs. Now, 
 the overeating of sugars, starches, or fats, is not such a serious 
 matter, as they may be stored in the liver and subsequently 
 used; and even if they are eaten in excess of what the liver 
 can care for they accumulate as fat or add extra fuel to the 
 fires of the body, their ashes being carried off in the form of 
 such harmless substances as water and carbon dioxid (CO„) ; 
 but the overeating of protein substances is always a strain on 
 the body and should be avoided. 
 
 ELEMENTS OF NUTRITION 
 
 There are seven distinct elements entering into the compo- 
 sition of human foods — protein, starch, sugar, fat, salts, cellu- 
 lose, and water, not to mention enzymes, vitamines, and other 
 little-known chemical principles. These elements are all vari- 
 ously concerned in the nourishment, energizing, and warming 
 of the body. 
 
DIET AND NUTRITION 363 
 
 PROTEINS 
 
 The proteins are the structure builders of the body. While 
 starches, fats, and sugars may be compared to the coal that 
 feeds the locomotive, the proteins represent the iron and steel 
 that are used from time to time to repair the engine and replace 
 its worn parts. The essential chemical difference between starch 
 and protein is that the latter contains nitrogen and a small 
 amount of sulphur and phosphorus. The most common forms 
 in which protein is used for food are the glutens of the grains, 
 the legumes, nuts, cheese, the white of egg, and lean meat. 
 
 STARCHES 
 
 The starches are by far the most abundant of all elements 
 in human food. They enter largely into the composition of 
 nearly all plants and seeds. Under the influence of the sun- 
 light, the green-colored plants gather up the C0 2 of the air 
 and, with the water absorbed from the ground, build up starch. 
 The plant takes all the carbon from which starch is made from 
 the air, but while the atmosphere contains almost eighty per 
 cent of nitrogen, the plant is unable to use it; it must secure 
 its nitrogen from the decaying refuse of the soil. Thus the 
 plant utilizes the waste products found in air and earth in the 
 building of its food substances. 
 
 Starch exists in the form of small granules. Since each little 
 starch granule is surrounded by a woody envelope of cellulose, 
 it becomes necessary to cook all starches thoroughly in order 
 to burst this cellulose envelope and thus enable the saliva to 
 begin, and other secretions to continue, the work of digestion. 
 
 FRUIT SUGARS 
 
 The sugar of fruits represents a form of food requiring prac- 
 tically no digestion; while the sugar found in beets, the cane 
 plant, and the maple tree, must be acted upon by the digestive 
 juices of the intestine before their absorption can take place. 
 During the winter, the maple tree stores its carbohydrates in 
 its roots in the form of starch. With the advent of spring 
 Mother Nature begins the digestion of this starch — actually 
 turns it into sugar — and in the form of the sweet sap it finds 
 
364 THE MOTHER AND HER CHILD 
 
 its way up into the tree trunk to be deposited in the leaves and 
 bark in the form of cellulose, a process very similar to that 
 performed by digestion in the human body, where starch by 
 digestion is first turned into sugar, and afterwards deposited 
 in another form in the liver and muscles. 
 
 Dextrine is a form of sugar resulting from thoroughly cooking 
 or partially digesting starch. There are about twenty-five stages 
 or forms of dextrine between raw starch and digested starch or 
 fruit sugar. Dextrine is found in the brown-colored portions of 
 well-toasted bread. 
 
 FATS 
 
 Fat is a combination of glycerine and certain fatty acids. 
 As a food, it is derived from both the animal and the vegetable 
 kingdom. Animal fat consists of lard, suet, fat meat, etc., while 
 fat of animal origin is represented by cream, butter, and the 
 yolks of eggs. The vegetable fats are found in nuts, especially 
 the pecan, cocoanut, Brazil, and pine nuts; also in the grains, 
 particularly oats and corn. The peanut also contains a con- 
 siderable amount of fat. Of the fruits, the banana and straw- 
 berry contain a trace of fat, while the olive is the only fruit 
 rich in fat. 
 
 As a food, fat is used in three forms. The emulsified form 
 is represented by cream, olive oil, and nuts. When the tiny 
 globules of fat, which are each surrounded by a little film of 
 casein, are crushed — united into a solid mass — we have a 
 free fat. This form is represented by butter and other animal 
 fats. Another form is fried fat — fat which has been chem- 
 ically changed by heat with the development of certain irritating 
 acids. 
 
 MINERAL SALTS 
 
 The mineral elements comprise but a small part of human 
 food as regards weight, but they are extremely important to 
 the health of the child as well as the adult. As found in the 
 food, they are not in the form of mineral salts, like common 
 table salt. The salts of food are living salts, organic or organ- 
 ized salts, such as are found in the growing plant. These salts 
 
DIET AND NUTRITION 365 
 
 are of great value to the various fluids of the body, and also as 
 stimulants to nerve action, but more particularly in the work 
 of building up the bones. 
 
 Salts are found largely in the cereals. A small amount is 
 also found in vegetables, particularly the potato, as well as in 
 most fruits. 
 
 CELLULOSE 
 
 Cellulose represents the great bulk of all vegetables and 
 fruits. It is digested by most animals, but in man it is digested 
 only to the extent of about thirty per cent. The presence of a 
 large amount of cellulose in the food enables us often to satisfy 
 the appetite without injury from overeating. It serves to 
 give bulk to the food, and thereby possibly acts as a preventive 
 to constipation. 
 
 WATER 
 
 Water fills an important place in the nutrition of the body. 
 The food changes in connection with digestion, assimilation, 
 and elimination, can take place only in the presence of water. 
 Water constitutes from fifteen to ninety-five per cent of the 
 various foods. The watery juices of vegetables and fruits 
 consist largely of pure, distilled water, in which fruit sugar 
 is dissolved, with added flavoring substances. Water is abso- 
 lutely essential to the performance of every vital function 
 connected with human metabolism. 
 
 ANIMAL HEAT 
 
 The source of heat in the animal body was the subject of 
 much superstitious speculation on the part of ancient scientists. 
 It is now known that animal heat is derived from the food we 
 eat by means of a peculiar process of vital oxidation — effected 
 in the presence of oxygen — by the action of water and enzymes 
 upon the food elements absorbed by the living cell. This process 
 of oxidation liberates the heat and energy stored by the sun 
 in the food, and thus the body is kept warm by this constant 
 combustion of the digested foodstuffs. The starches and 
 sugars, together with the fats, represent food elements which 
 
366 THE MOTHER AND HER CHILD 
 
 serve as the body's fuel. By this means we are able to main- 
 tain a constant body temperature of almost one hundred degrees. 
 The average human body produces enough heat every hour 
 to raise two and one-half pounds of water from the freezing 
 point to the boiling point. This is equivalent to boiling about 
 seven gallons of ice-water every twenty-four hours. Differ- 
 ently expressed, the body gives off each hour the same amount 
 of heat as a foot and a half of two-inch steam coil. This is 
 the same amount of heat which would be produced by burning 
 about two-thirds of a pound of coal. 
 
 FUEL VALUE OF FOODS 
 
 Expressed in terms of English weight, the fuel value of the 
 three different food elements would be: 
 
 i ounce of carbohydrates I2 7-5 calories 
 
 i ounce of proteins I2 7-5 
 
 i ounce of fat 289.2 
 
 It will be observed that fat contains more than twice as much 
 heat as the carbohydrates. This is due to the fact that fat con- 
 tains more carbon than either starch or sugar. Next to fats, 
 starches and sugars are the most important fuel elements. Pro- 
 tein is a very extravagant form of food for fuel purposes. Pro- 
 teins are the most expensive elements of human food; they are 
 incompletely burned in the body, and inasmuch as they leave 
 behind distressing and disease-producing ashes, it is clearly evi- 
 dent that only sufficient amount of proteins should be eaten each 
 day to supply the demand of the body for repairs. We should 
 depend more largely upon the carbohydrates and fats for heat 
 and energy. 
 
 A large part of our food is required to furnish heat to take 
 the place of that lost by radiation from the skin, and this is 
 why children require more food than adults — they have a 
 larger skin surface in proportion to their weight, and therefore 
 lose more heat by radiation, and it is for this reason that the 
 food for the growing child must be wisely and carefully 
 selected. 
 
DIET AND NUTRITION 367 
 
 DIET FOR CHILD TWO TO THREE YEARS OLD 
 
 Breakfast, 7-8 a. m. : Fruit; cooked or toasted cereal served 
 with thin cream; a soft boiled or coddled egg; bread (two or 
 more days old) and butter; plenty of milk. 
 
 Dinner, 12-1 : Soups; creamed vegetables — tomato, corn, 
 peas, and celery; any two of potatoes — creamed, mashed, or 
 baked — carrots, beets, spinach, peas, cornlet, squash, cauli- 
 flower, asparagus tips, string beans ; protein dish — the puree 
 of dried beans, peas, or lentils; macaroni or carefully selected 
 meats ; dessert — apples, baked or sauce — or other fruits, 
 junket, custard, milk. 
 
 Supper, 5-6 p. m. : Fruit; bread (bran bread if constipated) ; 
 milk; porridge, with rich milk or milk toast; sweetened graham 
 crackers. 
 
 FOODS ALLOWED CHILDREN OF FOUR YEARS AND OLDER 
 
 Protein Dishes: Purees of dried peas; lentils; beans; maca- 
 roni ; eggs — soft boiled, poached, scrambled, or omelette ; meats 
 — steak, chops, chicken, turkey, broiled fish. 
 
 Cereals: All the toasted-flake foods; toasted and not too fresh 
 bread, including both graham and bran; hominy; corn meal; 
 oatmeal; farina; rice; barley; tapioca; sago, etc. 
 
 Soups: Creamed vegetable soups of all kinds and broths. 
 
 Vegetables: Potatoes; all the small green vegetables; lettuce; 
 stewed celery ; beets ; squash ; cauliflower, etc. 
 
 Fruits: All, if stewed or baked. Raw fruits — pears, peaches, 
 ripe apples, berries, oranges, persimmons, grape-pulp without 
 seeds, etc. 
 
 Desserts: Custard; jellos; junkets; home-made ice cream; 
 sponge cake; baked fruits with whipped cream, etc. 
 
 FOODS TO BE AVOIDED BY YOUNG CHILDREN 
 
 1. Doughy breads, griddle cakes, insides of muffins, hot bis- 
 cuits, etc. 
 
 2. Fried meats, such as sausage, oysters, pork, ham, veal, salt 
 fish, corned beef, dried beef, etc. 
 
 3. Foods that arc hot when they are cold — such as catsup, 
 horse radish, mustard, highly spiced pickles, sauces, etc. 
 
368 THE MOTHER AND HER CHILD 
 
 4. Rich pastries, puddings, unripe fruit, salted peanuts, and 
 highly concocted dishes. 
 
 5. Certain salads, containing coarse but easily swallowed 
 foods, with highly seasoned sauces. 
 
 6. Tea, coffee, and all alcoholic beverages. 
 
 7. Soft candies, chocolate creams, bon-bons, patties, etc. 
 
 Average normal children crave sweets, and since their nor- 
 mal food is about seven per cent sugar it is not to be wondered 
 at. There are many forms of pure, hard candies which may 
 be taken by the three-year-old child. They are stick candy, 
 fruit tablets, sunshine candies, and other varieties which may 
 be sucked. 
 
 All soft candies, such as chocolate creams, bon-bons, patties, 
 etc., are to be avoided. Hard candies, taken along with the 
 desserts at meal time, in no wise injure the normal stomach 
 of the healthy child. 
 
 The other members of the family should set a correct example 
 by sucking the hard candies rather than chewing them; for if 
 the hard candies are allowed to dissolve slowly in the mouth 
 they produce a weak solution of sugar, which does not interfere 
 with digestion as do the strong and concentrated sugar solutions 
 which result from chewing chocolate creams, bon-bons, etc. 
 
 Candy, cookies, sandwiches, or bits of cake should never be 
 allowed between the meals. 
 
 EATING BETWEEN MEALS 
 
 Children who do not eat well at the breakfast table, if given 
 a " piece " at 10 a. m., will not be ready for the 12 o'clock 
 meal ; and then another " piece " at 2 p. m. interferes with the 
 normal appetite at 6 p. m. Digestion is disturbed, the nervous 
 system irritated, and a " puny child " is often the result. 
 
 Bring the three-or-four-year-old to a well-selected breakfast 
 some time between 7 and 8 a. m. Then nothing — absolutely 
 nothing — but water must pass the lips between that breakfast 
 hour and the 12 o'clock meal, which should be a good one. 
 Then the interval until 5 or 6 p. m. is passed in the same man- 
 ner. At the evening meal the appetite is again whetted; and 
 a good appetite always means good gastric juice to digest the 
 
DIET AND NUTRITION 
 
 369 
 
 meal. And so, good mother, guard carefully the interval 
 between meals if you would have good digestion and good health 
 for the little folks. 
 
 DAILY FOOD REQUIREMENT 
 
 The following table, taken from The Science of Living, * 
 shows the minimum of calories or food units required by boys 
 from five to fourteen years of age and girls from five to 
 twelve : 
 
 BOYS 
 
 
 
 
 Skin 
 
 Daily 
 
 Age 
 
 Height in 
 
 Weight in 
 
 Surface in 
 
 Calories or 
 
 Years 
 
 Inches 
 
 Pounds 
 
 Sq. Ft. 
 
 Food Units 
 
 5 
 
 41.57 
 
 41.09 
 
 7-9 
 
 816.2 
 
 6 
 
 43-75 
 
 45-17 
 
 8-3 
 
 855-9 
 
 7 
 
 45-74 
 
 49.07 
 
 8.8 
 
 912.4 
 
 8 
 
 47-76 
 
 53-92 
 
 9.4 
 
 981. 1 
 
 9 
 
 49.69 
 
 59.23 
 
 9-9 
 
 1043-7 
 
 10 
 
 51.58 
 
 65.30 
 
 10.5 
 
 "17-5 
 
 11 
 
 53-33 
 
 70.18 
 
 11.0 
 
 1 178.2 
 
 12 
 
 55-11 
 
 76.92 
 
 11.6 
 
 1254.8 
 
 13 
 
 57-21 
 
 84.85 
 
 12.4 
 
 1352.6 
 
 14 
 
 59.88 
 
 94.91 
 
 GIRLS 
 
 13-4 
 Skin 
 
 I47L3 
 
 Daily 
 
 Age 
 
 Height in 
 
 Weight in 
 
 Surface in 
 
 Calories or 
 
 Years 
 
 Inches 
 
 Pounds 
 
 Sq. Ft. 
 
 Food Units 
 
 5 
 
 41.29 
 
 39.66 
 
 7-7 
 
 784.5 
 
 6 
 
 43-35 
 
 43.28 
 
 8.1 
 
 831.9 
 
 7 
 
 45-52 
 
 47.46 
 
 8-5 
 
 881.7 
 
 8 
 
 47-58 
 
 52.04 
 
 9.2 
 
 957-1 
 
 9 
 
 49-37 
 
 57.07 
 
 9-7 
 
 1018.5 
 
 10 
 
 51-34 
 
 62.35 
 
 10.2 
 
 1081.0 
 
 11 
 
 53-42 
 
 68.84 
 
 10.7 
 
 1 148.5 
 
 12 
 
 55-88 
 
 78.31 
 
 11.8 
 
 1276.8 
 
 * Sadler, William S., The Science of Living ; or, The Art of Keep- 
 ing Well. A. C. McClurg & Co. 
 
CHAPTER XXXVI 
 CARETAKERS AND GOVERNESSES 
 
 BECAUSE of her versatile adaptability to the management 
 of details, woman, all through the ages, has willingly and 
 happily sacrificed herself upon the altar of service. It is not 
 in the province of this chapter to go into the details of the 
 tribal life of the early hordes and clans that came from the 
 north and from the east to establish civilization in the cities of 
 Rome and Britain — space forbids. In this chapter we wish 
 to hold up a picture to the mother, a picture which may speak 
 volumes to her soul ; one which perhaps she may ruthlessly throw 
 away — nevertheless, we propose to exhibit it. 
 
 HOMEMAKING VS. HOUSEKEEPING 
 
 A newspaper woman in my office recently told me a story 
 of a mother who finished her high-school education, took some 
 work in a university, and who yielded to the earnest pleas of 
 her lover-classmate through grammar school, high school and 
 college — and married him. To this happy family there came 
 a number of beautiful children. The mother willingly, lovingly, 
 cared for them during their helpless infancy — made their 
 clothes, managed their meals, opened the door for them as 
 they came home from school, met them with a cheery story, 
 listened to their problems, helped them with their lessons — but 
 all through it, first, last and ail the time, she also managed the 
 entire home. She dusted the furniture, changed the curtains, 
 looked after the linen, mended the clothes, and even pressed 
 the trousers of her " rapidly rising " husband that he might go 
 out into his " club life " and enjoy the evenings with his asso- 
 ciates. The duties of the day so wearied her, and the night 
 vigils with the sick child, — looking after the little coughs, the 
 
 370 
 
CARETAKERS AND GOVERNESSES 371 
 
 uncovered shoulders, getting the drinks of water and performing 
 a dozen other details — that she was too weary to accompany 
 her husband to the dance, to the theater, to the social gathering 
 or to ladies' night at the club; and so, in the course of a dozen 
 years, the mother had grown old, and quite naturally she had 
 grown " home centered." Her world's horizon was the walls 
 of her home. She was happy and quite contented in her chil- 
 dren's smiles, in the cheery " how do you do " of her husband, 
 in the fact that that gravy was good or that steak was fried to 
 the king's taste. 
 
 She was happy and contented until one day when the awaken- 
 ing blow came. In the attic she and her thirteen-year-old son, 
 who was just entering high school, were looking through an 
 old chest when she drew forth some examination reports and 
 some old school cards — holding them up side by side. One set 
 of the cards bore the father's name and the other set the 
 mother's maiden name. In great surprise the boy exclaimed, 
 " Why, mother, I never knew you studied algebra and Latin ; 
 why, mother, I never knew you were educated." Her eyes were 
 immediately opened, the scales fell off, she was awakened to 
 the fact that her own son was coming to regard his mother as 
 somewhat inferior, in intellectual attainments, to the father — 
 that she was considered in that home as a mere domestic. 
 True, the steak had been broiled well, the pudding was 
 exquisite, the children's clothes were always in order, the hus- 
 band's trousers were always beautifully pressed, his ties were 
 cleaned as well as a cleaner could clean them; but where did 
 she stand in her boy's mind and where was she in her husband's 
 mind? 
 
 " Do you notice how trim and nice Mrs. Smith always looks ? 
 Her clothes are always in the latest style, and she combs her 
 hair so becomingly." Such remarks as this from the well-mean- 
 ing husband cut keenly, and it is well that they do, for often 
 it is only such remarks that wake up our " home mother." 
 
 Dear reader, I want you to ponder this story. I wish to say 
 to the mother who has started out upon a career in life, who has 
 prepared herself for teaching school, for a business career, for 
 story writing, for millinery, for lecturing, or has perhaps gradu- 
 
372 THE MOTHER AND HER CHILD 
 
 ated in a domestic science course, that she makes the mistake of 
 her life in settling down, just because she has taken another's 
 name, to be perfectly satisfied with becoming the household 
 domestic, the household mender, the household cook. 
 
 MOTHERS IN THE PROFESSIONS 
 
 I have in my acquaintance scores of mothers in the professions, 
 newspaper women, women who have carved out brilliant careers 
 for themselves, women who have taught school for twenty years 
 while their children have been growing up, women physicians 
 who have risen in the esteem of all their professional brothers 
 and sisters, women who have conducted cooking schools, who 
 have occupied positions of trust in hospitals and in every walk 
 of life, and who have successfully reared children at the same 
 time. 
 
 You will pardon me for being personal when I say that 
 since our own little fellow was six weeks old his clothes have 
 been washed and mended and his food has been prepared by 
 earnest and honest women who had not fitted themselves for 
 the career which this boy's mother had chosen. His mother 
 went to her office, cared for her patients, kept up by the side 
 of her husband in the battle of life. All the time there was 
 a woman at home just devoted to that little fellow. 
 
 A newspaper woman recently told me her story — a story 
 which should impress everyone of my readers as it did myself, 
 and she, like many other mothers in the professions, leaves her 
 home as the little fellow goes to school. His hands have been 
 washed, his bowels have moved, his hair has been combed, his 
 breakfast has been eaten by the side of his mother — she has 
 directed it all. He goes forth to the schoolroom and she goes 
 forth to her profession. All through the day she lovingly keeps 
 in mind these children that are growing up. She works the 
 harder, real love entering into everything she does, because 
 she is not merely earning the bread that goes into their mouths, 
 but is forming a character not only for herself but, because 
 of her broadened horizon, is instilling into their little minds the 
 possibilities of their own career, their own opportunity to enter 
 into the world's work as real world workers. 
 
CARETAKERS AND GOVERNESSES 373 
 
 I contend that the mother in a profession has many blessings 
 that the mother who remains at home never has. The mother 
 who remains at home has a viewpoint that is often quite likely, 
 wholly unconsciously, of course, to become small, to become 
 narrow, to become focused upon small details; on the other 
 hand, the mother whose mind and whose heart are so full 
 of the affairs of the office, of the newspaper article she 
 has just written, or the lecture she has just given or is 
 about to give, or the meeting that she is to preside over, is 
 quite likely to become somewhat irritated sometimes if the little 
 fellow doesn't stand quietly to have his hair combed, she is 
 quite likely to " feel rushed ; " but under all circumstances, dear 
 reader, whether this mother be a home mother or in a pro- 
 fession, never, never must she allow mental panic to seize her. 
 Ever must we keep in mind that these little ones are just children 
 — children that are still in the developmental stage. 
 
 WORK OUTSIDE THE HOME 
 
 And now for the home mother. I believe it is necessary and 
 of paramount importance that she get away from her children 
 (if possible) several hours each day; that she provide for them 
 a caretaker who can relieve the children of her or relieve her 
 of the children, whichever way you may look at it, for we are 
 inclined to think that the children often tire of the mother just 
 about as often as the mother tires of the children. I would 
 have the woman who remains at home, whose husband is able 
 to provide outside help for the heavy work, of the house, 
 enter into some uplifting neighborhood work, social set- 
 tlement work, church work, wholesome club work — any- 
 thing but bridge and whist and gambling games. I would have 
 them bring into the nursery a woman who is cheery, who is 
 capable of teaching games, of entertaining and amusing these 
 little folks under their own roof. 
 
 The woman who has graduated from high school, who has a 
 diploma to teach, I would have take a school or, at least, do 
 substitute work. She will be happier — far happier — con- 
 tinuing along the lines for which she has prepared herself, even 
 if all the money she earns be used to pay the help. Some 
 
374 THE MOTHER AND HER CHILD 
 
 women are especially fitted for the important work of mother 
 and homemaker, and such wives will find for themselves a 
 worthy career in the home and its neighborhood activi- 
 ties. Each woman must find a field of action suited to her own 
 temperament, education, experience, talents, and opportunities. 
 
 SELECTING A CARETAKER 
 
 For a caretaker, the professional or business woman should 
 not select an ignorant servant girl; that would be a great mis- 
 take — a crime — a violation of the law that should govern 
 the training of these little people who have come to us to be 
 reared and cared for and fitted to occupy their place among 
 the world's workers. As a rule, one soul does not possess the 
 qualifications for scrubbing and laundry work and also the 
 firm but gentle ministering qualifications necessary for a suc- 
 cessful caretaker. They do not combine as a rule. It has 
 been my experience, as a mother with a profession, and that 
 of many others of my acquaintances, that an art student or a 
 music student makes a splendid caretaker. There are hundreds 
 and hundreds of genteel women, with winning manners and 
 beautiful dispositions, who may be obtained to sew on the but- 
 tons, wash the faces, and change the clothes of our darlings 
 while we are carrying forward in the world the great work for 
 which we have fitted ourselves during the long struggles of our 
 teens and early twenties. 
 
 The young woman who is brought in to care for the child 
 should be above the usual " servant " class. She must eat in 
 our dining-room, she should be welcome in the living-room or 
 sun parlor, and be treated as a respected member of the family. 
 Her salary is usually not large for she realizes that she is given 
 something in that home — something that money cannot buy. 
 
 THE UP-TO-DATE MOTHER 
 
 Now this young woman (the caretaker) wants to hold her 
 position, and so she is very anxious to carry out in detail the 
 laws and rules that are laid down by the mother. Mother can 
 keep abreast with the world, mother has time to read period- 
 icals that keep her in touch with the great, wide, pulsating 
 
CARETAKERS AND GOVERNESSES 375 
 
 affairs of life. She is able to meet more women worth while, 
 and with her husband attend lectures, musicals, theaters, and 
 other places for intellectual culture. 
 
 Anyone of my readers need not look four blocks from her 
 home to find a mother who is run down at the heel, whose 
 dresses are calico, whose hat is five or six years old, whose 
 black silk dress (the only one she ever had) is worn shiny 
 or threadbare, who works and saves every penny that she can 
 that her children may look well ; and, even when the husband 
 does invite her to go out with him, he will often be confronted 
 with this remark : " John, I would like to go, but really my 
 clothes are a little bit shabby." The world is just full of such 
 women, with their very hearts being eaten out of them for 
 the want of a beautiful gown, a beautiful hat or a pretty pair 
 of evening shoes, and they might have them every one if they 
 would be willing to allow the duties of the household to be 
 presided over by a woman that cannot do the things the 
 mother can do, while she goes out and accrues a number of 
 dollars each week which will more than provide for the things 
 that her soul desires so that she may go well dressed by the 
 side of her husband in quest of that very necessary intellectual 
 culture and social diversion. 
 
 The wife of a prominent judge, in my office just this week, 
 said to me that she believed that most of our social and domestic 
 uneasiness was due to the fact that fathers and mothers and 
 children went out together so seldom. The father goes to 
 his club, the children go to their little gatherings, and mother 
 usually stays at home ; although of late, she is beginning to 
 realize the value of the women's clubs. 
 
 QUALIFICATIONS OF THE GOVERNESS 
 
 The caretaker should not be too old. It is a very great 
 blessing if there is an older sister in the family who can come 
 in and assist with this work, or if there is an aunt. If one 
 is to be selected from the open market, then we suggest a 
 woman in her late teens or early twenties whose heart is full 
 of play, whose face is sunny, and who is young enough to 
 appreciate and like the becomingness of youthful dress. It is 
 
376 THE MOTHER AND HER CHILD 
 
 needless to say she should be free from tuberculosis and other 
 diseases. She should be trustworthy enough not to administer 
 soothing syrups because the children won't sleep, or to give 
 candy when mother has forbidden her, or to teach the children 
 bad habits of any sort. 
 
 It is impossible to exercise too much care in the selection of 
 this substitute mother, and when you do find one it is often wise 
 not to keep her too long. A year or so is plenty long enough 
 for any person to be with our children. It is only necessary 
 for anyone to walk out into the public parks and casually listen 
 to the conversations of many of the " chewing-gum caretak- 
 ers " to discover with what carelessness some people select 
 caretakers for their children. The language they use is not 
 only ungrammatical but oftentimes both slangy and profane. 
 The flirtations carried on with many of the park policemen and 
 bystanders lead us to feel that many people arrive at the idea 
 that their little folks " will grow up some way." If the care- 
 taker is a student, a young woman of culture, and is kept with 
 the family, she will be found to be more circumspect and depend- 
 able. Her gentleman friend, if she has one, should be allowed 
 to come to the home. She does not have to meet him out in 
 the park any more than a sister would have to go away from 
 home to meet a friend; and, to my mind, everything centers 
 around the viewpoint of the mother as sh . selects this care- 
 taker, for if she is her social equal it puts her in a different 
 place entirely to the well-meaning but ignorant servant girl to 
 whose care is often intrusted the lives of the little people. 
 
 HINTS FOR THE CARETAKER 
 
 There are a number of hints we wish to bring together in 
 this chapter for the mother to suggest to the caretaker. For 
 instance, here is a group that one author gives us: 
 
 BABY IS HAPPY BECAUSE 
 
 He is dry. 
 He is healthy. 
 His food is right. 
 He has sleep enough. 
 
CARETAKERS AND GOVERNESSES 377 
 
 His meals are on time. 
 
 He is dressed properly. 
 
 He is bathed regularly. 
 
 His habits are regular. 
 
 His bowels move regularly. 
 
 He has fresh air day and night. 
 
 He is not dosed with patent medicines. 
 
 He is not excited by frequent handling. 
 
 He is not annoyed by flies or other insects. 
 
 THINGS BAD FOR BABIES 
 
 Candy. 
 
 Pacifiers. 
 
 Thumb-sucking. 
 
 Soothing syrups. 
 
 Patent medicines. 
 
 Waterproof diapers. 
 
 Moving picture shows. 
 
 Sucking on empty bottles. 
 
 Being kissed on the mouth. 
 
 Play of any sort after feeding. 
 
 Sleeping in bed with the mother. 
 
 Whiskey or gin for supposed colic. 
 
 Sneezing or coughing in the face. 
 
 Irregular or too frequent feedings. 
 
 Sleeping on the mother's breast while nursing. 
 
 Spitting on handkerchief to remove dirt from baby's face. 
 
 Allowing a person with a cough or a cold to hold the baby. 
 
 Violent rocking, bouncing, and rollicking play at any time. 
 
 Dirty playthings, dirty nipples, dirty bottles, dirty floors. 
 
 Allowing any person with tuberculosis to take care of the 
 baby. 
 
 Testing the temperature of the baby's milk by taking the 
 nipple in the mouth. 
 
 THINGS TO REMEMBER 
 
 Keep baby out of dust. 
 Don't cover his face. 
 
378 THE MOTHER AND HER CHILD 
 
 Don't rock him to sleep. 
 
 Keep baby away from crowds and sick people. 
 
 Don't neglect a sore throat or a running ear. 
 
 His health, growth, and happiness depend largely upon you. 
 
 Cats and dogs have no place about a baby. They carry dis- 
 ease. 
 
 The baby is not a toy or a plaything, but a great responsi- 
 bility. 
 
 Don't wipe out baby's mouth. It tends to cause ulcers and 
 thrush. 
 
 OVERCOMING BAD HABITS 
 
 There are a few bad habits which older children fall into 
 such as lip-sucking or thumb-sucking or finger-sucking which 
 not only narrow and deform the upper jaw, but likewise deform 
 the hand itself. They should be stopped at the earliest oppor- 
 tunity by pinning the sleeve to the bedding or putting mittens 
 on the hand or putting a slight splint on the anterior bend of 
 the elbow. Some children suck their handkerchiefs, or bite 
 holes in their aprons and neckties. 
 
 Children often bite their finger nails, and a habit of this kind 
 fully developed during early childhood often remains with them 
 throughout life; whenever a nervous spell seizes them they 
 instantly begin to bite their finger nails. Other people pick 
 their nose when nervous, so during very early childhood these 
 habits should be discouraged. One mother helped her little son 
 by beautifully manicuring his nails for him each week. Another 
 child was cured by old-fashioned spanking. The finger tips 
 may be painted with tincture of aloes, or dipping the tips of 
 the fingers in strong quinine water will sometimes help. I 
 know of nothing better for the adolescent child than to teach 
 him how properly to manicure his own nails. Another bad 
 habit that children often get into is stooping or allowing the 
 shoulders to become rounded. Shoulder braces are not indicated 
 in these cases. The children should be allowed to enter the 
 gymnasium or the father should take off his coat and vest and 
 go through gymnasium stunts with the boy. The mother can do 
 the same for the girl. It is often the case that round-shouldered 
 
CARETAKERS AND GOVERNESSES 379 
 
 children are near sighted. The child really has to stoop to see 
 things. When a child holds his head to one side constantly on 
 looking at objects, astigmatism, an error of eyesight, is usually 
 indicated. An eye specialist should be consulted, the eyes exam- 
 ined, and properly fitted eye glasses should be worn. 
 
 Just as early as possible in the life of the little child he should 
 be taught to blow his nose, to spit out the coughed up mucus from 
 his lungs, to hold out his tongue for inspection and to allow his 
 throat to be examined. He should be taught to gargle, and to 
 regard the physician as one of his best friends. Attention to 
 these minor accomplishments will make it very easy indeed for 
 the physician in case of illness. 
 
CHAPTER XXXVII 
 THE POWER OF POSITIVE SUGGESTIONS 
 
 A CHILD is the most imitative creature in the world. Be- 
 fore he is out of pinafores he tries to talk and act just like 
 his elders. It is because of this inherent tendency to say and 
 do those very things which he hears others say and do, that, if 
 faith-thoughts are early and constantly suggested to the unfold- 
 ing mind of the child they will assist greatly in evolving a char- 
 acter of joy, confidence, and courage. On the other hand, if 
 fear-thoughts are continuously sown in the young mind they 
 will eventually distort the emotions, deform the conceptions, and 
 wholly demoralize the health and life activities of the growing 
 child. Within the limitations of the possibilities of hereditary 
 endowment, and in view of this wonderful imitative nature, we 
 are able to make of a child almost anything we desire ; not " an 
 angel," in the ordinary acceptation of the term, but a child who 
 knows his place and possesses the power of normal self-control. 
 
 EARLY FEARS 
 
 From two to six years of age, when the imagination is most 
 plastic and vivid, when the child's imitative instinct is so uncon- 
 sciously automatic, is the most effective and opportune time to 
 initiate good habits and lay the foundations for the later devel- 
 opment of a strong and noble character. " Baby's skies are 
 Mamma's eyes " is just as true as it is poetical. While a tired 
 and worn-out mother, exhausted by a multitude of harrassing 
 household cares, may be pardoned for her occasional irritability, 
 nevertheless the little one unconsciously partakes of her spirit. 
 When the mother is happy the child is happy. When Mother 
 is sick and nervous the child is impatient and irritable. 
 
 It is unfortunate that this very time of a child's life, when 
 
 380 
 
THE POWER OF POSITIVE SUGGESTIONS 381 
 
 we can do practically anything we choose with him, is the very 
 time when so many parents fill the child's mind with the un- 
 healthful fear-thoughts. " The bogie man'll get you if you don't 
 mind Mamma," or, " I'll get the black man to cut your ears off," 
 or, " the chimney sweep is around the corner to take bad little 
 boys," are familiar threats which are so frequently made to the 
 little folks. These efforts to terrorize the young child into 
 obedience never fail to distort the mind, warp the affections, 
 and, more or less permanently, derange the entire nervous sys- 
 tem. The arousal of fear-thoughts and fearful emotions in the 
 mind of the growing child is very often such a psychologic 
 and a physiologic shock 'to the child that the results are some- 
 times not wholly eradicated in an entire lifetime. 
 
 Just see how far we carry this unwholesome introduction of 
 fear-thoughts — even to the Almighty. Thousands of us remem- 
 ber being told as a child that " God don't like naughty boys," or, 
 " God will send the bad man to get you if you don't be good." 
 Thus, early in life, an unwholesome fear of the Supreme Being 
 is sown in the mind of the child, and, as time passes, these false 
 fears grow and come so to possess the mind and control the 
 emotions that in adult life this early teaching comes to mold the 
 character and shape the religious beliefs of the individual. 
 
 To the child who has been reared to dread God, who has come 
 to look upon the Creator as an ever present " threat," how is it 
 possible to convey the beautiful teaching of His fatherhood? 
 
 FEAR OF NOISES 
 
 How frequently some unusual noise leads a parent to say: 
 " Keep still ! What was that? Did you hear that noise? " The 
 little folks of the family are startled, their eyes grow large and 
 their faces pale, while they cling to the frightened mother. Of 
 course, investigation usually shows that the strange and alarm- 
 ing noise was merely the slamming of a cellar door, the rattling 
 of a curtain in the wind, some one walking about downstairs, or 
 the action of the new furnace regulator in the basement. But 
 meantime the harm is done to the children — fear, the worst 
 enemy of childhood, has been unconsciously planted in the mind 
 by the thoughtless and nervous parent. 
 
382 THE MOTHER AND HER CHILD 
 
 FEAR OF DARKNESS 
 
 Consider for a moment the thousands of children who are 
 early taught an abnormal fear of the dark. Even when the 
 child is absolutely free from such a fear, when sent into a dark 
 room some member of the family will thoughtlessly remark, " Do 
 you think it is quite right to send that child into that dark room ? 
 Suppose something should happen." The child quickly catches 
 the suggestion that something is supposed to be or happen in the 
 dark, and in his mind is sown the seed of fear. 
 
 When our boy was about two years old he was carried one 
 night to the window by a caretaker, and as they looked out into 
 the darkness the young woman said, " Boo ! dark ! " The little 
 fellow shuddered, drew back and repeated, " Boo ! dark ! Boo ! 
 dark ! " 
 
 That night, as was our custom after the evening story, we 
 tucked him in his little bed, turned out the light, and saying, 
 " Sweet dreams, Darling," closed the door. Imagine our sur- 
 prise to hear, " Mamma, Mamma, Willie 'fraid of dark, Willie 
 'fraid of dark," and it was with difficulty that he was induced to 
 go to sleep in the dark. Immediate inquiry revealed the occasion 
 of his fears, and the next night we set about to eradicate the 
 fear of darkness from the little fellow's mind. 
 
 For ten successive nights we took his hand, and, leading him 
 into a dark room, said, " Nice dark, restful dark ; we go to sleep 
 in the dark; we're not afraid of the dark, no." Each night, 
 save one, we were met with, " No, no, naughty dark. Willie 
 'fraid of dark." On the tenth night as we entered the room as 
 usual, repeating, " Nice dark, restful dark ; we go to sleep in the 
 dark; we're not afraid of the dark, no," his little mind re- 
 sponded. Suggestion had at last routed fear and given birth to 
 faith. We had won ! But it had taken ten nights of constant 
 work to undo one moment's work of a thoughtless girl. Every 
 night since he has gone to sleep in the dark without a murmur. 
 
 THE FOLLY OF MAKING THREATS 
 
 Threats only show weakness on the part of the disciplinarian. 
 Most school teachers early learn the folly of making threats. 
 When I was teaching school I recall that a number of slate pen- 
 
THE POWER OF POSITIVE SUGGESTIONS 383 
 
 cils had been dropped on the floor one afternoon. Thought- 
 lessly I threatened, " Now the next child that drops a pencil 
 will remain after school and receive punishment ! " My fate ! 
 The weakest, most delicate girl in the room was the next to drop 
 her pencil, and she was a pupil with a perfect record in deport- 
 ment. The reader can imagine my embarrassment. I had 
 threatened punishment, and so had to get out of the predicament 
 as best I could. This experience effectually cured me of making 
 such foolish threats. 
 
 Most of us live to regret the threats we make. " Your father 
 will thrash you when he comes home tonight," or, " You'd better 
 not let your father see you doing that," or, " You wouldn't be- 
 have that way if your father was here," etc., are common threats 
 which we hear directed at headstrong and willful boys. What 
 is the result? Do such threats cause the love of the child for 
 his father to increase? They make the child actually afraid of 
 his father. 
 
 " I'll ' bust ' your brains out," said a four-year-old to his pet 
 lion, because it wouldn't stand up. Now it should be remem- 
 bered that these things do not originate in the minds of the boy 
 and girl. They only repeat the things they hear others say. It 
 betrays both cowardice and ignorance to undertake to secure 
 obedience by such threats as " I will box your ears if you don't 
 mind," etc. 
 
 Obedience that is worth anything at all is only secured 
 by suggestion and love, never by promises of reward or threats 
 of punishment. 
 
 CHILDREN WHO ARE CALLED " COWARDS " 
 
 Recently we overheard a little fellow say, " Father says I'm 
 the only coward in the whole family." Looking him straight in 
 the face we said to him : " You're not a coward. Such a fine 
 boy as you couldn't possibly be a coward." The boy was greatly 
 amazed, and, as we left him, he was saying over to himself, 
 " I'm not a coward. She said I'm not a coward," finally adding, 
 " She said I couldn't be a coward." This one thought, repeated 
 to him several times and turned over and over in his mind, 
 eventually overthrew the false fears instilled by his father. 
 
384 THE MOTHER AND HER CHILD 
 
 A short time ago the daily papers contained the story of the 
 ten-year-old son of a New York business man who drew his 
 few dollars from the savings bank, boarded a train for Chicago, 
 and, after three days of amusement and loneliness, his money 
 all gone, was found in a hotel bitterly weeping. His identity was 
 revealed, the parents were notified at once, and the boy was sent 
 on the first train back to his home. On the way to the station 
 he sobbed out through his tears, " Well, my brother can't call me 
 a coward any more, anyway." Who knows but that this ever- 
 lasting taunting of the child with the accusation of being a baby 
 or being a coward has much to do with many such escapades 
 and other daring exploits on the part of the juveniles who are 
 chafed by such unjust insinuations? Those of us who are 
 acquainted with the vice and crime of a great city can imagine 
 just what might have happened if this boy had been a little older, 
 if his heredity had not been so good, if his money hadn't run 
 out, if he had been able to remain in the big city long enough 
 to make undesirable acquaintances. 
 
 Many criminals have confessed behind prison bars that when 
 they were children they were called cowards. After a while 
 they actually came to believe that they were cowards, and in 
 their efforts to acquire courage and demonstrate their bravery 
 they were led to desperate and even criminal acts. They prowled 
 around the dark alleys just to convince themselves that they 
 were not afraid, that they were not cowards, and there they 
 made the acquaintance of the criminals who led them into new 
 and dangerous paths. Even if a child enters this world handi- 
 capped by heredity, let us not lessen his chances of success by 
 adverse suggestion. 
 
 Faith-thoughts, thoughts of bravery and of courage, may 
 just as easily be instilled into the mind of the normal child as 
 thoughts of fear and cowardice. A child should never have 
 suggested to him that he is afraid. He should be constantly 
 assured that he is brave, loyal, and fearless. The daily repeti- 
 tion of these suggestions will contribute much to the actual 
 acquirement of the very traits of character that are thus sug- 
 gested. This does not mean that a child should not be taught 
 caution and forethought. 
 
THE POWER OF POSITIVE SUGGESTIONS 385 
 
 THE GIRL WHO WOULD " TURN OUT BAD " 
 
 Parents do not begin to realize how fearfully dangerous is 
 this habit of constantly reiterated negative suggestion. Let me 
 illustrate by an actual incident: A beautiful girl in a near-by 
 state grew up quietly in the little village until she was eighteen 
 3 r ears of age, when suddenly she decided to run away from 
 home, declaring she was old enough to do as she pleased. She 
 confided in one of her girl friends that she was going to Chi- 
 cago, and had made all arrangements to lose herself in the 
 " redlight " district. All that this girl friend said had not the 
 slightest influence. As the train bore her away to the city and 
 to ruin, a social worker in Chicago was wired to meet her at 
 a suburban station. The girl was met, taken from the train 
 and whisked in a cab to the home of a Christian woman. So 
 possessed was this girl with the idea of throwing herself away 
 that the captain of police was asked to talk to her ; but the 
 combined efforts of the police captain, a magistrate, and several 
 Christian people could not persuade her to recall her threat. 
 She declared she would kill herself if her parents were notified. 
 This siege lasted for ten days. Then she finally broke down, 
 saying : " I simply can't help it. All my life my mother has 
 told me that I was going to turn out bad. No matter what 
 would happen at home, if I broke a dish or went out with the 
 young people and remained away ten minutes later than I was 
 told to, it would always be thrown up to me, ' Oh, some day 
 you'll turn out bad.' I have heard it until I am sick of it, and 
 something within seems to push me on and on, telling me I 
 must turn out bad." 
 
 Of course the girl was persuaded to believe that these were 
 only fear-thoughts; that she was a beautiful, virtuous girl, that 
 she simply had received the wrong training, that she couldn't 
 possibly turn out bad. She was thus saved by the sympathy 
 and advice of understanding friends, was subsequently married 
 and is today the mother of a splendid boy. 
 
 WHAT HEALTHY FAITH-THOUGHT WILL DO 
 
 Here is another story which illustrates what healthy faith- 
 thought will do. A young man was not long ago selected for 
 
386 THE MOTHER AND HER CHILD 
 
 the highest position within the gift of a large religious organiza- 
 tion. When he was a lad his parents held this thought con- 
 stantly before his mind : " David, if you will be a good boy, 
 if you will do what is right, you may some day be President of 
 the General Assembly." He became a minister of the Gospel, 
 a very successful one, and subsequently married a young woman 
 who was also much interested in religious work. She continued 
 to encourage him in this ambition, saying : " David, preach the 
 best sermons you can; make an effort to bring many souls to 
 Christ, and some day I believe you will be President of the 
 General Assembly." The man presided over the General As- 
 sembly of his denomination, not one term, but term after term. 
 He kept his eye long fixed on that particular aim, and by faith 
 he won it. 
 
 THE POWER OF SUGGESTION 
 
 To see how powerful suggestion may be in a child's life take 
 this incident that every parent knows : The little one trips 
 and tumbles. Mamma says, "Oh, did you fall? Well, never 
 mind; come here, I'll kiss it. There, now it's well." Immedi- 
 ately the child goes back to his play perfectly happy. One little 
 fellow was taught that when he fell he should get up at once, 
 rub the bump, and say, " That didn't hurt." All through his 
 career the bumps and the hardships of life were met with the 
 same pluck. On the other hand, a thoughtless caretaker will 
 excitedly jump and catch up the slightly injured child, coddle 
 it, rock it, pet it — and the crying continues indefinitely. This 
 early training in meeting minor hurts and obstacles lasts 
 throughout the lifetime. Pluck and grit are lacking. The be- 
 havior of the man in the face of difficulties is foreshadowed by 
 the attitude of the child toward his petty trials and bumps. 
 
 Successful child training follows in the path of positive sug- 
 gestion. Impatient words and careless threats of punishment 
 can only contribute to the wrong training of the young mind. 
 
 When is the best time to suggest to the child? Catch the 
 little fellow when he is happiest, when he is overjoyed and 
 filled with glee; for it is at such times that the suggestions 
 offered will meet with the least resistance. 
 
THE POWER OF POSITIVE SUGGESTIONS 387 
 
 Teach the children through the spirit of play and through 
 the medium of the story. The boy or girl in the story always 
 can have a clean face, always close the doors quietly, and other- 
 wise so conduct himself or herself as to constitute a powerful 
 positive suggestion for good. The story-child always says, 
 " All right, Papa," " All right, Mamma," when corrected. 
 
 •BEDTIME A GOOD TIME TO SUGGEST 
 
 The " going-to-bed time " is the time par excellence for sug- 
 gestion in early childhood. After the play time, the study 
 time, and the evening story, when all is quiet, in the peaceful- 
 ness of the darkness, while you are seated in a low chair close 
 beside the little bed, with your hand in his, repeat over and 
 over again the positive suggestions which you desire to take 
 root in the mind and bear fruit in the character. Again and 
 again tell the little fellow that he is the noblest and bravest of 
 boys, that he loves truth and hates deceit. No matter what 
 disturbs him, if it is the lessons at school or a wrong habit, 
 first think out exactly what you desire him to be or to do, and 
 firmly, but quietly, tell it over and over to him. 
 
 As a concrete example: Suppose Henry, at three-and-a- 
 half years of age has to be coaxed or almost forced to eat. Say 
 to him : " Now, Henry, you are a good little boy. Papa and 
 mamma love you dearly. If you are going to grow up to be 
 a big man you must not forget to eat; so tomorrow when you 
 go down to the table you will eat everything mamma or nurse 
 puts before you. It won't be necessary for papa to feed you 
 at all ; you will eat the potatoes, the gravy, the toast, and the 
 cereal, and drink your milk. You will make mamma very 
 happy, and papa will be proud of you; and then after dinner 
 we will have a good romp, and you will soon grow up to be 
 big enough to have a velocipede and a watch." After two or 
 three evenings of this suggestion you will be surprised to see 
 there is a great difference in his eating. 
 
 Take the timid little girl who is unable to recite well at 
 school, who is shy, and has great difficulty with her lessons. At 
 the going-to-sleep time sit by the side of her bed and tell her 
 that tomorrow she will have her lessons better, that she will 
 
388 THE MOTHER AND HER CHILD 
 
 not any more be afraid, that she will get up and recite without 
 the least fear in her heart. By constantly repeating these sug- 
 gestions she will be given confidence, and in most cases it will 
 result in effecting the deliverance of the child from her bond- 
 age to fear. Never tell her that she is shy or that she cannot 
 do things. Constantly tell her that she is a successful girl with 
 a strong character, and that she is going to make a very useful 
 and courageous woman. Hold high aims and ideals before her. 
 Suggestion cannot atone for all the defects of character which 
 may be inherited, but it can do much to help such unfortunate 
 little ones gracefully bear their burdens. 
 
 NEVER ACCUSE CHILDREN OF DISHONESTY 
 
 Never tell children that you suspect they are dishonest or 
 untruthful. Be very slow to accuse and suspect them of false- 
 hood or theft. Tell them over and over again they are the best 
 boys and girls in the world; that they are going to make the 
 noblest of men and women; that they love honesty and truth. 
 Even when you discover them in minor faults do not make 
 the mistake of unduly magnifying and emphasizing the error. 
 As soon as possible direct the thoughts and attention of the 
 wrongdoer away from his error, and focus his thoughts and 
 attention on the high goal you expect him to reach. This will 
 not be construed as doing away with proper punishment for 
 persistent faults after the more ideal methods seem to have 
 failed. 
 
 A patient recently called us to see her little girl, and as we 
 made ready to make the examination the mother said : " Now, 
 Mary, stop your playing and come and be undressed and let 
 the doctor look at you." 
 
 " I don't want to stop playing," murmured Mary. 
 
 " But you must come. You know you don't feel well at all, 
 your cheeks are so red. Now swallow and see if it don't 
 hurt. Now try again. I know you don't feel well." By the 
 time we had begun our examination Mary began to succumb 
 to her mother's suggestions, and began to feel a trifle indis- 
 posed. She was being made temporarily ill by the unwise and 
 unfortunate suggestions of the overanxious mother. The ex- 
 
THE POWER OF POSITIVE SUGGESTIONS 389 
 
 amination revealed that there was nothing whatever the matter 
 with her. 
 
 IT IS EASY TO FORM GOOD HABITS 
 
 Let us get the truth firmly into our minds as parents that 
 it is just about as easy to form a good habit as a bad habit, 
 just about as easy to acquire helpful, happy thoughts as those 
 that are injurious; and we can do it, if we will but see to it 
 that our children early form correct and proper habits of think- 
 ing and acting. While the children are taught proper respect 
 for authority, let fear be an unknown word to them. Don't 
 let a thought of the fear of insanity, of haunted houses, of 
 drafts, of this and of that enter into your home. Instead, live 
 in the glorious sunshine of strong, healthy, faith-thought, and 
 a supreme happiness will come into your life, and you will give 
 a legacy to your children for which they will " rise up and call 
 you blessed." 
 
 CHIVALROUS SPIRIT 
 
 The love of mother and sister can naturally and happily be 
 turned early to a chivalrous attitude toward all women when 
 it is developed by suggestion and other training. In giving up 
 a chair or bringing one for a guest, in lifting the hat, in noticing 
 ways to be polite and attentive to mother, a lifelong conduct may 
 be ensured. 
 
 Each day gives us trying and sometimes shocking revelations 
 of the prevalent lack of courtesy, or even humanity, on the street 
 cars during the " rush " hours. The indifference to the comfort 
 of women, even the aged, on the part of many men and boys in 
 the matter of giving them seats or other care, indicates a dan- 
 gerous social condition. 
 
 The mother, instead of exercising selfish concern for her 
 boy, should make it her duty very early to suggest that he give 
 his seat to a woman or girl, as he would be glad to have some- 
 one do for his mother or sister. Such unselfish service will 
 become a habit of pleasure, and help the boy become a pure- 
 minded, manly gentleman with that respect for womanhood 
 without which a nation is doomed. 
 
CHAPTER XXXVIII 
 PLAY AND RECREATION 
 
 THERE are a number of theories advocated by late authors 
 on the " psychology of play," in which they connect the 
 free and easy play of the modern child with the more serious 
 and sober pursuits of our ancestors — our racial parents of 
 prehistoric and primitive times. We quote from Worry and 
 Nervousness: 
 
 And so we are told that the spectacle of the young infant suspend- 
 ing its weight while holding on to some object, and the early in- 
 stincts so commonly shown to climb ladders, trees, or anything 
 else available, are but racial mementos of our ancestral forest life. 
 The hide and seek games, the desires to convert a blanket into a 
 tent, the instinct for " shanties " — which all boys universally mani- 
 fest — we are told that these forms of play are but the echo of remote 
 ages when our ancestors sojourned in caves, lived in tents, or dwelt 
 in the mountain fastness. In this same way the advocates of this 
 theory seek to explain the strange and early drawings which the 
 young lad has for wading, swimming, fishing, boating, and other 
 forms of aquatic recreation.* 
 
 In this chapter we purpose to discuss the play of the child, 
 whose career we will divide, for convenience, into three stages : 
 
 1. The age from three to six — juvenile days. 
 
 2. The age from six to twelve — the " going to school " child. 
 
 3. The age from twelve to twenty — the adolescent youth. 
 
 JUVENILE PLAY DAYS 
 
 As nearly as is possible the little child should be out of doors 
 the greater part of his waking hours. To our mind it is nothing 
 
 * William S. Sadler, Worry and Nervousness, p. 377. 
 
 390 
 
PLAY AND RECREATION 391 
 
 short of criminal to keep the little folks in the house when the 
 weather permits outdoor life. 
 
 Of the outdoor games which we have to suggest, perhaps 
 the sand pile stands at the head of the list. Clean white sand 
 should be placed in an inclosure just low enough for the child 
 to climb over. Many, many happy hours may be spent in this 
 sand pile, at the same time the little fellow is in his own yard 
 and the watchful mother knows the drift of the conversations 
 which take place. 
 
 In a previous chapter we called attention to the fact that the 
 little girls' frocks should be provided with knickerbockers, so 
 that she may run and jump, or sit as comfortable as the little 
 boy, without a conscious reproof ever ringing in her ears, 
 " Mary, do keep your dress down." 
 
 OUTDOOR PLAY 
 
 Tree climbing is another source of enjoyment to these little 
 people and they should early be taught how to climb. Instead 
 of suggesting fear to the child let the mother go into the yard 
 and talk with her something like this : " Now, Mary, put your 
 foot in that fork, now catch hold of that upper limb, hold on 
 tight, you will get there yet;" instead of the following con- 
 versation, which all of our readers have heard: "John, do 
 take care or you will fall and break your neck; be careful, you 
 will fall. There, I knew you'd fall ! " etc. Both mothers are try- 
 ing to accomplish the same thing — one mother suggests " fore- 
 thought," while the second mother thoughtlessly suggests 
 " fear-thought." 
 
 These little, people should be provided with rakes, spades, and 
 hoes, and a portion of the yard should be given them in which 
 they are at liberty to dig and rake and have a royal good time. 
 We have yet to see the child who is not interested in flower- 
 bed making, and the mother should think of the virgin oppor- 
 tunity to instill the story of life into the child's mind as he 
 plants the seed, and day by day watches its development and 
 growth. 
 
 A pen of rabbits may be a good thing, if proper measures 
 are taken to prevent their burrowing out of the pen, destroying 
 
392 THE MOTHER AND HER CHILD 
 
 the lawn, causing much sadness of heart to their little keeper, 
 and no end of annoyance to the neighbors. 
 
 Roller skating and hoop rolling, as well as sledding, are all 
 valuable recreations. The snowman, snowballing, and the sled 
 riding all bring the ruddy glow of health to the cheek, and are 
 wonderful producers of good appetites and restorers of " tired 
 out nerves." 
 
 INDOOR GAMES 
 
 There is no end to the number of things that can be done 
 when the weather shuts us in, but before we take up these 
 games let us never forget that every child thoroughly enjoys 
 going out in the rain well protected with rubber boots, raincoat, 
 and umbrella. 
 
 It is not extravagant to burn plenty of electricity or gas on 
 cloudy days, for the artificial sunlight helps to cheer the heart. 
 Such indoor games as those which may be had from blocks, 
 puzzles, cutting out of pictures, darning of cardboard, soldier 
 games, dolls, housekeeping, etc., are all splendid means of rec- 
 reation for the little ones. Let the mother or caretaker join 
 with the little folks in these pleasant games. For the older 
 children, checkers and dominoes are most excellent indoor 
 games. 
 
 THE " GOING TO SCHOOL " CHILD 
 
 First of all we must decide upon the bedtime hour, as well as 
 the hour for rising. Between the ages of six to twelve, the bed- 
 time hour should be eight o'clock, or not later than eight-thirty, 
 and the rising hour at seven, or seven-thirty in the morning, for 
 children of this age require eleven to twelve hours sleep. 
 
 Again, there must be taken into consideration the home work 
 that the children at school are asked to do by their teachers. 
 While this home work is not usually taxing, yet the time spent 
 in doing the work must be taken account of. In our opinion 
 the best time for home work is an hour and a half to two hours 
 after the little fellow gets home from school. He should be 
 allowed to relax for one and a half or two hours, to play out 
 of doors whenever the weather permits, and then with either 
 
PLAY AND RECREATION 393 
 
 his mother or his caretaker from one-half to three-quarters of 
 an hour should be spent on the lesson for the following day. 
 Following this, the dinner hour is enjoyed with the parents, 
 and after that there should always be provision in the daily 
 duties of the father and mother for at least a half hour for the 
 evening romp; so that play and recreation during the school 
 age occupies possibly not more than two or two and one-half 
 hours a day outside of school hours. 
 
 The playgrounds of schools are of inestimable value, and we 
 quite agree with one who said : " If we can only afford one of 
 the two — the playground or the school — have the playground 
 first and afterward the school." The small parks and play- 
 grounds of the cities are a great blessing to the little folks. 
 
 COMPANIONS 
 
 The companions of the school child are usually his playfel- 
 lows at school, and we urge the throwing open of the home 
 during inclement weather to allow these school friends to come 
 in and make trains out of our chairs and tents out of our 
 couch covers, steamer rugs, afghans, etc. 
 
 We do suggest that caution be used in allowing children to 
 play indoors who are suffering from colds in the head, running 
 noses, running ears, tuberculosis, or other chronic disorders, 
 which are often highly contagious. Running noses and running 
 ears, as well as tuberculosis, may be contracted by susceptible 
 children when the play at recreation time takes place indoors; 
 while such disorders are much less dangerous in connection 
 with outdoor play. 
 
 We are well aware of the fact that some playmates may 
 choose the bathroom, requesting that doors be locked, or wish 
 to play in a bedroom securely away from mother and the care- 
 taker. Under no circumstances should this be allowed. Let 
 the child early learn that good wholesome play in the open is 
 better than secretive misdemeanor behind closed doors. 
 
 THE " IN THE HOUSE " HOUR 
 
 It is a pitiful fact that many mothers apparently are wholly 
 unconcerned as to the whereabouts of their little folks, even 
 
394 THE MOTHER AND HER CHILD 
 
 after dusk; this is unwise to say the least, for a boy or girl 
 under twelve years of age should be found under the parental 
 roof at dusk. The city mother should impress upon her child 
 that when the street lamps are lighted his first duty is at once 
 to come into the house. During the winter months this light- 
 ing of the street lamps occurs anywhere from four to six. Dur- 
 ing the summer months another rule should be laid down, de- 
 pending upon the neighborhood, the character of the friends on 
 the street, the surroundings, etc. By all means let us see that 
 our young people are in the house by dusk. 
 
 PARTIES 
 
 Every mother who reads these lines has had to meet this 
 question : " Shall I let my little one begin to go to parties ? " 
 and every mother will have to answer that question for her- 
 self. We personally feel that the social life extended by the 
 school, together with the meeting of the companions at Sunday 
 school, in the park, or on the playground, is quite enough; and 
 we deplore the fact that many children grow into the idea that 
 much time must be spent at " parties " in the drawing-room 
 under unnatural surroundings, in dressed-up clothes, eating 
 ice cream and cake, etc. Outdoor gatherings of children are 
 wholesome and hygienic, but most of these indoor gatherings 
 of groups of children we consider decidedly unhygienic. One 
 child coming down with scarlet fever, measles, or whooping 
 cough can infect twenty others at an afternoon party. The 
 eating of so much ice cream, candy, and cake is deplorable in 
 that it upsets the digestion, and all this is irritating to the de- 
 veloping nervous system of the child; and not infrequently 
 brings on a lot of other symptoms, resulting in discomfort and 
 disease. We believe in outdoor picnics but not in too frequent 
 indoor parties. 
 
 PICNICS 
 
 Groups of children gathering in the park, on the beach, in the 
 woods, when well chaperoned, are among the pleasant and 
 profitable pleasures of childhood. It is just such gatherings 
 that mothers and children should indulge in — and once a week 
 
PLAY AND RECREATION 395 
 
 is not too often during the long vacation. The mothers, too, 
 should enter enthusiastically into the joys of a day's outing, 
 where the enormous intake of oxygen, the hearty laughter, the 
 races, the games, etc., all create a wonderful appetite, which 
 can be so delightfully satiated from the well-filled lunch bas- 
 kets; and while the children are thus playing together what a 
 wonderful opportunity for the mothers to engage in an ex- 
 change of helpful ideas. Each mother has her own way, which 
 is " the best way " to make this cake or that salad ; or has 
 met this particular difficulty in child training in a carefully 
 thought out way; a neighborhood women's club can thus be 
 held out in the open, while the children are having the time of 
 their lives in the frolic of the picnic. 
 
 " MOVIES " 
 
 The movie is an institution that has come to stay, and today 
 mothers everywhere are perhaps discussing this particular insti- 
 tution more than any other. The movie affords a wonderful 
 opportunity to see the sights and scenes of other lands, of feed- 
 ing the imagination of the child on travel pictures and nature 
 pictures. It is a most deplorable fact, however, that this won- 
 derful institution which is fraught with so many opportunities 
 to educate and enlighten the mind of the growing child has 
 carefully to be censored. Women's clubs have done much to 
 purify the movies for the school-age child; many theaters are 
 now showing on certain days a special afternoon movie for the 
 children; and while many of these movies have great possibili- 
 ties for good, we most earnestly urge that the school child see 
 the movie that he is to see before dinner, and not have his mind 
 excited and his nervous system " thrilled " just before going to 
 bed. Someone asked me several years ago, " Are you going 
 to let your little fellow go to movies?" I instantly answered, 
 " No, but I shall take him." If the mother or the father sits 
 by the side of a growing child and carefully, thoughtfully, and, 
 yes, prayerfully, points out the good and explains the evil, then 
 even the questionable movies will prove the means of bringing 
 father and son and mother and daughter, into closer compan- 
 ionship. 
 
396 THE MOTHER AND HER CHILD 
 
 Under no circumstances should children under twelve years 
 of age be taken to long lectures, entertainments, or concerts, 
 which will keep them out until eleven 
 
 VACATIONS 
 
 Let the vacation be well planned. This is the opportunity 
 " de luxe " for the child to earn a few pennies to enlarge his 
 bank account. Allow him a truck garden, guinea pigs, chickens, 
 anything remunerative, which will enable him to become one 
 of the world's workers and one of the world's savers. Let 
 him start a bank account wdien he is six, and watch him as he 
 puts the dime in the bank, instead of taking it to the ice-cream- 
 soda cashier. 
 
 Some time during the vacation, if possible, mother and father 
 should accompany the little folks to the camp, to the beach — 
 somewhere, anywhere — to get back to nature and live like 
 Indians for a short time. Each member of the family will come 
 back rested, happier, and more ready for the next year's work. 
 
 In the summer time learn to eat on the porch — it is great 
 sport for the children. Many meals can be served on porches 
 that are so often served in hot, stuffy rooms. 
 
 The " home " does not consist in the furniture, the rooms, 
 the bric-a-brac, or the curtains. The home is the mother and 
 the father and the children and the spirit of good fellowship 
 which should possess them. Make the companions of the little 
 folks very welcome, letting them learn the early use and abuse 
 of the different articles of furniture in the house. It is all right 
 to play tent with the beautiful couch cover; it is all right at 
 certain times to dress up in father's best clothes and mother's 
 beautiful gown, but while they are thus having a good time let 
 them learn that all these things are to be used and not abused. 
 
 ADOLESCENT DAYS 
 
 The homely boy or the homely girl usually grows up free 
 from the flattery and undue attention which are sure to be 
 heaped upon the good-looking boy and the popular girl. Way 
 back in the early days of five or six, and all the way up to the 
 ages of twelve to twenty, children should be taught that it is 
 
PLAY AND RECREATION 397 
 
 altogether natural and correct to do things well and to look 
 well ; parents should stop, and cause their acquaintances to stop, 
 " making over " the boy or the girl just because they have done 
 something well, or have beautiful curls, or because their eyes 
 are a magnificent brown, etc. If a girl should be especially 
 endowed with a charming complexion, a wonderful chin, and 
 if she does possess a beautiful nose or neck, let her early realize 
 that she has been made the custodian of goodly features and 
 that she must give an account for this particular blessing, and 
 under no circumstances must she become self-conscious about 
 it. Ofttimes a good frown to an unwise friend is all that is 
 necessary to stop this " lip service " flattery. 
 
 The " chewing-gum girl " is just a thoughtless girl, that is 
 all; sit her in front of a mirror and compel her to chew gum 
 for one-half hour and watch herself do it, and it will often 
 suffice to cure her. Young ladies should be taught that chew- 
 ing gum should be done in the bedroom, but never in the living- 
 room or on the streets. It is not only a disgusting habit, but 
 it often creates an occasion for criticism as to the quality of 
 one's home training. 
 
 ICE-CREAM PARLORS 
 
 The mother who cares will not allow her lovely daughters 
 nightly, or even semi-weekly, to frequent the ice-cream par- 
 lors and secluded soda fountains. She had far better arrange 
 group dinners and group receptions in her own parlor; with 
 ice cream served in her own dishes and eaten with spoons that 
 she has supervised the washing of. 
 
 Young women and young men in their late teens crave com- 
 panionship, and they should have it; but let it be under wise 
 chaperonage at home or in public rooms, and not in the solitude 
 of a lonely bench in the public park, or the seclusion of an out- 
 of-the-way, ice-cream parlor. This " running the streets " 
 which is so freely indulged in by the adolescent youth in the 
 early teens need not occur, if wise provision is made for the 
 assembly of small groups in the home. 
 
 Some elders think it pleasing and cute for young men and 
 young women — fourteen to sixteen, or even seventeen — to 
 
398 THE MOTHER AND HER CHILD 
 
 wrestle and roll around on the floor like two huge kittens; but 
 it is unwise and indiscreet and should be discouraged. 
 
 DANCING 
 
 We hesitate to speak of dancing for we realize it is a very- 
 popular indoor recreation of today, but we most earnestly urge 
 that if dancing must be done, it be done under proper chap- 
 eronage, and if young people must meet in public dance 
 halls let them be municipal dance halls, where motherly matrons 
 are in charge. Many of the social dances which bring the par- 
 ticipants into such close physical contact are to be discouraged 
 and stricken off the list; and while dancing is a splendid form 
 of exercise — let us add that it is also sometimes a danger- 
 ous one. 
 
 QUESTIONABLE PLAY 
 
 After the boys and girls graduate from grammar school they 
 may come into contact with such agencies as secret societies — 
 which nine times out of ten are questionable — and while we 
 realize that there is a contention both for and against these 
 organizations, we may dismiss the subject here by simply add- 
 ing that we have known little special good to come out of these 
 societies. 
 
 While it may not be any more wrong to hit a ball from the 
 end of a stick — as in billiards — <than it is to hit it from a 
 mallet in croquet; or from a stretched tendon, as in tennis; or 
 from a bat, as in baseball — we do not feel that we have to 
 argue the point, when we remind the reader that billiards and 
 pool, especially in the public parlors, do assemble questionable 
 companions, who use questionable language; while these games 
 are often accompanied by betting, which is always to be de- 
 plored. And so with card playing, we see no greater harm in 
 playing a game of euchre, than a game of authors, as far as the 
 cards are concerned, but your boy and girl, as well as mine, as 
 a rule, have cleaner and purer minds at the home game of 
 authors than is probable in a game of cards in a public place. 
 
 In closing this chapter we have to announce a group of 
 wholesome recreations which may be entered into by our lovely 
 
PLAY AND RECREATION 399 
 
 young people — the man and the woman of tomorrow — whom 
 we one and all wish to keep clean and good and pure; all the 
 while helping them to develop the sense of humor and the ele- 
 ment of play. Such recreations are tennis, golf, croquet, roque, 
 boating, sledding, skiing, bicycling, motoring, horseback riding, 
 and a host of others too numerous to mention. Let us not for- 
 get that ofttimes pursuits such as garden-making and helping 
 the parent in the office or in the home, may be made a great 
 source of enjoyment to the adolescent youth, if they are allowed 
 to earn a small amount of money each week, which they may 
 deposit in the bank. 
 
 We close this chapter " Play and Recreation " with the wish 
 that all, old and young, would develop a greater sense of humor, 
 a greater love for play and recreation, which will increase the 
 health of both mind and body and prevent many nervous dis- 
 orders such as neurasthenia. 
 
CHAPTER XXXIX 
 THE PUNY CHILD 
 
 IN every neighborhood there is to be found the delicate child, 
 and everywhere anxious mothers are putting forth every 
 effort to improve the condition of their puny boys and girls. In 
 carefully looking over the puny child, we see an underweight 
 little creature with pale skin, and as he comes to the table 
 everybody notes that he refuses more or less food. 
 
 DIET AND HYGIENE 
 
 As we give the child a closer examination we find that cer- 
 tain lymph glands are enlarged, possibly adenoids are present 
 in the post-nasal pharnyx, and, in many instances, there are 
 badly diseased tonsils. Usually the puny child is constipated, 
 hands and feet are cold, and he jumps and starts at any unusual 
 noise, thus showing a tendency to nervousness. One of the 
 first things necessary is to take this little one to a good spe- 
 cialist and if necessary have the adenoids and tonsils removed. 
 This having been done, the diet should be carefully looked into. 
 There should be served him for breakfast a generous bowl of 
 dextrinized grains with a good portion of diluted cream, a 
 glass of rich milk, a baked potato, and fruit. For lunch at 
 twelve o'clock he should be given a glass of malted milk with 
 egg, or eggnog, six or eight dates or three or four figs, a hand- 
 ful of pecan kernels, and perhaps a lettuce sandwich. For din- 
 ner at half past five, another nourishing meal of baked potatoes, 
 a protein dish of either cheese and macaroni or eggs or meat, 
 a generous fruit salad, a glass of rich milk, and bread and but- 
 ter, should be enjoyed. 
 
 There is no class of little folks who eat between meals more 
 often than do these delicate children, for mothers painstakingly 
 
 400 
 
THE PUNY CHILD 401 
 
 endeavor to feed these children all they can possibly take; so 
 one mother thoughtlessly went about it something like this: the 
 half past seven breakfast having been only touched — nibbled 
 at — with the ten o'clock hour came this request : " Mother, 
 I am so hungry, I want something to eat." Eagerly the mother 
 prepared either a meat sandwich or a jelly sandwich and pos- 
 sibly a glass of milk. 
 
 When it was time for the twelve o'clock dinner hour, or 
 lunch hour, again the well-filled plate was refused, the appetite 
 having been satisfied at ten o'clock. Having taken very little 
 nourishment at noon, by half past two the plaintive plea again 
 came to the mother ears: "May I have a piece?" and again 
 the well-meaning mother gave him the desire of his heart. So 
 the day passed, the dinner making the fifth time food was 
 taken into the stomach, and in all probability there was eaten 
 a cookie in between. The reader can readily see that the diges- 
 tion was consequently very much disturbed, fermentation oc- 
 curred, decomposition of food took place in the digestive tract, 
 with its result — constipation. 
 
 IMPROVING THE APPETITE 
 
 Not a morsel should pass the lips of any child, and particu- 
 larly our delicate child, between meals. Let him come to the 
 table at half past seven or eight o'clock, and if he does not 
 want to eat tell him frankly that that is all he is to receive until 
 twelve — and stick to it. Nothing more than water or fruit 
 juices should be taken between meals. 
 
 It may be necessary to create an appetite for the three meals 
 we have just described, and as we now take up the outdoor 
 hygiene we would not forget that some simple treatment should 
 be instituted each day in a well-heated bathroom or bedroom. 
 Roller skating or ice skating, hoop-rolling, rope-skipping, and 
 Irish mail, or a coaster, all furnish splendid exercise for the 
 delicate child. Under no circumstances should he be allowed to 
 remain all the time in the house; and so pleasing recreations 
 must be provided for him out of doors. The sand pile should 
 not be forgotten, flower-bed making, raking the lawn, a polished 
 coasting board fastened in a slanting position to an upright 
 
402 THE MOTHER AND HER CHILD 
 
 which can be mounted by means of a ladder, create splendid 
 outdoor sports for these children. 
 
 THE DAILY PROGRAM 
 
 Take the child into a warm bathroom each morning and let 
 him stand in six inches of well-warmed water. With a rough 
 mitten made out of either mohair, crash, or turkish towel, the 
 entire body should now be rubbed until it is pink. This pro- 
 cedure is known as a dry-friction rub. Do not stop until the 
 skin is pink, particularly the arms and legs, for the back and 
 chest usually get pink quickly. Then with simply a cold dash 
 of water to the feet, dry them well and allow him to dress. 
 Twenty minutes before the meal hour, let him get out of the 
 house and roller skate around the square as many times as he 
 can in twenty minutes, or let him race and have a royal good 
 time in the fresh morning air and then after this forced oxygen 
 intake let him come in to breakfast. 
 
 And now for school, and as we say " school," we regret that 
 there are not more " open-air schools." Some day the Ameri- 
 can people, more particularly the American mothers, will 
 awaken to the fact that we need more schools with simply win- 
 dow space rather than so many closed glass windows. Some 
 day we will send our children with sweaters, leggings, stock- 
 inet caps, mittens, even in the cool days of spring and fall, to 
 " open-air schools," and in the cool fresh air they will think bet- 
 ter and work faster and make wonderful progress in both 
 studies and appetites. 
 
 The particularly delicate child, under treatment, will not 
 spend the whole day in school. In all probability the forenoon 
 session only will be attended, after which the half-past-twelve 
 or one-o'clock meal that has been previously described will be 
 given him. Now if the appetite is variable, arrange a little 
 surprise for him by serving this meal on the porch or in the 
 living-room by the open grate, or out under the trees. In all 
 probability such a meal will be taken eagerly, particularly if 
 the mother will read a pretty story. Now the afternoon is to 
 be spent in doing a number of different things. We would 
 like a pleasant walk, a visit to the park, hoop-rolling, roller- 
 
THE PUNY CHILD 403 
 
 skating, rope-skipping, ice-skating, outdoor sliding, anything 
 that will take our little fellow out of doors to increase his 
 oxygen intake until possibly the half-past-three hour is reached, 
 when he should come into the house and lie down and prepare 
 for the treatment for that particular day. 
 
 TREATMENT SUGGESTIONS 
 
 Twice a week he should be given a salt glow (described in 
 the Appendix). Twice a week he should be given a thorough 
 soap shampoo (also described in the Appendix). After each of 
 these baths a special rub should be administered to the spine, 
 and as there is so often spinal curvature in these children, cer- 
 tain stretching movements of the spine are valuable, together 
 with hot fomentations (see Appendix) over the spinal centers. 
 These are wonderful stimulants to the delicate child and should 
 precede the salt glow twice a week. Every afternoon a hot- 
 and-cold foot bath may be given to create a better circulation. 
 The feet are put in hot water from three to five minutes (as 
 hot as can be borne), and then they are quickly plunged into 
 the coldest water obtainable for three seconds, then back "into 
 the hot water, and vice versa, until three changes have been 
 made, always finishing the treatment with the cold dip. On the 
 three remaining days of the week at half past three, the child 
 will simply relax in the hammock or on the porch couch while 
 the mother aids in the relaxation by a pleasant story. We 
 would suggest that on Monday the salt glow be administered; 
 Tuesday a rest is taken; Wednesday the soap shampoo is to be 
 administered; Thursday another rest; Friday a salt glow; Satur- 
 day another rest, and Sunday the shampoo, etc. 
 
 Before going to bed at night, with the mother's hands well 
 oiled with either olive or sweet oil, the circulation is again 
 stimulated by the heavy friction rub. 
 
 Constipation is taken care of along the same lines as men- 
 tioned elsewhere in this book. 
 
 It is surprising to see how often these delicate children are 
 infested by worms, and while a great deal of dependence can- 
 not be put in that single symptom " grinding the teeth at night," 
 or " pallor around the mouth," yet we do believe that many 
 
404 THE MOTHER AND HER CHILD 
 
 a delicate child continues to suffer from worms many years. 
 It is a very simple procedure to obtain a specimen of the stools. 
 A cathartic should be given and after usual free-bowel move- 
 ment, the second time the child desires to go to stool this should 
 be saved and taken to the laboratory for a careful search for 
 worm eggs which are usually in evidence if worms infest the 
 child. The treatment for worms is described elsewhere in this 
 work. 
 
 We have seen scores of young people between the ages of 
 eight and eleven who, before treatment, were pale, listless, 
 under weight, irritable and cross, after three months of such 
 treatment as has been outlined gain six to ten pounds and look 
 as ruddy as their healthiest neighborhood friends. It is per- 
 fectly marvelous to notice how a child will put on from six 
 to eight pounds in a short period, at the same time overcom- 
 ing his irritableness and fretfulness. I am more and more in- 
 clined to believe that most bad children are sick children — 
 are undernourished children — and it behooves us American 
 mothers and fathers to give proper attention to this under- 
 nourished child, call a halt, and devote three months to giving 
 him the help that he needs. He did not ask to come into this 
 world ; and it is " up to us " to give this child what he deserves 
 — for every child in this world has a right to be well born, to 
 be well fed, and to be well reared. 
 
CHAPTER XL 
 TEACHING TRUTH 
 
 WE confidently believe that most of the sex immorality 
 seen in young people is more or less the result of 
 ignorance and curiosity; therefore we most earnestly desire in 
 this chapter to portray so interestingly the beautiful story of 
 life as seen in the vegetable and animal world, that our mother- 
 readers will be seized with the great desire wisely to convey to 
 the young child's mind this sublime and beautiful story. The 
 questions most naturally arising in the mind of the reader at 
 this time are: When shall we begin to tell this story? How 
 shall we tell it? Where shall we begin? Where shall we 
 stop? Realizing full well that the subject is usually handled 
 prematurely and with unpreparedness, we will attempt in this 
 chapter to discuss it with courage and candor, believing that 
 there is a right way, a right time, and a right place to impart 
 this information. 
 
 A LESSON FROM NATURE 
 
 When the little folks are about three or four years of age, 
 when confidence and trust are at their height, they often come 
 to us begging for a " story ; " and this is the golden opportunity 
 for the parent or caretaker to tell them the story of Mr. and 
 Mrs. Corn, and all their little babies ; or Mr. and Mrs. Morning 
 Glory and their little folks. There are a score of other equally 
 interesting and instructive botanical stories which are just as 
 beautiful in their sublimity, and fairy-like in their personality. 
 The little children's eyes grow big with wonder as you tell the 
 story of a whole township of families by the name of Corn (See 
 Fig. 17), who have their residences out in the wide country 
 fields. 
 
 405 
 
406 
 
 THE MOTHER AND HER CHILD 
 
 Ovules 
 Seed Babies 
 
 Fig. 17 
 
 Fig. 18 
 
TEACHING TRUTH 407 
 
 We will first introduce the child to Mr. Corn, the tassel, wav- 
 ing proudly and majestically in the breezes, and seeming to 
 say : " I am master of all I survey." The little fellow is filled 
 with wonderment as he learns how the clouds give up their 
 drops of water to quench his thirst and how the sun smiles 
 upon him to yellow his beard; and how the wonderful all- 
 important pollen is developed and ripened. 
 
 Often the child eagerly asks, " And where, mamma, is Mrs. 
 Corn? " and to that interested upturned face we relate the pleas- 
 ing story of the beautiful silken tresses of Mother Corn. Early 
 in her life she is a beautiful shade of green, and as she thus 
 gracefully hangs out from the ear of corn, day by day the 
 smiles of sunshine turn this mother corn to brown, and then to 
 a still darker shade. 
 
 " And where, mamma, are the babies ? " the child next in- 
 quires; and, as we take the ear of corn, removing the outer 
 clothing — the husks — we find the underclothing, a much 
 lighter shade of green, and here now we are in close contact 
 with the babies themselves — the kernels — and to each little 
 kernel or baby corn we find mamma closely clinging. Here is 
 a beautiful opportunity to teach mother-love and mother watch- 
 fulness, as also the opportunity to draw lessons from the baby 
 kernels sitting there in even rows, with their faces clean, 
 silently contented — just doing their duty. The stories that 
 may be told are limitless, and possibly as interesting as are the 
 myths and fairy-tales, yet all the while as true as truth itself, 
 with no fakery, no legends — just simple truth. 
 
 THE ALL IMPORTANT POLLEN 
 
 Now on a second trip into the cornfield, another story may be 
 told of the important work of the pollen. This " father part " 
 of the plant falls upon the silken tresses of the " mother part," 
 by which the pollen is carried down to the sleeping corn-baby 
 seeds — the kernels. And when the " corn dust " does reach 
 the sleeping seeds a great change begins to take place. This 
 change is known to the adult as " impregnation ; " to the little 
 child it may be presented as " an awakening " of the sleeping- 
 seeds, so that they begin to grow, to develop, to expand and 
 
408 THE MOTHER AND HER CHILD 
 
 push out, until we have the full-grown seeds seen in the deli- 
 cious and juicy roasting ear. 
 
 Sometimes, in the case of the larger plants and trees, Father 
 Tree may be miles and miles away from Mother Tree and so 
 this all important pollen must be carried by the wind or by the 
 bees, and as it blows against the mother part of the plant-flower 
 she catches it and pushes it downward to the seed babies. The 
 wind scatters the pollen of the oak tree, the hazlenut, the wal- 
 nut, the birch, the willow and many others; for, without the 
 good kind wind or the bees, the pollen would never find its way 
 to many a mother flower, and the " fertilization " of the seed 
 could not take place. 
 
 THE MORNING GLORY FAMILY 
 
 Perhaps the story of life can be told as beautifully from the 
 morning-glory as from any other flower. Here the beautiful 
 flower cup is the home of Father and Mother Morning-Glory 
 and all their little babies. (See Fig. 18). 
 
 As we carefully take away their little home, the flower 
 cup, we have left a little green cup, and coming up from 
 the center you will see five little stems, every one of them 
 wearing a hat of powder or pollen and this — if you 
 please — is Papa Morning-Glory. Look closely and you will 
 see coming up from the center of these five stems (stamens) 
 one central stalk without a hat, Mother Morning-Glory, known 
 in botany as the " pistil " ; and as you follow down this pistil 
 you will find an enlarged part at the base, which is known as 
 the cradle-nest — the home of the seed babies. 
 
 Little was known about this wonderful fertilization of the 
 seeds by the pollen two hundred years ago, and a whole cen- 
 tury passed before the secret of the blossom and the bees was 
 discovered; and even then it was not fully realized how great 
 was the work of the bees in cross-fertilization. Nor was it 
 understood that the beautiful blossom of the flower, with its 
 sweet nectar, was an exceedingly important factor in attracting 
 the bees. Another century passed before Darwin gave to the 
 world the story of the great work performed by the bees in 
 cross-fertilization — in carrying the pollen from flower to 
 
TEACHING TRUTH 409 
 
 flower, for it is now a well-known fact that all of the blos- 
 soms visited by the bees produce better fruit and better flowers. 
 In the flower where the father and mother part matures at 
 the same time, self-fertilization is the rule. Cross-fertilization 
 occurs in instances where either the father part or mother 
 part ripen at different times, in these cases the pollen is carried 
 from plant to plant by the wind or by the nectar-seeking bees. 
 These busy bees, with their fluffy little feet and fuzzy coats, 
 become completely covered with this all-important flower dust, 
 and in seeking nectar from other flowers they leave the " awak- 
 ening dust " behind, and thus cross-fertilization takes place ; 
 new types of babies are produced, new generations of fruits 
 and flowers. 
 
 HOW MOTHER NATURE WORKS 
 
 Dr. Chadwick, in her Blossom Babies, gives us a beautiful 
 recital concerning the fertilization of plants, which provides 
 an endless number of interesting stories. The water plants 
 are very interesting in that the pollen is just light enough to 
 float on the exact level of the mother part of the flower, other- 
 wise fertilization could never take place, and there would be 
 no more lovely lilies. Long throated blossoms are fertilized 
 by their attraction for certain moths or humming birds who 
 have long tongues. Mother Nature is exceedingly careful to 
 reproduce her children, and in every conceivable way she 
 sees to it that her plant-seeds are fertilized and distributed. 
 We are all familiar with the dandelion and the thistle and a 
 host of others which fly through the air with actual plumes, 
 some seeds fly with wings, such as the maple ; other seeds travel 
 by clinging or sticking, such as the cockle burr ; still others 
 float and shoot; while we all know about a lot of seeds that 
 are good to eat, such as the nuts and fruits, as well as many 
 of the grains, such as corn, etc. 
 
 An incubator about hatching time is a wonderful object 
 lesson in teaching the story of life. Take the children to visit 
 one and let them actually see the live baby chicks coming forth 
 from the seed-shells. Other wonderful lessons may be drawn 
 from the mother horse or the mother cow; and it is impossi- 
 
410 THE MOTHER AND HER CHILD 
 
 ble to portray the close companionship, the sublime trust and 
 confidence, which exists between the mother and the child who 
 have been bound together by these ties and sentiments of truth- 
 fulness, trustfulness, and frankness. 
 
 THE SALMON FAMILY 
 
 The little fellow is daily learning that everything that 
 grows comes from a seed, even the salmon which was eaten at 
 lunch yesterday was the text for an impressive story about 
 Papa and Mamma Salmon. In the beautiful Columbia river 
 Mother Salmon is swimming about quietly seeking a shallow 
 place in the stream where she may deposit her cluster of baby 
 seeds, which looks very much like a mass of tapioca pudding 
 as they gently sink to the bed of a shallow spot in the river. 
 There they lay " sound asleep " until Father Salmon, swim- 
 ming by, is attracted to the spot and, hesitating, talks something 
 like this to himself : " Why the idea, here are some helpless 
 fish-baby seeds, they can't grow and develop without me, here 
 they are sound asleep ; " and, nestling over them, he contributes 
 the self-same and all important " something " — comparable to 
 the pollen of the plants — which wakes them up. In the case 
 of the fish the " awakening " substance is not in the form of a 
 powder as in the plant world; but is in the form of a semi- 
 liquid mass, much resembling the white of an egg. The little 
 seeds soon begin to tremble — begin to wake up — and then 
 begin to swell and grow and develop. In a few days what do 
 you suppose happens to these little bulging baby seeds? the 
 very same thing that happened to the chick seed — they burst 
 and out come hundreds of cute little fish minnows. In just 
 a few hours they are all swimming about in a most wonderful 
 fish-like manner. 
 
 EARLY QUESTIONS 
 
 Some day you will be surprised by your little child suddenly 
 asking you some such question as this : " Mother, where did 
 I come from ? " while in the same frank manner you reply : 
 " Why from your mamma, of course ; where do you think you 
 could have come from? Everything that grows comes from 
 
TEACHING TRUTH 411 
 
 its mamma — oranges, apples, radishes, cabbages, cats, dogs, 
 and chickies — everything that grows has to have a mamma 
 and papa ; " and they are often satisfied with this answer for 
 a long time. No child should go to kindergarten without 
 knowing that he came from his mother, and this knowledge 
 should come to him from his own mother's lips. These are 
 different days than those in which our grandmothers lived. 
 The spirit of investigation and of inquiry is in the air. The 
 moving-picture show makes it necessary for children of nine 
 or ten to understand these things — to have a knowledge of 
 certain of the conventionalities of life. Twenty years ago this 
 may not have been so necessary — the youth of that day might 
 have waited several years longer for certain phases of his sex 
 instruction. It is highly important that this knowledge be ob- 
 tained from a wise and pure and sympathetic mind — from the 
 child's own parents. 
 
 One mother put her little girl's questions off week after 
 week, saying : " I will tell you when you get older, dear — no, 
 not now, dear; run away, you are not old enough to know 
 such things, you must forget about them." Thus the unpre- 
 pared mother sought to gain time in which to consult the doc- 
 tor or the library. Finally the day came when the mother 
 felt that she was sufficiently wise to answer the query, " Where 
 did I come from," and so with her heart in her throat she 
 approached her daughter, saying : " Come, Mary, mother is 
 going to tell you all about it. I am now ready to answer your 
 question." Imagine her surprise and astonishment when Mary 
 said : " Oh, you needn't mind, mother, Kate told me all about 
 it last week." Now the question in my mind is : how did 
 Kate tell her? How much unnecessary information did this 
 older and experienced Kate put into the pure mind of this inno- 
 cent little girl? 
 
 ONE MOTHER'S AWAKENING 
 
 One mother in a western state — a county superintendent of 
 schools — told us the following interesting story of her own 
 experience, which we think may be of help to some of our 
 mother readers. 
 
4 i2 THE MOTHER AND HER CHILD 
 
 One morning her seven-year old son rushed into the house 
 exclaiming: "Oh, mother, there is a new calf out in the 
 barn, and I know where it came from; I saw a wagon load of 
 calves come by here yesterday, and one of them must have 
 dropped off, for it is right out there in the barn with old Bess 
 this minute." 
 
 The mother was very busy with her papers and her reports, 
 and she let the incident pass with a smile, thinking it was 
 a very pretty little story. A week later the six-year old 
 brother came in saying: " Mother, I think there must have been 
 another wagon load of calves passed by, and one must have 
 been lost off, for old Nell is cleaning up a little calf out in 
 the barn for all she is worth," while the older brother piped up : 
 "Sure, it was another load of calves; that is just exactly the 
 way the other calf got here;" and the two little fellows went 
 off to school. 
 
 About a month later that county superintendent suddenly 
 became a much wiser mother than she was before, although 
 her heart was made to ache. Both boys came home from 
 school one day and the older one met her with something 
 like this : " I am mad ! I've been lied to ; all the fellows at 
 school say I have, and they are making sport of me, too," and 
 with a glare in his reddened eye he continued, " You know 
 that new calf did not come off that wagon; you know that 
 calf came from old Bess herself; all the fellows say so at 
 school, and they are making all kinds of fun of me, and I 
 don't want to go back. I'd like to run away from home." 
 The mother quietly drew the boy to her side and reminded him 
 that she had simply listened; that she had not opened her 
 mouth; that he came into the room and told about the incident 
 himself, but this did not satisfy him. He turned to her wounded 
 and crushed, saying: "Well, you let a fellow believe it, and 
 that's just as bad;" and this educated mother — this trusted 
 custodian of a county full of school children — beseeched me to 
 warn mothers everywhere to teach their children the truth, 
 and to never let a child go to school with a sex misunderstand- 
 ing. She told me that it took her six months to get that boy's 
 confidence back again. 
 
TEACHING TRUTH 413 
 
 don't get shocked 
 
 I believe that many mothers make the sad mistake of show- 
 ing the child that they are shocked by trivial sayings and tri- 
 fling experiences of their little people. If we could only get 
 it into our heads for once and for all that our children are 
 born into this world veritable little thieves and falsifiers, as 
 well as adventurers and explorers, we would then cease being 
 so shocked and outraged by their frank statements of what 
 they have heard or have done. Let the mother listen to all these 
 things with calmness, while she seeks to direct the child's mind 
 in pure and elevated channels — to help him upward by im- 
 parting "precept upon precept; here a little and there a little." 
 
 Children will come in with stories that at first thought do 
 greatly shock the parent; but under no circumstances should 
 the boy or girl discover that the parent is shocked, for if he 
 does he will not likely come again with another such " shock- 
 ing " difficulty. One mother told me that her seven-year-old 
 boy, beginning third grade, came into her bedroom one morn- 
 ing saying: "Mother, I am just busting to say something," 
 and this mother very wisely said, " Well, say it ; certainly I 
 don't want you to burst," and she told me that this boy whis- 
 pered to her three of the filthiest words that he could possibly 
 have heard on the streets. In relating this experience to me 
 she said : " Do you know, doctor, that I really did not know 
 what to think at first, but I remembered that you had taught 
 me never to be shocked, and so I looked up and asked : " Do 
 you feel better?" whereupon he breathed a big sigh and 
 exclaimed: "What a relief! I have just been busting to say 
 that to somebody." Mother, to whom would you rather he 
 would say these things? to you, or to some little girl out on 
 the street, or to some older boy? Think what trouble and 
 possible mischief were avoided by whispering into the sympa- 
 thetic ear of mother. This wise mother turned to that little 
 boy and said: "Son, that ear is always waiting for just such 
 things and whenever you feel like saying something — like 
 getting it off your mind — you just come to me;" and he 
 came repeatedly. One time he came in saying : " I don't 
 know whether you want me to play with Harold or not ; he does 
 
414 THE MOTHER AND HER CHILD 
 
 some of those things you told me about the other day." And 
 the mother thoughtfully and wisely looked up and said : " Did 
 he do it in front of his mother? Why of course he didn't. 
 " Did he ask you to go into the bedroom or bathroom and lock 
 the door?" and the little fellow quickly answered: "Why 
 sure he did; how did you guess it?" and added "now I sup- 
 pose you are not going to let me play with him any more," 
 and this wise mother, knowing that if she denied him this 
 privilege that it would quite likely be frequently sought, said: 
 " Why, certainly play with Harold in the open, but whenever 
 he suggests secrecy — " she did not have time to finish the 
 sentence, the boy said: " I am wise; whenever he gets to doing 
 that ' funny business ' I'll skiddoo." The confidence between 
 that mother and son, to my mind, was wonderfully sublime — 
 all the while practical and helpful in his daily training. 
 
 don't repulse the child 
 
 A little older child sees the fowls, the dogs, or the cats, 
 " mating," and then, rushing into the house, inquires what it 
 is all about; and unless the mother is on her guard some older 
 member of the family may show surprise and thus thought- 
 lessly convey to the child's mind that his question is improper 
 and entirely out of place. To the question, " What are they 
 doing, mamma?" quietly answer, "Just mating, dear, just as 
 the flowers mate; everything that lives or grows comes as the 
 result of mating." 
 
 Suppose that you were repulsed every time you approached 
 a dear friend, your husband, or some other member of the 
 family? Take, for instance, the matter of a caress or an 
 embrace — how would you react to repeated rebuff? And 
 so with the little child; he comes into this world full of confi- 
 dence and trust, full of wonder and curiosity; possessed with 
 the spirit of exploration and investigation — everywhere and 
 all the time he asks questions. Usually, his questions are 
 answered thoughtfully and without hesitancy, except along the 
 line of one thought — that of sex. Do not think for one 
 moment that he is satisfied by your evasive answers. You 
 have but to recall your own childhood experiences, and 
 
TEACHING TRUTH 415 
 
 remember that today the moving picture show and general 
 public sentiment has placed the age for such knowledge from 
 one to five years earlier in this generation than in the past. 
 I do not care what the child comes into your presence with, 
 be it the most shocking thing in this world, do not under any 
 circumstances let it disturb your mental poise, or raise your 
 ire or shock you ; for if you do, then and there — at that 
 moment — occurs a break in the sublime confidence which the 
 child reposes in you. 
 
 NECESSARY MORAL TRAINING 
 
 While we are using the plant and animal world as object 
 lessons in teaching our children the facts of sex and the secrets 
 of life; while we face the commonplace sex matings of the ani- 
 mals about us without cringing, without appearing to be 
 shocked when our children call attention to these things; 
 nevertheless, when the child is old enough to take cognizance 
 of these phenomena, he is old enough to begin to receive some 
 definite instruction from his parents regarding the moral phase 
 of these great biologic problems. We cannot safely and indefi- 
 nitely utilize the animal world as an object lesson in sex edu- 
 cation, without at the same time emphasizing the moral differ- 
 ence between man and the beast. 
 
 Many parents treat these sex problems so lightly and en- 
 deavor to act so naturally and unconcerned about these ques- 
 tions, that the child comes to look upon the promiscuous sexual 
 relations of the animal world as something altogether natural; 
 and, unless proper moral and religious training is carried on 
 at this time, he stands in danger of coming to regard lightly 
 the moral standards of modern society. 
 
 At the same time of life that Mother Nature fully develops 
 the sex instincts — at adolescence — she also awakens the relig- 
 ious emotions; the one being so necessary for the proper and 
 adequate control of the other. Let parents take a cue from old 
 Mother Nature, and at the same time the sex relations of ani- 
 mals are freely discussed with the growing child, let the mother 
 or father wisely call attention to the fact that but very few 
 of the animals live family lives as do human beings. In this 
 
416 THE MOTHER AND HER CHILD 
 
 connection valuable use — by way of illustration — can be 
 made of the ostrich and some of the ape family who are loyal 
 and true to their chosen companions. 
 
 Moral and religious instruction must accompany sex-hygiene 
 teaching just as soon as you leave the realms of botany and 
 enter the sphere of zoology. We could here relate many a 
 tragic experience which our patients have passed through as 
 a result of volunteering too much sex knowledge and at the 
 same time neglecting this very necessary moral instruction. 
 
 SANTA CLAUS AND THE STORK 
 
 We must bear in mind that the child believes what we tell 
 him; he trusts us implicitly and we owe it to him to teach him 
 the truth in answer to his numerous questions. We must 
 keep his confidence. Take the matter of Christmas, for 
 instance. How many confidences have been broken over the 
 falsehood of Santa Claus and the chimney. Two little fellows 
 hesitated in their play in the back yard, and the following 
 conversation was heard : " You know that story about Santa 
 Claus is all a fake." " Sure it is, I know it isn't so, I saw my 
 father and mother filling the stockings. You know that stork 
 story is all a lie too, there's nothing to it, babies don't come that 
 way, and now I'm investigating this Jesus Christ story, I sup- 
 pose that's all a fake too." The fact of the matter is, that 
 while these children have discovered the truth of the first two 
 stories, for a long time they will query the third story, for to 
 them, that too is mysterious and fairy-like. They hadn't seen 
 Santa or the Stork and had only heard about Jesus. 
 
 STORY OF THE HUMAN BABY 
 
 The story of the human baby may be told to any child of 
 seven to ten years. Each mother will have to decide in her 
 own mind the right time to go into the details of the human 
 baby seed. The child should have had an opportunity to have 
 planted some seeds in the ground, to have visited an incubator, 
 or to have visited the farm and observed the family groups of 
 babies — the chicks, pigs, calves, etc. — with their mothers. 
 
 Let me see now how many different baby seeds do we know? 
 
TEACHING TRUTH 417 
 
 Yes, we do know the radish seeds, many flower seeds, chicken 
 seeds, bird seeds, corn, potatoes, and many others, and we can 
 tell them all apart. The boy and girl baby seeds are too tiny 
 to be seen with the eye. They are so small that it takes about 
 two hundred of them in a row to make one inch. We can 
 only see these human baby seeds with the aid of a microscope. 
 It is such a precious seed that it cannot be intrusted to the 
 ground or to a tree nest for development. The great Wise 
 Father decided that a mamma would love and care for it bet- 
 ter than anything or anybody in all the world. So, just as 
 there is a cradle bed in the mamma flower, so there is in the 
 human mother's own warm body, tucked far away from the 
 cold rains and the hot sun, a little bed, for the boy and girl 
 baby seeds. Right near to this little seed bed Mother Nature 
 has prepared a little room, which holds the tiny " waked up " 
 seed for nearly a year as it slowly grows into a little baby girl 
 or baby boy. 
 
 THE MATING STORY 
 
 You remember the story of how Bob Robin found Jenny 
 Robin, don't you? You remember mamma told you how Bob 
 came up from the southland early in the spring and asked 
 Jenny in lovely bird song to come and be his very own wife? 
 How he promised her he would feed her on cherries, and cur- 
 rants and the fattest of worms? And that she told Bob she 
 loved him and went to live with him, and how they built that 
 cute little nest to hold the eggs; and how Jenny Robin sat on 
 the nest until the little baby robins were all hatched out. 
 
 Well, one day papa found mamma. He met her and loved 
 her dearly and told her he wanted her to come and live with 
 him, and they built their home nest and were very happy 
 together, because they decided they would always love each 
 other more than any one else in the world. After mamma 
 and papa built their home and lived together, one day a won- 
 derful change came to one of the baby seeds and it awakened 
 and began to grow. Mother Nature whispered to it, and told 
 it how to find its way into this little room and there it clung 
 to the wall and grew for nearly a year. Papa brought mamma 
 
418 THE MOTHER AND HER CHILD 
 
 nice things to eat, just as Bob Robin did Jenny. Papa did 
 everything he could to make mamma happy and comfortable. 
 For nearly five months this little seed just grew and did not 
 let anybody know it was there, until one day it began to tap 
 against the sides of the walls of this little room, and every 
 time it did mamma's heart just bounded with joy as she thought 
 of the precious seed growing to be a darling baby — and all 
 inside of her very own body. And one day, after nearly a 
 whole year had passed, the door to the room began to open, and, 
 very soon, a lovely baby found its way out of this special room 
 into the big, big world. Mother Nature then told this little 
 baby that it might still remain close to the mamma it had been 
 with so long, and so she taught it how to get its food every 
 day from mamma's breast. At this point the child usually 
 breaks out by saying, " Now, mamma, I know just why I love 
 you so much." 
 
 UNFOLDING THE TRUTH 
 
 I shall always remember with pleasure my own son, not quite 
 two-and-a-half years old, who sat at the table one day asking 
 numerous questions such as, " Mamma, what is that ? Mamma, 
 where did that come from?" etc. 
 
 He picked up a navel orange, and pointing to the navel said, 
 "What is that?" 
 
 I frankly said to him, " Why, my dear, that is the baby 
 orange." 
 
 " Why, Mamma," he exclaimed, " do oranges come from 
 oranges ? " 
 
 "Certainly, dear child; where else could they come from?" 
 
 " But," he says, " Mamma, do potatoes come from potatoes? " 
 
 " Why, honey," I said, " Orange babies come from orange 
 mammas, potato babies from potato mammas, grapes come 
 from grape mammas, little kitties from kitty mammas, and lit- 
 tle boys from their mammas." 
 
 We simply mixed all the babies up, just as you would mix 
 up a delicious fruit salad. We took from the mind all ques- 
 tion of mystery and surprise by quickly and honestly answering 
 his question. Thus, his first knowledge of his origin, if he is 
 
TEACHING TRUTH 419 
 
 able to recall it, will ever be associated with oranges, grapes, 
 potatoes, kittens, etc. 
 
 We did not tell the whole story for some two or three years 
 later, but day by day we simply answered the questions as he 
 asked them. 
 
 One day, when he was about three, he burst into my bed- 
 room, saying, " Mamma, dear, I did come from you, didn't I ? " 
 
 "Why, yes, darling, from nobody else; just from your own- 
 mamma and papa." 
 
 " Say, mamma, was my hand in your hand, my foot in your 
 foot, my head in your head? " 
 
 " No, dear," I replied, " You were all curled up as snug as 
 a little kitty is when it's asleep, and you slept for nearly a 
 year in a little room underneath mamma's heart." 
 
 It was a wonderful story. He threw his chubby arms about 
 my neck, his legs around my waist, and said : " You dear, 
 dear, mamma. I do love you and papa more, just awful 
 much." 
 
 THE DOCTOR'S PART 
 
 In my private sitting-room, where William and I have had 
 many conferences, there hangs my medical-class picture with 
 classmates and faculty. A member of my family was one day 
 answering the boy's queries as to who this one or that one 
 was, etc. Finally, on pointing to one particular face, the 
 answer came to his inquiry, " That's Dr. P. You wouldn't 
 be here if it wasn't for him. That evening the little fellow, 
 just past three years, came to me and asked, " Mamma, didn't 
 you say I came from you?" 
 
 " Yes, dear," I replied. 
 
 " Well, Auntie says I wouldn't be here if it wasn't for Dr. 
 P. What did the doctor have to do with it ? " 
 
 " Why, simply this, dear. The door to the little room in 
 which you grew in mamma's body wouldn't open, and so kind 
 Dr. P. came and helped open the door." 
 
 " And let me out? " exclaimed the eager child. " Oh, I want 
 to go and see Dr. P. and thank him for helping me out ! " 
 
 And this little fellow was neither shocked or surprised, any 
 
420 THE MOTHER AND HER CHILD 
 
 more than he was over finding out that orange babies came 
 from orange mammas. 
 
 In the same frank manner in which the simpler questions 
 are answered, strive to answer these important ones. If we 
 seek to evade, to postpone, to wrap in mystery these sex ques- 
 tions, the little ones will not forget but will ponder and worry 
 over them, and seek to obtain certain knowledge from others 
 who oftentimes tell too much or too little, and such informa- 
 tion is usually mixed with much unnecessary matter which 
 may or may not be foreign to this particular subject. On the 
 other hand, if we frankly and honestly answer the question at 
 hand, curiosity is avoided and the child feels he understands 
 it all. The subject drops into the background of his mind — 
 into the marginal consciousness — with the countless other 
 facts he has accumulated. A sense of " knowledge posses- 
 sion " is as comfortable to the child as it is to the adult. 
 
 TRUSTING YOUR CHILD 
 
 Often the question arises: "Will they tell to other children 
 this newly found knowledge? " If the wise mother makes them 
 feel they are a part of a " family," and reminds them that 
 such matters as the secrets about Santa Claus, the stork, and 
 the baby nest are only discussed in " family groups," they are 
 often seized with the normal pride which accompanies confi- 
 dence, and often keep secrets as well or even better than do 
 most adults. 
 
 One day a little man, three-and-a-half years old, was posing 
 for a photograph. The photographer said : " My little fellow, 
 you pose well. We've had such a good time together. Where 
 did they get such a lad as you ? " 
 
 The mother's heart stood still. From her hiding place behind 
 a large curtain at the back of the studio, she listened, wonder- 
 ing what would be his answer. 
 
 At first he hesitated, but after a moment's pause, said: 
 " Really, Mr. W. if you don't know I feel sorry for you, and 
 I'd really like to tell you, but I can't, it's a secret between me 
 and my mamma." 
 
 Children enjoy secrets. If possible, isolate a group of sub- 
 
TEACHING TRUTH 421 
 
 jects that are not to be discussed with playmates, such as 
 Santa Claus facts, the stork story, and the baby story; often 
 the very isolation of one single fact stands out so big in the 
 child's mind that he is many times tempted to mention it, when, 
 if it were associated with a whole group of " family secrets " 
 he would seldom be led to talk about it. As we have said, 
 children can keep secrets much better than most adults; and 
 just suppose they should tell something — what harm? With 
 twenty-five false stories in the neighborhood, suppose one story 
 of truth should escape ! No particular harm would result ; but 
 I find they keep these secrets well. 
 
 Numerous questions will arise which should be met with open 
 frankness. No blush, no shame, should even suggest itself, for 
 we are dealing with a wonderful truth, so let us give out our 
 answers with clean hearts and pure minds. The Great Father 
 will bless us and surround our loved " flock " with a garment 
 of confidence in mother and father that will protect from 
 much of the evil which is in the world, and, eventually, our 
 little ones will grow into men and women whose very life of 
 purity will cast its influence into the social circle. Only 
 the company of the good and the true and the pure will be 
 sought when associating with the opposite sex; while, in the 
 end, better mothers and better fathers will be developed for 
 the work of the next generation. 
 
 TEN POSSIBLE CAUSES OF SECRET VICE 
 
 1. The attention of the little folks is often drawn to the 
 sexual organs by a sensation of itching which accompanies a 
 state of uncleanliness and filth. The genitals must be kept 
 scrupulously clean. Elsewhere in this book we paid our 
 respects to the rubber diaper, and we wish to reiterate at this 
 time that it is in all probability responsible for a great deal 
 of masturbation. The constant moisture and heat keeps the 
 genital organs in a state of congestion which is more or less 
 accompanied by itching sensations. 
 
 2. A long or tight foreskin in the male child favors the 
 accumulation of secretions which not only occasion itching sen- 
 sations but oftentimes are the cause of convulsions in early 
 
422 THE MOTHER AND HER CHILD 
 
 infancy. In the case of the female, a tight foreskin over 
 the clitoris will retain secretions which also cause an itching 
 sensation. 
 
 3. Unscrupulous nurses sometimes actually teach these little 
 fellows to masturbate. 
 
 4. Lying in bed on the back with a full bladder, in the case 
 of the boy, often produces an erection of the penis, and this 
 is usually accompanied by a feeling of fullness which serves 
 to direct the mind to the genital organs. 
 
 5. Lying in bed alone with nothing to do but to investigate 
 often results in secret vice. 
 
 6. The unwise practice of allowing children to visit each 
 other over night and sleep together, is often productive of 
 mischief. 
 
 7. Constantly telling a little girl to keep her feet down, to 
 keep her dress down, makes her over conscious of sex and 
 otherwise causes the attention to be directed in unhealthy 
 channels. 
 
 8. Teasing a child unnecessarily about a little sweetheart 
 often produces an emotional reaction which is not altogether 
 desirable. These suggestions are especially bad in the older 
 children. 
 
 9. Unwise sex knowledge is usually productive of curious 
 investigations, which if not properly followed up, particularly 
 in those children who are temperamentally secretive, and who 
 do not fully confide in mother and father, often results in 
 moral misdemeanors. 
 
 10. Do not allow two young children habitually to isolate 
 themselves in their play. Direct their play away from the 
 attic, the basement, and other places remote from direct obser- 
 vation. 
 
 There is no use telling a child not to touch that part of his 
 body, particularly if it is a boy, for it is going to be absolutely 
 impossible for him to carry out such instructions. One mother 
 overheard her caretaker say, " Don't put your hand there, it 
 isn't nice." Immediately the wise mother called the caretaker 
 to her and reminded her that most children usually continue 
 to investigate even though they are told not to, and so the care- 
 
TEACHING TRUTH 423 
 
 taker received this instruction : " When you see Harry putting 
 his hand to that particular part of his body, just gently draw 
 it away and divert his attention to something else, and when 
 he goes to sleep in his little bed teach him to lie on his side 
 and bring his little hands up under his chin or the side of his 
 face and remain near him telling him a beautiful story until 
 the eyes begin to get sleepy and pick him up immediately on 
 awaking in the morning." 
 
 This mother was quite unlike the mother who once came to 
 my office, saying : " Doctor Lena, I have done everything to 
 prevent my boy's handling himself, why every time he wakes 
 up at night I am always awake and I instantly say to him, 
 Charlie where are your hands? You see Doctor, I am doing 
 the best I know how." Very likely it is unnecessary to call 
 the attention of the reader to the fact that this mother was 
 doing more harm than good in constantly calling his attention 
 to the fact that he did have a sexual side to his nature. 
 
 TRUTH VS. EXAGGERATION 
 
 And just here let us add that while masturbation is an 
 unclean habit, an impure habit, and a thing altogether to be 
 shunned, we would not be honest to ourselves and to our 
 readers if we did not explain that under no circumstances 
 does it make foolish minds out of sound minds or insane 
 minds out of sane minds. If your boy or your girl is going to 
 grow up to be foolish or insane he had a through ticket for 
 the feebleminded institution or the insane asylum when he 
 was born into the world. The time when masturbation does 
 affect the mind of the child is when the mind awakens to the 
 fact that it is allowing an abnormal, unclean, or filthy habit 
 to dominate mind, soul, and body, and then, and usually not 
 until then, does this bad habit begin to cause mental depression 
 and a host of other symptoms that so often accompany mas- 
 turbation. 
 
 In our worthy efforts to combat the evils of secret vice let 
 us not go to the other extreme and create such a condition of 
 mind in the youth of our generation as to lay the foun- 
 dation for sexual neurasthenia later on in life, as a result of 
 
424 THE MOTHER AND HER CHILD 
 
 the protracted worry, constant brooding, and conscientious con- 
 demnation, which they so often experience following some 
 brief or trivial indulgence in early secret vice. Let us fight 
 this vice with the truth, and not resort to over-exaggerated 
 pictures which can only serve to blight the hopes and destroy 
 the courage of over-sensitive boys and girls after they have 
 grown up — as they look back on their lives and recall perhaps 
 a single misstep in their childhood. In this way we can hope 
 to do good today without mortgaging the child's happiness 
 and mental peace in years to come. 
 
APPENDIX 
 
APPENDIX 
 
 BATHS USED TO REDUCE FEVER 
 
 1. The Sponge Bath. The child, completely undressed but 
 loosely wrapped in a wool blanket, is placed on a table so that 
 the mother or a nurse may conveniently stand while administering 
 the bath. Close at hand have a number of soft linen towels and 
 a large bowl of tepid water which may or may not contain a 
 small amount of alcohol, witch-hazel, salt, or vinegar, according 
 to the doctor's directions. The upper portion of the body is 
 partially uncovered and the tepid water is applied with the hands 
 to the skin surface of one arm. The hands may be dipped in 
 water from one to four times, thus making repeated applica- 
 tions of the water to the arm. These are followed by careful 
 drying — patting rather than rubbing. The other arm is now 
 taken, then the chest, then the back and last the legs. 
 
 2. The Wet-Sheet Pack. Two light-weight wool blankets are 
 folded to fit the child; they should extend eighteen inches below 
 the feet and should be wide enough to lap well in front. A sheet 
 just large enough to envelop the body is then wrung out of 
 cold water and spread out over the woolen blankets. The fever- 
 ish child is entirely disrobed and is placed on the wet sheet, 
 which is quickly wrapped about the body, over the chest, under 
 the arms, and between the legs — coming in contact with the 
 entire skin surface. The dry blankets are quickly brought 
 around and tucked snugly about the patient. This is a cooling 
 wet-sheet pack and will often so relieve the nervousness and 
 irritability of a feverish child that he will go to sleep in the 
 pack. In the very young child, under two years, it is important 
 to put some accessory warmth to the feet such as a warm-water 
 bottle — not hot. The effect of this pack is very quieting, and 
 is indicated when the temperature of the child reaches 103 F. 
 or more. 
 
 427 
 
428 THE MOTHER AND HER CHILD 
 
 3. The Graduated Bath. This is usually administered in a 
 large bathtub and is beneficial in the fevers of the older chil- 
 dren. The temperature of the water should be one or two 
 degrees higher than the body temperature, for example — if 
 the child's temperature is 103 F. then the bath starts out with 
 a temperature of 104 or 105 F. The temperature is then grad- 
 ually lowered, about a degree every two minutes, until it reaches 
 92 or 90 F. A helper should support the head while the mother 
 or nurse briskly rubs the entire skin surface of the body. This 
 friction greatly facilitates the fever-reducing work of the bath 
 because it brings the blood to the surface where it is more 
 readily cooled by the bath. This bath should last ten or fifteen 
 minutes. 
 
 4. The Hot Sponge Bath. Often, in combating the high fever 
 of typhoid, the hot sponge bath is valuable. The hands are 
 dipped in water just as hot as can be borne and are applied to 
 the chilly, mottled skin which is so often seen in high fever. This 
 bath is administered just as is the tepid sponge bath. Evapora- 
 tion is allowed to take place to some extent by delaying the dry- 
 ing. In this instance the child should be wrapped in a warm 
 wool blanket with only a portion of the body exposed at one 
 time. 
 
 5. The Hot-Blanket Pack. The hot-blanket pack is indicated 
 at the onset of many fevers such as in typhoid, grippe, pneu- 
 monia, etc. Like the wet-sheet pack, the blankets are spread 
 upon the bed, abundant accessory heat is applied- — such as a 
 half-dozen hot-water bottles. In the absence of these, glass 
 jars or hot ears of corn may be utilized. Hot bricks or hot 
 stove lids wrapped in paper are also serviceable. A blanket, in 
 size to suit the individual (an adult would use a full single 
 blanket, a child one-half of a single blanket), is wrung very 
 dry from boiling water. This may be done by the means of a 
 wash wringer, or two persons grasping the blanket by its gath- 
 ered ends may so twist it that it looks very much like an old- 
 fashioned twisted doughnut. The twist is now lowered into 
 boiling water, and as each pulls the twist wrings itself. This is 
 at once quickly spread out so as to let the child lay on the 
 center, and then the hot sides are brought in contact with the 
 
APPENDIX 429 
 
 skin, just as in the wet-sheet pack. The dry blankets are now 
 brought quickly and snugly about the child. Just outside the 
 second dry blanket the accessory heat is placed to the sides of 
 the trunk, the sides of the thighs, and one at the feet. A 
 wrapped stove lid or a hot-water bottle is placed over the 
 pelvis and one under the back. Cold cloths are put on the face 
 and around the neck, and these should be changed every three 
 minutes. This pack continues for fifteen or twenty minutes, at 
 the end of which time the accessory heat and the wet blanket 
 are removed and the patient is cooled off by a cold mitten fric- 
 tion, a saline rub, a witch-hazel rub, or an alcohol rub; or the 
 patient may be placed in a tub of water, temperature 98 F., 
 after which he should be carefully dried off. 
 
 6. Sweating Baths. Another bath which is effectual at the 
 onset of grippe or pneumonia is the sweating bath. The bowels 
 should have moved some time before the treatment. Have ready 
 a large bowl of ice water, two turkish towels, one sheet, and 
 four wool blankets. The bathtub is now filled with water at the 
 temperature of 100 F. ; which is quickly raised up to 103 or 
 104 F. Ice-water towels are applied to the head, neck and heart. 
 The patient remains in this bath for about ten minutes, after 
 which he steps out and at once gets into the four hot, dry 
 blankets previously spread out on the bed. No time is lost, the 
 patient is quickly wrapped in the hot blankets and sweating 
 continues for twenty minutes. The covering is now loosened 
 and gradual cooling takes place. It is well to go to bed at once. 
 
 TONIC BATHS 
 
 1. The Cold Mitten Friction. The cold mitten friction is a 
 bath that is applicable to any condition where the child or adult 
 needs " toning up." It should always be preceded by heat to the 
 feet. The following articles are necessary. Four or five turkish 
 towels, a warm wool blanket, a hot-water bottle for the feet, 
 a bowl containing water, a generous piece of ice, and a rough 
 mitten without a thumb. The patient's clothes are removed 
 and he is wrapped in the warm blanket with heat to the feet. 
 One part of the body is taken at a time, first the arm, then the 
 other arm, then the chest, the abdomen, one leg, the second 
 
430 THE MOTHER AND HER CHILD 
 
 leg, and last the back and the buttocks. A dry turkish towel is 
 placed under the part to be treated, and after the mittened hand 
 is dipped in ice-water, brisk short friction strokes are given to 
 the arm until it is pink. Several dippings of the mitten in ice- 
 water are necessary. One cannot be too active in administering 
 this bath. Slow, Delsarte movements are entirely out of place 
 at this time. Action — and quick action — is a necessity. No 
 part of the child's body is left until it is pink. It is an invigor- 
 ating tonic bath and is indicated in all conditions of low vitality, 
 functional inactivity, puniness, rickets, etc. 
 
 2. The Salt Glow. Fill the bathtub half full of warm water, 
 temperature ioo F. Slightly moisten one quart of coarse salt. 
 Stand the patient in the water, placing one foot on the side 
 of the tub while you rub the entire leg with the salt until it is 
 very pink. The other leg is treated in the same manner, as also 
 are the arms, abdomen, chest, and last, the back. By this time 
 he will be all aglow from head to foot. Rinse off the salt, and 
 give him a cold dash with the hands or a spray. 
 
 THE NEUTRAL BATH 
 
 Fill the tub with water at just 97 F., and remain in the bath 
 for twenty minutes or more, with the eyes covered, all the while 
 maintaining the temperature at 97 F. Dry gently with a sheet 
 to avoid exertion and exposure. Go at once to bed. 
 
 FOMENTATIONS 
 
 Hot fomentations often relieve suffering and are indicated 
 in such conditions as menstrual pain, abdominal cramps, colic, 
 backaches, etc. A good substitute for fomentations may be 
 given as follows : Fill a hot bag half-full of boiling water. 
 Over this place a wet flannel and two layers of dry flannel. 
 Apply for fifteen or twenty minutes over the skin area to be 
 treated, finishing up with a cold water or alcohol rub. 
 
 A very effectual way of applying moist heat to any portion of 
 the body is by the means of hot fomentations which are given 
 as follows : 
 
 One-fourth of a single woolen blanket (part cotton) is folded 
 and grasped at the ends and twisted like an old-fashioned dough- 
 
APPENDIX 43i 
 
 nut. The twist is then immersed in boiling water, the hands 
 still grasping the dry ends, and then by simply pulling out the 
 twist (widely separating the hands) the fomentation wrings 
 itself. This is placed steaming hot over the affected area which 
 has been first covered by a dry flannel. It is allowed to remain 
 on for three or four minutes, and then another hot one wrung 
 from the boiling water replaces the cool one. About four or 
 five such applications are made. The skin should be very red 
 at the close of this treatment. It is finished up with a quick, 
 cold application to the reddened skin area. 
 
 THE SOAP SHAMPOO 
 
 The undressed child is placed upon a low stool in the half- 
 filled bathtub at 100 F. with the feet in the warm water. A 
 good lather is applied all over the body with good friction by 
 the means of a shampoo brush and soap. He is then allowed 
 to sit down in the tub and splash about all he pleases, rinse the 
 soap off and allow him to have a good time generally. At the 
 close of the treatment the water is cooled down and the treat- 
 ment is finished with a brisk rub with the hands dipped in cold 
 water. The skin of the child should be pink at the close of the 
 treatment. 
 
 MOIST ABDOMINAL BANDAGE 
 
 The moist abdominal bandage is indicated in such condi- 
 tions as kidney inflammation which is so often seen in the second 
 week of scarlet fever; or in congestion of any of the internal 
 organs such as the liver, the stomach, intestines, etc., and is 
 applied as follows : Spread out the flannel bandage and over it 
 place the mackintosh. Wring dry the cotton strip from cold 
 water, and spread it over the mackintosh. Wrap all three layers, 
 the wet cloth next the skin, closely about the body, so as to pre- 
 vent the air from getting under it. Be sure that the feet are 
 warm while adjusting the bandage. In the morning remove 
 the bandage, and rub the skin briskly with a turkish towel 
 dipped in cold water, until the skin is pink and dry. The 
 cotton strip should be boiled every other day to avoid skin 
 eruptions. 
 
432 THE MOTHER AND HER CHILD 
 
 HEATING COMPRESS 
 
 The heating compress is indicated in the following cases: 
 Sprained ankles, rheumatic joints, arthritis, sore throat, etc. 
 Directions: Wring two thicknesses of cheesecloth from cold 
 water, place over the painful part, and quickly cover with a 
 mackintosh and two thicknesses of woolen blanket bandage. 
 On removing in the morning, sponge with cold water or 
 alcohol. 
 
 MUSTARD PASTE 
 
 In the bronchitis of small children, particularly babies, 
 mustard pastes are to be preferred to the hot fomentations 
 which are used to such great advantage in children above ten. 
 The mustard paste is administered as follows : One part of 
 mustard and six parts of flour of the same measurements are 
 quickly stirred up with warm water to a paste thin enough 
 to spread well upon a piece of thin muslin, which is large 
 enough to cover twice the part to be treated. One-half of this 
 muslin is thus covered with the mustard and the dry piece of 
 cloth brought over. The edges are then folded in such a way 
 that the mustard will not run out. This is applied to the affected 
 part and allowed to remain for seven minutes on an infant, 
 nine minutes on a child, and ten or twelve minutes on an adult. 
 It is then removed and the moisture which is always seen 
 on the reddened skin surface is not wiped off but talcum powder 
 is sprinkled on thickly to absorb it. If this is done, a mustard 
 paste may be repeated every two hours if necessary and no 
 blistering or other harm will come to the skin. 
 
 THE OIL-SILK JACKET 
 
 The oil-silk jacket is used in bronchitis of babies and chil- 
 dren. It consists of three layers, the innermost layer of cheese- 
 cloth, the middle layer of thin sheet wadding, and the outer 
 layer of oil-silk. This jacket should comfortably cover the 
 chest, front, and back; it has no sleeves, and is opened on the 
 shoulder and under the arm. It should always follow the 
 mustard paste in bronchitis. There should always be two 
 
APPENDIX 433 
 
 such cheesecloth and cotton jackets with the oil-silk covering 
 so they may be changed every twelve hours, thus allowing for 
 airing. 
 
 STEAM INHALATIONS 
 
 1. Steam inhalations are indicated in hoarseness and bron- 
 chitis. They may be given in a number of ways. Perhaps 
 that most convenient for the young infant is the " bronchitis 
 tent." A sheet completely covers the crib, and, with the bed 
 amply protected with rubber sheeting or an extra blanket, steam 
 is allowed to enter under the sheet at the foot of the bed from 
 a funnel put into the nose of the teakettle. The steam should 
 continue for seven or eight minutes. 
 
 2. A large, heavy-paper funnel is put in the nose of the 
 teakettle which is boiling on the gas range. The mother holds 
 the child in her arms while she is enveloped with a sheet which 
 also includes the funnel. A helper carefully guards the flame. 
 The mother and baby may thus conveniently get the steam 
 with very little difficulty. 
 
 3. For the older child or adult, steam inhalations are to be 
 had from the ordinary croup kettle or from a twelve- or four- 
 teen-inch tin can which is filled two-thirds full of boiling 
 water. Over the top is loosely spread a cheesecloth upon which 
 a few drops of compound tincture of benzoin or eucalyptus are 
 sprinkled. The opened mouth is brought near the top of this 
 can and a towel is thrown over the head, can and all; the 
 patient thus being able satisfactorily to inhale the medicated 
 steam. 
 
 LOTIONS FOR SORE MOUTH 
 
 Boric-Acid-and-Myrrh Lotion. 
 
 Boric acid 20 grains 
 
 Tincture of myrrh y 2 fluidrachm 
 
 Glycerine 1 fluidrachm 
 
 Water, enough to make 1 fluid ounce 
 
 Apply frequently to the inside of the mouth for in- 
 flammation or thrush. 
 
434 THE MOTHER AND HER CHILD 
 
 FOR NOSEBLEED 
 
 Tannic acid 2 drachms 
 
 Glycerine 1 fluidrachm 
 
 Water 2 fluid ounces 
 
 To be injected or snuffed into the nose in obstinate 
 cases of nosebleed. 
 
 THROAT GARGLES 
 
 Dobell's solution is an excellent throat gargle. A solution of 
 half alcohol and half water is also a splendid gargle. 
 
 MOUTH WASH 
 
 Listerine 2 teaspoons 
 
 Soda bicarbonate 10 grains 
 
 Water 4 ounces 
 
 Essence of cinnamon, six drops- in one-half glass cold water, 
 
 may also be used in brushing the teeth and in cleansing the 
 
 tongue and mouth. 
 
 DISINFECTANTS 
 
 1. Carbolic Acid. 
 
 Carbolic acid (95%) 6 ounces 
 
 Glycerine 4 ounces 
 
 Water 1 gallon 
 
 Clothes should be soaked in this for several hours, then 
 removed in a covered receptacle and boiled thoroughly. Sheets 
 may be wet with this and hung at the doors in case of infec- 
 tious diseases. 
 
 2. Chloride of Lime. 
 
 Chloride of Lime 4 ounces 
 
 Water (rain) 1 gallon 
 
 In typhoid fever, all the movements from the bowels should 
 be thoroughly mixed with this, covered and allowed to stand 
 several hours before pouring down the water closet. All 
 vomited matter should be treated the same way. 
 
 POULTICES 
 
 There are a number of mush poultices recommended for 
 different conditions — boils, felons, etc., but we find the aseptic 
 
APPENDIX 435 
 
 heating compress to be as effectual as any of these dirty, 
 mush poultices and we suggest that our readers try the boracic- 
 acid poultice which is put on as follows: Over any infected 
 area or abrasion of the skin a thick padding of cotton moistened 
 by a saturated boracic-acid solution is placed. This is entirely 
 covered with wax paper or oiled-silk, and held in place by a 
 binder. It is sanitary and much to be preferred to any of the 
 mush poultices of bygone days. 
 
 COUGH SYRUP 
 
 A very useful cough syrup may be made as follows: Two 
 tablespoons of flaxseed are steeped on the stove until clear, 
 the jelly strained and flavored quite sour with lemon juice to 
 which is added rock candy for sweetening. This will often 
 effectively relieve the irritating coughs of childhood. 
 
 LOTIONS FOR CHAPPED HANDS 
 
 No. i. Glycerine 3 ounces 
 
 Tr. Benzoin ]/ 2 ounce 
 
 Water i ounce 
 
 No. 2. Glycerine 2 ounces 
 
 Lemon juice l / 2 ounce 
 
 Tr. Myrrh l / 2 ounce 
 
 No. 3. Glycerine 2 ounces 
 
 Rose Water 2 ounces 
 
 Acetic Acid 2 ounces 
 
 ECZEMA 
 
 We wish to submit two very useful prescriptions for that 
 troublesome skin disease which is so annoying in childhood 
 as well as in adult life. Prescription No. 1 is a clear fluid, and 
 after the affected area is thoroughly cleansed with resinol 
 soap and rinsed in soft water, the lotion is applied and allowed 
 to dry. No. 2 is then patted on with sterile cotton and often 
 repeated to keep the ecezmatous skin area moist. This has 
 proved curative in many persistent cases. 
 
436 THE MOTHER AND HER CHILD 
 
 Lotion No. I. 
 
 Acid Carbolic I drachm 
 
 Listerine I drachm 
 
 Rose Water 3 ounces 
 
 Alcohol q. s 6 ounces 
 
 Apply No. i and allow to dry of itself. 
 
 Lotion No. 2. 
 
 Ichthyol 4 drachms 
 
 Lime Water I ounce 
 
 Oil sweet almonds i ounce 
 
 Glycerine i Yz ounces 
 
 Rose Water i y 2 ounces 
 
 Apply No. 2 and repeat to keep moist. 
 
 CONSTIPATION 
 
 We submit the following home regime, which has . proved 
 successful to many sufferers for the treatment of constipa- 
 tion. 
 
 i. On rising in the morning, remove the moist abdominal 
 bandage (mentioned above) ; drink two-thirds of a glass of 
 cold water; and spend fifteen to twenty minutes in the follow- 
 ing exercises, before dressing: Abdominal lifting with deep 
 breathing, auto-massage, leg raising, trunk twisting, trunk bend- 
 ing — forward and to sides ; lying down for the trunk raising, 
 and sitting for the trunk circumduction. Immediately follow- 
 ing these exercises, go to stool. Have feet raised from the 
 floor eight or ten inches, in order to simulate the squatting 
 position. 
 
 2. Breakfast should include bran or bran bread, and two or 
 three of the following foods : Apples with skins, grapefruit, 
 cranberries with skins (but little sugar), and figs. Immediately 
 after breakfast walk fifteen minutes in the open air, practicing 
 deep abdominal breathing. If the results at stool before break- 
 fast were not satisfactory, vaseline rectum and go to stool 
 again. 
 
 3. Lunch should consist of fruit only, while dinner should 
 include bran bread and two of the following foods: Spinach, 
 celery, carrots, parsnips, squash, or cabbage. 
 
APPENDIX 
 
 437 
 
 4. Before retiring, walk in the open air for fifteen minutes; 
 after undressing, exercise same as morning; and on retiring, 
 apply the moist abdominal bandage. 
 
 TABLE OF POISONS AND ANTIDOTES 
 
 Poison. Antidotes. 
 
 Unknown 
 
 rEmetic, followed by Jeaunel's antidote 
 1 and soothing drinks. 
 
 Acid — acetic, hydrochloric, 
 sulphuric, nitric 
 
 'An alkali, such as magnesia, chalk, 
 whiting, soda, soap ; followed by 
 soothing drinks or sweet oil. 
 
 . ., , .. f Epsom salts in abundance; soap; no 
 
 Acd-carbohc, creosote.. \ ^ Dilute alcohol . 
 
 Acid — oxalic, including 
 " salts of lemon " 
 
 Emetic, followed by lime (as chalk, 
 plaster, whiting) or magnesia, but 
 not by potash or soda ; then soothing 
 drinks. 
 
 Acid — prussic 
 
 r Fresh air; ammonia to nostrils 
 \ douche; artificial respiration. 
 
 cold 
 
 Aconite 
 
 rEmetic, followed by digitalis; no pil- 
 \ low under head ; free stimulation. 
 
 Alcohol (brandy, etc.) 
 
 rEmetic; cold douche on head; warmth 
 X and artificial respiration. 
 
 Alkalies — ammonia, spirits 
 of hartshorn, lye, caustic 
 potash 
 
 Vinegar or lemon juice, followed by 
 soothing drinks or sweet oil. 
 
 Antimony (tartar emetic) . - 
 
 Emetic if vomiting is not already pro- 
 fuse; then tannic acid freely, or 
 strong tea ; later, milk or other 
 soothing drinks ; finally, castor oil 
 to empty the bowels. 
 
438 
 
 THE MOTHER AND HER CHILD 
 
 Arsenic (Fowler's solution 
 Paris green, "Rough on- 
 Rats") 
 
 Emetic, quickly followed by plenty of 
 a fresh mixture of the tincture of 
 chloride of iron with calcined mag- 
 nesia, washing or baking soda, or 
 water of ammonia, or by Jeaunel's 
 antidote. Then white of egg, sooth- 
 ing drinks, or sweet oil; castor oil 
 to empty bowels. 
 
 Atropine (see Belladonna) . 
 
 Belladonna (atropine) 
 
 ["Emetic; tannic acid freely; cold to 
 A head ; coffee. Stimulants and 
 I warmth if needed. 
 
 Blue stone; blue vitriol (see 
 Copper). 
 
 Chloral 
 
 'Emetic (but often useless) ; external 
 heat ; stimulants ; strong coffee ; 
 strychnine; atropine; artificial res- 
 piration. 
 
 Chloroform, inhaled. 
 
 JCold douche; friction of skin; invert- 
 1 ing child ; artificial respiration. 
 
 „ ... L1 fEmetic, followed by white of egg or 
 
 Copper (blue stone ; blue M1 .« . L , * , 
 
 . . , ,. . . A milk, yellow prussiate of potash; 
 
 vitriol ; verdigris) . . . , . , 
 
 I then soothing drinks. 
 
 Corrosive sublimate (bi- 
 chlorid of mercury) 
 
 Emetic, followed by white of egg or 
 milk; soothing drinks; tannic acid 
 freely; castor oil to open bowels. 
 
 Cyanide of potash (see 
 Acid, prussic). 
 
 Fowler's solution (see 
 Arsenic). 
 
 _..,... , r Inhalation of oxygen; artificial respi- 
 
 Gas (illuminating gas, coal ,. • , -, ,, 
 
 ^ J ration; ammonia to nostrils; cold 
 
 gas) 1 douche. 
 
APPENDIX 
 
 439 
 
 Iodine 
 
 [Starch or flour mixed with water given 
 I freely; emetic; soothing drinks. 
 
 Laudanum (see Opium). 
 
 Lead (sugar of lead) 
 
 ["Emetic, followed by Epsom salts: 
 \ white of egg or milk ; alum. 
 
 Matches (see Phosphorus). 
 
 Morphine (see Opium). 
 
 Nux vomica (see Strych- 
 nine). 
 
 Opium 
 
 (including 
 
 lauda- 
 
 num, 
 
 morphine, 
 
 pare- 
 
 gone, 
 
 soothing 
 
 syrups, 
 
 etc.) 
 
 
 
 Emetic (but generally useless) ; per- 
 manganate of potash in doses of 4 or 
 5 grains if case is seen early; strong 
 coffee; atropine; keep child awake 
 and breathing by cold douche to head 
 and spine, walking, etc., but not to 
 extent of exhaustion ; artificial res- 
 piration. 
 
 Paregoric (see Opium). 
 Paris green (see Arsenic). 
 
 Phosphorus (match-heads, 
 some roach and rat poi- 
 sons) 
 
 Emetic; then permanganate of potash 
 in doses of 4 or 5 grains well 
 diluted, and frequently repeated ; 
 then Epsom salts or magnesia to 
 open bowels, but no milk or oil of 
 any kind. 
 
 Poisonous plants (Jimson 
 weed, poisonous mush- 
 rooms, deadly nightshade, 
 tobacco, etc.) 
 
 Prussic acid (see Acid, 
 prussic). 
 
 'Emetic, followed by tannic acid ; strong 
 coffee or brandy ; ammonia to nos- 
 trils ; external warmth ; artificial 
 respiration. 
 
440 THE MOTHER AND HER CHILD 
 
 Silver nitrate (lunar caus- rTable-salt, followed by emetic; milk 
 tic) \ or white of eggs. 
 
 ., j c j rEmetic, followed by castor oil as 
 
 Spoiled food J 
 
 \ purgative. 
 
 Strychnine (nux vomica, ("Emetic, followed by tannic acid, bro- 
 some rat poisons) [ mide of potash freely, or chloral. 
 
 Tartar emetic (see Anti- 
 mony) . 
 
 TABLE SHOWING THE AVERAGE WEIGHT, HEIGHT, AND CIRCUM- 
 FERENCE OF HEAD AND CHEST OF BOYS * 
 
 At birth. 
 
 Weight 7 z /2 pounds 
 
 Height 20^4 inches 
 
 Chest 13^2 inches 
 
 Head 14 inches 
 
 One year. 
 
 Weight 21 pounds 
 
 Height 29 inches 
 
 Chest 18 inches 
 
 Head 18 inches 
 
 Two years. 
 
 Weight 27 pounds 
 
 Height 32 inches 
 
 Chest 19 inches 
 
 Head 19 inches 
 
 Three years. 
 
 Weight 32 pounds 
 
 Height 35 inches 
 
 Chest 20 inches 
 
 Head 19^4 inches 
 
 Four years. 
 
 Weight 36 pounds 
 
 Height 38 inches 
 
 Chest 20% inches 
 
 Head 19^ inches 
 
 * Weights for the first four years are without clothes, after that with ordi- 
 nary house clothes. 
 
 The weight of girls is on the average about one pound less than boys. They 
 are about the same in height. 
 
APPENDIX 441 
 
 Five years. 
 
 Weight 41 pounds 
 
 Height 41^ inches 
 
 Chest 21 y 2 inches 
 
 Head 20^ inches 
 
 Six years. 
 
 Weight 45 pounds 
 
 Height 44 inches 
 
 Chest 23 inches 
 
 Seven years. 
 
 Weight 49^2 pounds 
 
 Height 46 inches 
 
 Chest 22^/2 inches 
 
 Eight years. 
 
 Weight 54^ pounds 
 
 Height 48 inches 
 
 Chest 24^2 inches 
 
 Nine years. 
 
 Weight 60 pounds 
 
 Height 50 inches 
 
 Chest 25 inches 
 
 Ten years. 
 
 Weight 66^4 pounds 
 
 Height 52 inches 
 
 Chest 26 inches 
 
 ICHTHYOL SUPPOSITORIES 
 
 Ichthyol 5 per cent 
 
 Cocoa Butter q. s. ad. to make 24 suppositories. 
 
 Sig. Use one suppository in the rectum each evening 
 for hemorrhoids. 
 
 OIL ENEMA 
 
 The best way to administer an oil enema is by means of a 
 special enema can which holds one pint, to which is attached 
 a rubber tube. It is wise not to use an ordinary fountain 
 syringe as the oil spoils the rubber very quickly. This oil is 
 allowed to flow in slowly, tinder low pressure, and should be 
 retained over night. Any oil is acceptable, the cheaper sweet 
 oils will serve just as well as olive oil. 
 
442 
 
 THE MOTHER AND HER CHILD 
 
 
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APPENDIX 443 
 
 HOT COLONIC FLUSHING 
 
 The hot colonic flushing is particularly serviceable in com- 
 bating the sick headaches of migraine. They should be taken at 
 night just before retiring with the temperature of water as hot 
 as can be borne, from 108 to no F. Half of the water is 
 allowed to flow into the colon and is retained as long as possible. 
 This brings the heat in close contact with the sympathetic nerv- 
 ous system whose headquarters is in the abdomen. 
 
 ENEMAS 
 
 Position for an Enema. Lie on left side, knees brought up 
 against abdomen, with the left arm well underneath. This 
 will relax the abdominal muscles and allow the water to pass 
 upward more freely. The water should be allowed to flow until 
 it is felt low on the right side. 
 
 The one, two, three enema is an injection that is used for the 
 relief of gas in the bowel. It consists of the following: One 
 part epsom salts, two parts glycerine, and three parts soap suds. 
 It is introduced by the aid of the colon tube and retained as 
 long as is possible. 
 
 Glycerine and soapy water, equal parts, may be introduced 
 into the bowel for temporary relief of a persistent constipation. 
 
 In instances when feeding by the mouth is impossible, nutrient 
 enemas should be given every three or four hours during the 
 day. The absorption does not take place in the large bowel as 
 readily as in the small intestines, so only a small amount of a 
 more highly concentrated solution is given at one time. A 
 child one year of age will be given one teaspoon, from one to 
 four years of age a teaspoon to a tablespoon is allowed, and 
 up to twelve years from one to eight tablespoons are given in 
 the nutrient enema. Peptonized meat preparations may be 
 employed in greater concentration than directed by the use of 
 the mouth. Peptonized milk containing an egg is often used. 
 The pepsin is added to the mixture only when warm, and is 
 injected at once. 
 
 EMETICS 
 
 i. A glass of warm water containing as much common table 
 salt as can be dissolved. 
 
444 THE MOTHER AND HER CHILD 
 
 2. A teaspoon of mustard in a large glass of warm water. 
 
 3. A teaspoon of syrup of ipecac, repeated in fifteen minutes 
 if necessary. 
 
 Any one of these emetics is useful in instances where it is 
 desirable to empty the stomach at once. 
 
 A CALORIE 
 
 A calorie is the heat unit used in the estimation of the fuel 
 value of various foods. For instance, an ordinary slice of 
 homemade bread contains 100 calories. An ordinary fig con- 
 tains almost 100 calories. A large orange or an apple or a 
 glass of grape juice contains about 100 calories. There are 
 100 calories in three teaspoons of sugar or honey. 
 
 A complete food list with the estimation of calorie value of 
 foods is found in The Science of Living, page 370, while on 
 page 99 of the same book is a very helpful table showing the 
 amounts of various foods required to equal 100 calories. The 
 reader will find this exceedingly practical in estimating food 
 values for the household. 
 
 ACIDIFYING AND ALKALINIZING FOODS 
 
 Since we find that in all acute diseases the acidity of the 
 urine is greatly increased and in time of health it is less acid, 
 we submit two lists of foods which tend to acidify the urine or 
 to alkalinize the urine. 
 
 FOODS WHICH TEND TO FOODS WHICH TEND TO 
 
 ACIDIFY. ALKALINIZE. 
 
 1. Animal Foods: All forms I. Dairy Products: Milk, ice 
 of flesh foods, fish, fowl, etc., cream, cottage cheese, cheese, 
 including all kinds of meat buttermilk, etc. 
 
 broths, soups, beef tea, bouillon, 2. Potatoes and bananas. 
 
 etc. 3. Soups: All forms of vege- 
 
 2. Eggs. table and fruit soups and broths. 
 
 3. Breadstuff s: All kinds of 4. Fruit Juices: All the fresh 
 breads, whether made of wheat, fruit juices except plums. 
 
 rye or corn, crackers, toasts, 5. Fresh Fruits: All fresh 
 
 griddle cakes, etc. fruits, sweet and sour, except 
 
 4. Pastries: All sorts of pies plums and cranberries. 
 
APPENDIX 445 
 
 and cakes — except fruit pies, 6. Vegetables: All kinds, espe- 
 and other desserts containing cially beets, carrots, celery, let- 
 milk or sour fruits. tuce, and muskmelon. 
 
 5. Cereals: Rice, oatmeal, and 7. Dried Fruits: Figs, raisins, 
 breakfast foods of all kinds, in- dates, currants — all except 
 eluding the flaked and toasted prunes. 
 
 breakfast foods. 8. The Legumes: Beans, peas, 
 
 6. Peanuts, plums, prunes, and and lentils. 
 
 cranberries. Plums and cran- 9. The Nuts: All the nuts 
 
 berries fall in this column be- belong in this column, including 
 cause of their benzoic acid, almonds and chestnuts, 
 which the body cannot fully 
 oxidize. 
 
 CEREAL WATERS, ETC. 
 
 It is often necessary to give the infant or the young child 
 cereal water to replace food in occasions of summer diarrhoea, 
 etc. 
 
 1. Barley Water. 
 
 One tablespoon of barley flour in one pint of water. Boil for 
 one-half hour, strain, and add sufficient boiled water to make 
 one pint. 
 
 2. Flaxseed Tea. 
 
 One tablespoon of flaxseed, one pint of boiling water; let 
 stand and keep warm for one hour; strain. Add juice of 
 lemon. 
 
 3. Oatmeal Jelly. 
 
 Four tablespoons of oatmeal, one pint of water; boil for 
 three hours in double boiler, adding water from time to time; 
 strain. 
 
 4. Toast Water. 
 
 One, two, or three slices of bread toasted dark brown, but 
 not burned. Put in one quart of boiling water, cover, and 
 strain when cold. 
 
 5. Arrowroot Water. 
 
 Wet two teaspoons of arrowroot with a little cold water, and 
 rub until smooth; then stir into one pint of boiling water and 
 boil for five minutes, stirring all the while. 
 
 6. Oatmeal Water. 
 
446 THE MOTHER AND HER CHILD 
 
 One tablespoon of oatmeal to one pint of boiling water, cover 
 and let simmer for one hour. Add water from time to time 
 as it evaporates; strain. 
 
 y. Rice Water. 
 
 One tablespoon of (washed) rice to one pint of water. Boil 
 three hours adding water from time to time. 
 
 FRUIT JUICES 
 
 Fruit juices are exceedingly beneficial all through life; par- 
 ticularly is this true during early childhood when the little ones 
 are so likely to be constipated. Any of the fruit juices are good, 
 particularly the juices from oranges, raisins, prunes, apples, 
 pears, and cranberries. All these juices are better cooked than 
 raw with the exception of orange juice. All children should 
 have some fruit juice every day. For the very young baby 
 the juices are strained through a wire strainer and a clean 
 cheesecloth so as to remove every particle of solid matter, and 
 there should be added an equal amount of cold, boiled water 
 for the infant under ten months. 
 
 LEMONADE AND EGGN0GS 
 
 Lemonade, along with orangeade, grapefruitade and limeade 
 should be used for children above a year. They should be 
 well diluted and not too sweet. 
 
 Eggnogs are splendid for children who need to be helped 
 along with their diet. They may be given at the close of the 
 meal, never between meals — unless so prescribed by a physician. 
 The stomach should have ample time to complete the work of 
 digesting one meal before another partial meal is allowed to 
 enter it. Eggnogs consist of a well-beaten egg into which 
 there is placed a small amount of sugar, flavoring with either 
 nutmeg, vanilla, or cinnamon, and the glass filled up with rich 
 milk. 
 
 MILKSHAKE 
 
 Milkshake is a delightful drink. The white of an egg with 
 one or two teaspoons of sugar, two tablespoons of chopped ice, 
 
APPENDIX 447 
 
 flavoring, and one ounce of cream are briskly shaken in a milk- 
 shaker for two minutes. Cold milk is added to fill the glass. 
 
 MEAT AND MEAT JUICES 
 
 Beef extracts are regarded by the medical profession as 
 purely stimulants. Beef juice is practically without food value. 
 In the preparation of beef juice the extractives and juices leave 
 the fibre. The food is in the fibre of the meat. The extractives 
 are purely of a stimulating order. We do not advocate the 
 giving of beef tea and beef juices to children; as a rule, we 
 think that cereal, gruels, strained soups, and milk are preferable. 
 
 The only reason for cooking meats is to destroy the parasites 
 such as tapeworm, trichina, etc., which are so often found in 
 the meat. The cooking of meat decreases its digestibility, as 
 raw meat is more easily digested than cooked meat, but we feel 
 it is necessary to advocate the cooking of meat in order to 
 kill the parasites. 
 
 CODDLED EGG 
 
 A fresh egg, shell on, is placed in boiling water which is 
 immediately after removed from the fire. The egg then 
 cooks slowly in the water, which gradually cools, for seven or 
 eight minutes, when the white should be about the consistency 
 of jelly. For a delicate digestion the white only should be 
 given, with salt; it can be easily separated from the yolk. 
 The above is the best form of egg for the young child. Later 
 on the eggs may be soft boiled or poached, or even soft 
 scrambled. 
 
 SOUPS 
 
 Two varieties of soups are given children. In the early 
 months of childhood, from six years to eighteen months, the 
 soups are usually strained, but after eighteen months, soups 
 may be thickened with flour and rich milk making a cream 
 soup of it. Most vegetables make good soups. The pulp from 
 such vegetables as asparagus, carrots, beans, peas, tomatoes, 
 and potatoes are made into cream soups by the addition of a 
 little flour, rich milk, butter, and a dash of salt. 
 
448 THE MOTHER AND HER CHILD 
 
 BREADS 
 
 New breads should never be given to a child. Only bread 
 twenty-four hours old should ever be given to a child under 
 six years; it should be cut into slices and allowed to dry out; 
 and even then is better if slightly toasted. We publish a 
 recipe for bran bread and bran biscuits which are exceedingly 
 good for children and adults. 
 
 Recipe for Bran Bread. Two eggs, beaten separately ; three- 
 fourths of a cup of molasses, with one round teaspoon soda; 
 one cup of sour cream; one cup of sultana seedless raisins; 
 one cup of wheat flour, with one heaping teaspoon baking 
 powder; two cups of bran; stir well and bake one hour. 
 
 Bran Biscuits. Mix one pint of bran, one-half pint of 
 flour, and one level teaspoon of baking soda. Mix one-half 
 pint of milk and four tablespoons of molasses. Add this to the 
 bran mixture and bake in gem pans. 
 
INDEX 
 
INDEX 
 
 Abortion, advice on occurrence of, 
 39 ; care needed at third month 
 of pregnancy, 38 ; consequences 
 of, 7, 8 ; defined, 39 ; remedy for 
 threatened, 38 ; warning signs 
 of, 38. See also Miscarriage ; 
 Pregnancy 
 
 Adenitis, 345 
 
 Adenoids, 303 
 
 Air, supply of fresh, for baby, 
 213-17, 219 
 
 Baby, care of the : Abdomen, 
 shape of, at birth, 105 ; advice 
 in care of baby, 377-78 ; bathing, 
 107-8, 111-12, 190-201; bed for, 
 arrangement of,i 108, 115 ; bounc- 
 ing harmful, 226 ; bowels and 
 bladder, training of, 242 ; breast 
 of baby, care of, 229 ; buttocks, 
 care of, 200 ; chafing, how pre- 
 vented, 201, 333 ; chest, shape of, 
 105 ; circumcision, when desir- 
 . able, 110; clothing of the, 108; 
 constipation, 279 ; cord, dressing 
 of, 107; diet after first year, 
 245-47; ears, treatment of, 198- 
 99 ; exercise of baby, 223 ; eyes, 
 treatment of, 107, 198-99; falls, 
 to be prevented, 228 ; feeding 
 the, 109 ; genitals of the, how 
 cared for, 110, 200; habits to 
 be guarded against, 378; hair, 
 treatment of, 201, 233 ; handling, 
 111; head, treatment of, 104, 
 233, 344; legs of, at birth, 105; 
 lifting the baby, how accom- 
 plished, 228 ; mouth, treatment 
 of, 199 ; necessities for new- 
 born baby, 60-61, 64; nose, 
 treatment of, 198-99 ; pulse and 
 respiration, 105 ; putting to 
 sleep, 127, 217; registration of 
 birth of, 113; respiration, how 
 
 started at birth, 105-6 ; second 
 summer, care during, 230 ; skin 
 of baby, 106 ; stools, regulation 
 of, 142 ; temperature of baby, 
 226 ; the " spoiled "baby, 128 ; 
 things bad for babies, list of, 
 377 ; treatment of baby during 
 and after birth, 67, 69 ; umbili- 
 cus, how cared for, 112; urine 
 of baby, 109, 223 ; warmth neces- 
 sary, 225 ; water, how and when 
 administered, 140 ; 222 ; weight 
 of baby at birth, 106; when to 
 give first feeding, 70. See also 
 Colic ; Crying ; Nursery ; Nurs- 
 ing the baby ; Sleep ; Urine ; see 
 also under several diseases 
 
 Babyhood, 1 
 
 Backache, cause of, 43 ; method of 
 relief for, 43-44 
 
 Bathing the baby, toilet, etc., 190- 
 201. See also Baby, care of the 
 
 Bed for baby. See Baby, care of 
 
 the; Sleep 
 Bed-wetting, 328. See also Urine 
 
 Birthmarks, discusson of, 16, 17, 
 18, 40, 338 
 
 Bites, of dogs, snakes, cats, etc., 
 349 
 
 Blindness, precautions to avoid, 
 in new-born infant, 69, 331. See 
 also Baby, care of the 
 
 Blisters (fever), 338 
 
 Blood-pressure, 46 ; observation 
 of, 3 
 
 Boils, 337 
 
 Bottle 'feeding, additional foods, 
 153 ; bottle, preparation of. 149 ; 
 ice-box, home-made, 14S; in- 
 tervals between meals, 153; 
 nipple, how withdrawn, 152; 
 
 451 
 
452 
 
 INDEX 
 
 position of baby during feeding, 
 150-51; quantity of food, 148; 
 refrigeration a necessity, 148 ; 
 rules for, 154; schedule for, 
 147; stomach, capacity of, 148; 
 time allowance for, 152; travel- 
 ing, food for baby while, 153 ; 
 treatment of baby after, 152 ; 
 water, when and how admin- 
 istered, 147 . 
 Bowel, prolapse of the, 283 
 Bow legs, how avoided, 228 
 Bran bread, recipes for, 448 
 Bravery, how to instil in a child, 
 
 382-84 
 Breasts, caked (mastitis), care of, 
 100, 136 ff . ; changes in, a sign 
 of pregnancy, 4; care of, during 
 pregnancy, 33. See also Preg- 
 nancy 
 Bronchitis, 304 
 Bruises, 354 
 Burns, 358 
 
 Calisthenics, how applied, 244 
 
 Caretaker (for children), 376-77 
 
 Carriages and go-carts, 227 
 
 Chafing, 333. See also Baby, care 
 of the 
 
 Chicken-pox, 294-95 
 
 Chilblains, 356 
 
 Child culture, 1 
 
 Cleft palate, 341 
 
 Clothing the baby, bands, 204; 
 booties, 206; caps, 210; diapers, 
 204; errors in clothing, 208; 
 layette, the, 203-208; night- 
 gowns, wrappers, and slips, 207 ; 
 rules for, 212 ; shirts, 204 ; shoes, 
 210; short clothes, 209; skirts 
 and petticoats, 206 ; sleeping-bag, 
 207 ; stockings, 206 ; suggestions 
 for, 202; suits for play, 210; 
 winter garments, 211; wraps, 
 210 
 
 Clubfoot, 342 
 
 Colds, 300, 301 
 
 Colic, causes and treatment of, 
 129-32, 142, 274 
 
 Confinement, bed and accessories, 
 61-62, 64; calculation of date 
 of, 5, 6 ; preparations for, 53 ff., 
 57 ; supplies needed for, 58 ff. ; 
 room for, 61. See also Labor 
 
 Constipation, treatment of, 31, 40; 
 in baby, 184, 185, 279 
 
 Contagious diseases, how con- 
 tracted, 285 ; incubation period 
 of various, 287 ; spread of, 286. 
 See also under various diseases 
 
 Convulsions, 326 
 
 Coughing, 255 
 
 Cramps, 41 
 
 Croup, 306 
 
 Crying, abnormal, 124; birth cry, 
 123; cause of, 132; colicky cry, 
 129; fretful cry, 125; habit 
 cry, 127 ; healthy crying, 123 ; 
 hunger cry, 124 ; illness cause 
 of, when, 129; pain cry, 126; 
 " spoiled-baby " crying, 128; 
 temper cry, 128 ; thirst cry, 124 
 
 Cuts, wounds, etc., 353 
 
 Deaf-mutism, 331 
 
 Deafness, 302 
 
 Deformities, causes of, 17 
 
 Delivery, calculation of date of, 
 5, 6 
 
 Depressors, function of, 9, 15 
 
 Determiners, function of, 9, 15 
 
 Development of child, 240-41 
 
 Diarrhoea, 185, 280 
 
 Diet : Appetite, improvement of 
 the, 401 ; assimilation, 360 ; baby, 
 diet of, 245-47 ; cellulose, 365 ; 
 eating between meals, 368 ; elim- 
 ination, 360-62 ; fats, 364 ; food 
 requirement (daily), 369; foods, 
 full value of, 366; for children, 
 367 ; fruit sugars, 363 ; hygiene, 
 400; mineral salts, 364; nutri- 
 tion, 362 ; proteins, 363 ; starch- 
 es, 363 ; treatment of child, daily 
 program for, 402-4 ; water, 365. 
 See also Feeding the baby ; 
 Nursing the baby 
 
 Digestion : Disorder of, chronic 
 indigestion, 275 ; stomach, dis- 
 ordered, 278 ; stomatitis or 
 thrush, 279 ; vomiting, 274. See 
 also under various diseases 
 
 Diphtheria, 296 
 
 Discipline, methods of, 316-22 
 
 Dislocations and fractures, 254 
 
 Doctor, choice of, 55 
 
INDEX 
 
 453 
 
 Earache, 351 
 
 Ears, running, 299 
 
 Eclampsia, 47, 48; prevention of, 
 50. See also Urine 
 
 Eczema, 334-35 
 
 Embryonic development, 11, 12 
 
 Enema, how administered, 280 
 
 Exercise, necessity of, during preg- 
 nancy, 27 
 
 Exercise of baby, 223 
 
 Eye infections, 298 
 
 Eyes, ears, and nose, care of, 198 ; 
 foreign bodies in, 351 
 
 Fainting, 359 
 
 Fear, overcoming of, in children, 
 380-82 
 
 Feeble-mindedness, 331 
 
 Feeding the baby : Bottle-fed baby, 
 healthy characteristics of, 178 ; 
 changes in food to be gradual, 
 179 ; constipation, how treated, 
 185, 279 ; diarrhoea, cause of, 
 185, 280 ; dissatisfaction, signs 
 of, 181 ; flatulence, 182; formula, 
 choice of, for, 178; infant foods, 
 187-89 ; mistakes in formulas, 
 180; mixed feeding, 186; over- 
 feeding, 183; vomiting, 182; 
 weight of baby, 183. See also 
 Diet ; Milk ; Nursing the baby 
 
 Fertilization, process of, 8, 9 
 
 Fever, 264. See also Sickness of 
 child 
 
 Flatulence. See Feeding the baby 
 
 " Flour ball," how prepared, 175 
 
 Foods, for baby, 153, 165-76; full 
 value of, 366. See also Bottle 
 feeding ; Infant foods ; Milk 
 
 Freckles, 336 
 
 Frostbites, 356 
 
 Games for children, 392 
 Germ plasm, 8 
 Glands, enlarged, 345 
 Goitre, 42 
 
 Governesses, 370-75 
 Grippe, 302 
 
 Habits, inculcation of good, 380-89 
 Harelip, 341 
 
 Headache, in children, 326 ; relief 
 for, during pregnancy, 45 ; sign 
 of auto-intoxication during preg- 
 nancy, 47 
 
 Heartburn, care for, 36 
 
 Hemorrhoids, treatment of, 41 
 
 Heredity, effect of, on individual, 
 9, 14; extent of influence of, 14, 
 15, 19, 20 
 
 Hip-joint disease, 343 
 
 Hives, 336 
 
 Homemaking, 370-75 
 
 Hookworm, 278 
 
 Hospital, recommended for con- 
 finement, 55-56 ; requisites for, 
 60 
 
 Housekeeping, 370-75 
 
 Hygiene, of baby, 222-31 ; of child, 
 400-4. See also Diet 
 
 Hysteria, prevention of, 315 
 
 Indigestion, 275 
 
 Infant foods, 187-89. See also 
 Feeding the baby ; Nursing the 
 baby 
 
 Infant welfare, 178 
 
 Insects, bites of, 348 
 
 Insomnia, relief for, 45 ; in chil- 
 dren, 323 
 
 Itch, the, 339-40 
 
 Jaundice, 276 
 
 Kissing the baby, precautions 
 against, 224 
 
 Labor, analgesia in, 86 ; anesthesia 
 in, 84-92 ; bath, preliminary, 64 ; 
 care of mother during and after, 
 67-68 ; chloroform and ether, 
 administration of, 91 ; duration 
 of, 65 ; duties of nurse before and 
 during, 67 ; " false pains " in, 66 ; 
 fear in, importance of allaying, 
 84; laughing gas (nitrous oxid), 
 administration of, 85 ; effect of, 
 87 ; pain of, 71, 84-85 ; prepara- 
 tions for, 64-65, 67, 72-73; 
 progress of, 65 ; second stage of, 
 66 ; "sunrise slumber" in, 84-90 ; 
 symptoms of approaching, 64 ; 
 third stage of, 66 ; " twilight 
 sleep" in, 71-72, 73-83; what to 
 do in, before arrival of doctor, 
 67 
 
454 
 
 INDEX 
 
 Layette. See Clothing of baby 
 
 Leucorrhea, relief for, 37-38 
 
 Lice, 339 
 
 Lime water, use of, in baby's food, 
 173 
 
 Lochia, the, 97 
 
 Lying-in period, the, 93 ; abdominal 
 binder, 97 ; " after-pains," 95 : 
 bowels, care of, 98 ; breast 
 binder, 97 ; " cold-mitten fric- 
 tion " during, 95 ; cystitis, how 
 avoided, 100 ; diet, rules for the, 
 98 ; getting up from bed, when 
 to be permitted, 99 ; hemorrhage, 
 treatment of, 100 ; infection 
 advice for treatment of, 100 
 lochia, the, 97 ; nipples, care of 
 98 ; nurse, duties of, during, 93 
 pneumonia, how avoided, 100 
 rest and exercise during, 94 
 temperature of mother, 96 ; toilet 
 of the vulva, 96 
 
 Malaria, 346 
 
 Maternal instinct, the, 1 
 
 Maternal impressions, explained 
 
 and discussed, 16 
 Measles, 293-94 
 Medical supervision in early days 
 
 of pregnancy, 2 
 Medicine chest, the, 270 
 Meningitis, 329 
 
 Menstruation, cessation of, a sign 
 of pregnancy, 4 ; cessation of, 
 due to other causes than preg- 
 nancy, 4 ; passage of ovum at 
 time of, 9. See also Pregnancy 
 
 Milk, acidity, how counteracted, 
 158; analysis of cow's, 156; 
 analysis of mother's, 156; annat- 
 to, test for, 159; boiling, when 
 necessary, 161 ; bottled milk, 
 care of, 163 ; bottles, care of, 
 166 ; buttermilk, when used, 174 ; 
 certified milk, 161 ; condensed 
 milk, how used, 175 ; cow's 
 milk, modification of, 157 ; cream 
 gauge, 158; cream, gravity of, 
 172; dairy, essentials of a good, 
 159; "flour ball," the, 175; 
 food, special, 175 ; formulas for 
 feeding, 171. 173 ; goat's milk, 
 use of, 157; herd milk desirable, 
 159 ; lactometer, 158 ; lime water, 
 use of, 173; "modification" of 
 cow's milk, 165 ; nipples, care of, 
 
 166; pasteurization of, 162; pep- 
 tonized, 174 ; preparation of, 168- 
 70; schedule for feeding, 171; 
 seven per cent milk, 173 ; spores, 
 how guarded against, 163 ; 
 sterilization of, 162; sugar, use 
 of, with, 157; "top-milk" for- 
 mula, 172; whey, how used, 176. 
 See also Feeding the baby 
 
 Milk crust, 198 
 
 Miscarriage, care needed at 
 seventh month of pregnancy, 39 ; 
 causes of, 39 ; defined, 390. See 
 also Abortion ; Pregnancy 
 
 Monstrosities, causes of, 17 
 
 Moral training of child, 415-24 
 
 Morning sickness, a sign of preg- 
 nancy, 4; remedies for, 35 ff. ; 
 vomiting (pernicious), 44. See 
 also Pregnancy 
 
 Mothercraft, 1 ; science of, 2, 370- 
 75 
 
 Motherhood, characterized, 1 ; 
 preparation for, 2 
 
 Mouth of baby, care of, 199 
 
 Mouth wash for use during preg- 
 nancy, 30 
 
 " Mulberry Mass," the, 11 
 
 Mumps, 291 
 
 Nails, ingrowing, 342 
 
 Nature, lessons from, in teaching 
 
 children, 405-12 
 Navel, bleeding from the, 284 
 Nervousness, hereditary (in child), 
 
 308-10; how overcome, 310-14, 
 
 323-32 
 
 Nervous system, absence of con- 
 nection between, of mother and 
 child, 18 
 
 Nitrous oxid, effects of, 87-90 
 
 Nosebleed, 352 
 
 Nurse, choice of, 56-57 
 
 Nursery, bath equipment, 121 ; bed, 
 arrangement of, 108, 115, 119; 
 cleanliness, necessity for, 122; 
 equipment of, 114; heating and 
 ventilation, 118; lighting, 120; 
 refrigerator, 268 ; sleeping blank- 
 et, 118; ventilation of, 120 
 
 Nursing the baby, caked breasts, 
 136-37 ; diet of mother, 135 ; 
 foods to be avoided by mother, 
 136; hygiene of nursing mother, 
 
INDEX 
 
 455 
 
 134; importance of, 133; irrita- 
 bility of mother, effect of, 142 ; 
 mastitis (caked breast), treat- 
 ment for, 100 ; milk supply, how 
 increased, 143 ; mixed feeding, 
 186 ; mother's milk, constituents 
 of, 139 ; overheating of mother 
 to be guarded against, 142 ; 
 position of mother when, 141 ; 
 regularity in feeding, 141 ; sore 
 nipples, how treated, 138; stools, 
 regulation of, 142; successful or 
 unsuccessful, how determined, 
 142-43 ; time of first feeding, 
 139; to be avoided, when, 144; 
 water, administering, 140; wet 
 nurse, the, 145. See also Bottle 
 feeding; Diet 
 
 Ovary, the, 8 
 
 Ovum, development of, into foetus, 
 11, 12 
 
 Paralysis, infantile, 330 
 
 Parents, relation of to children, 
 413-24 
 
 Pernicious vomiting. See Morn- 
 ing sickness 
 
 Physician, selection of, for treat- 
 ment during pregnancy, 21-22 
 
 Pigeon toe, 342 
 
 Placenta, role of, 18 
 
 Play and recreation, 390-91 
 
 Playmates of children, 311 
 
 Pneumonia, 307 
 
 Poisons and antidotes, 356-58 
 
 Pott's disease, 343 
 
 Pregnancy : Bathing, necessity of, 
 during, 29 ; blood-pressure in, 
 49, 50, 52; breasts, care of the, 
 33 ; cheerful anticipation, ad- 
 vantages of, 4 ; clothing appro- 
 priate during, 22 ; constipation, 
 how avoided during, 31-33, 40; 
 convulsions, treatment for, 48 ; 
 craving for special food, in, 40 ; 
 diet during, 24 ff. ; dizziness dur- 
 ing, 47; duration of, 5, 12; 
 exercise, necessity of, 27 ; fresh 
 air, necessity of, 29 ; goitre in, 
 42 ; hemorrhoids, treatment of, 
 41 ; hygiene of, 21 ff. ; irritation 
 of the bladder, 37; kidney com- 
 plications, 3 ; medical supervi- 
 sion in early days of, 2 ; mental 
 state during, how regulated, 
 
 33 ; miscarriage, danger of, at 
 seventh month, 39 ; morning 
 sickness, remedies for, 35 ; prog- 
 ress of, 11, 12; quickening, 5; 
 resentfulness of mother, conse- 
 quences of, 3 ; rest, necessity 
 of, 28 ; signs of, 4 ; swellings 
 in, 42, 47 ; teeth, care of, during, 
 30 ; urine, diminution of, 47 ; 
 urine, testing of. 30 ; vision, 
 blurring of, the, 47 ; water, 
 necessity of, in, 26. See also 
 Abortion ; Miscarriage 
 Puerperium. See Lying-in period 
 
 " Quickening," 5. See also Preg- 
 nancy 
 
 Rheumatism, 344 
 Rickets, 345 
 Ringworm, 337 
 Rupture, 283 
 
 Saint Vitus' Dance, 330 
 
 Saliva, flow of, not indicative of 
 teeth-cutting, when, 233 
 
 Scalds, 358 
 
 Scarlet fever, 292-93 
 
 Scurvy, 344 
 
 Senses of new born baby, 232, 233 
 
 Shortening clothes of baby. See 
 Clothing the baby 
 
 Sickness of the child : Abdomen in 
 sickness, 254 ; breathing, 256 
 chest in sickness, 254; convales 
 cence, 272-73 ; cough, the, 255 
 cry of infant in sickness, 255 
 disinfectants for sick room, 269 
 examination of sick child, 260 
 facial expression, 254 ; feeding 
 directions, _ 259 ; fever, 264 ; 
 gestures indicating sickness 
 253 ; head indicates sickness 
 254 ; medicine chest, the, 270 
 medicines, 263 ; mouth, the, 257 
 nurse, the, 251 ; nursing records 
 262; patent medicines, 271 
 position of, in sickness, 252 
 pulse, the, 257 ; sick room, loca 
 tion of, etc., 266; skin color, 
 253 ; stools, the, 258 ; swallow- 
 ing, 258 ; temperature and pulse 
 263 ; temperature, the, 257 
 treatment of sick child, 261 
 urine, the, 258. See also under 
 several diseases 
 
456 
 
 INDEX 
 
 Skin troubles, 333 
 
 Sleep: Air, supply of fresh, 213- 
 17, 219; bed-clothes, 219; bed- 
 time for baby, 218; daily naps, 
 221 ; food, effect of, on, 220 ; 
 position of baby in, 218; putting 
 baby to, 127, 217 ; requirements 
 of, by baby, 217; soothing 
 syrups, 220 ; waking up in night, 
 219 
 
 Smallpox, 295 
 
 Soothing syrups, 220 
 
 Sore throat, 302 
 
 Spasms, 326 
 
 Speech of baby, 243 
 
 Sperm, blending of, with ovum, 11 
 
 Spinal curvature, 342-44 
 
 Spoiling the child, 310 
 
 Sprains, 355 
 
 Stools of baby, 184, 185 
 
 Stream of life, the, 8 
 
 Sucking habits in baby, to be 
 guarded against, 224, 378 
 
 Suggestion, effect of, 19, 380-89 
 
 Summer complaint, 278. See also 
 Diarrhoea ; Dysentery 
 
 Sunrise slumber. See Labor 
 
 Suppressors, function of, 9, 15 
 
 Swallowing of bones, buttons, etc., 
 350 
 
 Syphilis, 346, 347 
 
 Teeth, care of, during pregnancy, 
 
 30 
 Teething, 234-37; suggestions for 
 
 treatment during, 237 
 Thrush, 279 
 Tonsils, diseased, 303 ; tonsilitis, 
 
 302 
 Toys, selection of, 230 
 Tuberculosis, 346 
 Twilight sleep. See Labor 
 
 Twitchings, 327. See also Nerv- 
 ousness, hereditary 
 Typhoid fever, 288-91 
 
 Umbilical cord, function of, 18 
 Uremic poisoning. See Urine 
 Urine: Albumin and casts in, 47, 
 50 ; bed-wetting, 328 ; diminution 
 of, during pregnancy, 47 ; dis- 
 turbance in, a sign of pregnancy, 
 4, 5 ; eclampsia, 3 ; examination 
 of, 3 ; irritation of the bladder, 
 37; retention of, by child, 328; 
 testing of, during pregnancy, 30, 
 42, 45, 49, 55 ; toxemia, indica- 
 tions of, 48 ; uremic poisoning, 
 3 ; urinating after labor, 97 ; 
 urination of baby, 223 ; urine an 
 index of disease or sickness, 
 258. See also Pregnancy; Sick- 
 ness of child 
 Uterus, entrance of fertilized 
 ovum into, 9, 10 
 
 Vaccination, 295 
 Varicose veins, 41 
 Vice, secret, causes of, 421 
 Vomiting, 274. See also Diges- 
 tion, disorders of; Feeding the 
 baby 
 Vulva, toilet of the, 96 
 Vulvovaginitis, 334 
 
 Walking of baby, 244 
 
 Warts, 338 
 
 Water : Administered to baby, 
 when, 222 ; necessity of, during 
 pregnancy, 26, 45, 48, 50; part 
 played by in nutrition of body, 
 365 
 
 Water on brain, 331 
 
 Weaning : Breast-fed babies, 241 ; 
 bottle-fed babies, 241 
 
 Weight of baby, 183, 238-39 
 
 Whooping cough, 297 
 
 Worms, 276 
 

 
 
 
 
 
 
 
 
 
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