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MOTHER AND CHILD, 
 
 PART I. 
 
 MOTHER, 
 
 PART II. 
 
 CHILD. 
 
 BY BY 
 
 EDWARD P. DAVIS, A.M., M.D. JOHN M. KEATING, M.D., LL.D. 
 
 PHILADELPHIA: 
 
 J. B. LIPPINCOTT COMPANY. 
 
 London: id Henrietta Street, Covent Garden. 
 1893. 
 
Copyright, 1892, 
 
 BY 
 
 J. B. LippiNcoTT Company. 
 
 Printed by J. B. Lippincott Company, Philadelphia, U.S.A. 
 
PREFACE. 
 
 We have endeavored to make this manual both instructive 
 and readable. Our aim has been, not to supplant the physi- 
 cian, but to supplement his advice and render intelUgible 
 those matters that mothers and nurses find difficult to under- 
 stand. Although our own views are definite and positive, as 
 the result of large experience, we recognize that the experi- 
 ence of others causes them to differ in many points of detail 
 and management, and in order to make our book cover as 
 large a field as possible, we have added much material from 
 the writings of other physicians whose opinions have great 
 weight and whose advice is of incalculable value. Frequently 
 a change of diet from a well-recognized formula to one possibly, 
 in theory not so good, is most important for the child, and on 
 that account we have endeavored to incorporate all the sugges- 
 tions that experience has shown to be of value, at the risk of 
 being prolix, that a choice may be made to suit each individual 
 case. There ai*e undoubtedly times when a competent physi- 
 cian is not obtainable, also there are emergencies when some- 
 thing has to be done at once, and consultation with books 
 becomes a necessity ; under such circumstances we hope that 
 our little work will prove useful. Then, again, frequently the 
 physician has not the time to instruct his jDatient in all the 
 
 3 
 
4 PREFACE. 
 
 little details of treatment, noi' can he answer in a few words 
 the many questions put to him ; we have tried to anticipate 
 this, and to place in his hands a manual that, instead of en- 
 croaching upon his prescriptions, will, on the contrary, aid him 
 by instructing the mother and care-taker, — not sufficiently to 
 make them inferior doctors, but enough to make them intelli- 
 gent patients and skilful nurses. 
 
 In order to more thoroughly individualize each part, it was 
 thought advisable to adopt the plan here presented ; but each 
 author carefully revised the proofs of the whole book, and the 
 views and recommendations are endorsed by both. 
 
CONTENTS. 
 
 PART I. 
 
 nVEO THEIR. 
 
 CHAPTER PAGE 
 
 I. — Girlhood 9 
 
 II. — The Period of Puberty , 14 
 
 III. — The Hygiene of Womanhood 17 
 
 IV. — Conception 19 
 
 V. — Symptoms of Pregnancy 21 
 
 VI. — Duration of Pregnancy 22 
 
 VII. — Miscarriage . 25 
 
 VIII. — Diseases affecting the Woman during Preg- 
 nancy 26 
 
 IX. — Hygiene of Pregnancy — Diet 29 
 
 X. — Hygiene of Pregnancy — Exercise and Clothing 32 
 XI. — Hygiene of Pregnancy— Bathing — Care of Ner- 
 vous System 33 
 
 XII. — Constipation 36 
 
 XIII. — Hygiene of Pregnancy — Breasts — Varicose 
 
 Veins .37 
 
 XIV. — General Hygiene of Pregnancy— Climate . . 40 
 
 XV. — Nurse and Eoom 42 
 
 XVI. — Appliances for the Mother 4-5 
 
 XVII. — Appliances for the Child 50 
 
 XVIII. — Child's Cradle and Basket 58 
 
 XIX. — Labor 56 
 
 XX. — Puerperal Peter 60 
 
 XXI. — First Few Days after Confinement 63 
 
 XXII. — Mother's Eecovery 70 
 
 XXIII. — Diet and Lactation 74 
 
 1* 
 
CONTENTS. 
 
 PART II. 
 
 G H I L ID. 
 
 CHAPTER PAGE 
 
 XXIV. — Care of JSTew-Boes- InpaisT 79 
 
 XXY. — Child's Navel and Intestines 85 
 
 XXVI.— Care op the Brain and Neryous System ... 94 
 
 XXVII. — The Nursing of Infants 97 
 
 XXVIII.— Bottle-feeding 104 
 
 XXIX. — Sterilizing and Sterilizers 110 
 
 XXX. — How to Prepare the Bottle for a Healthy 
 Babe from Birth to Two or Three Months 
 
 OP Age 119 
 
 XXXI. — How TO Prepare the Bottle for a Delicate 
 
 Babe prom Birth to Three Months op Age . 128 
 
 XXXII.— Condensed Milk 132 
 
 XXXIII.— Prepared Bottle , 138 
 
 XXXIV.— Weaning 154 
 
 XXXV.— Menstruation 162 
 
 XXXVI. — Education and School-Hygiene 179 
 
 XXXVII. — Surgical Emergencies 241 
 
 XXXVIII. — Fresh Air, Ventilation, Out-Door Exercise . 275 
 
 XXXIX.— Bathing 298 
 
 XL.— Teething . 304 
 
 XLI. — Diet after Early Dentition 317 
 
 XLII.— The Bowels 336 
 
 XLIII. — Constipation 337 
 
 XLIV.— DiARRHCEA 348 
 
 XLV. — Nursing of Sick Children 357 
 
 XL VI. — Acute and Chronic Nasal Catarrh 380 
 
 XLVII. — Diseases op the Eye 388 
 
 XLVIIL— Diseases op the Ear 399 
 
 XLIX. — Diseases op the Throat and Air-Passages . . 411 
 
 L. — "Whooping-Cough 424 
 
 LI— Fever 429 
 
 LII. — Scarlet Fever 434 
 
 LIII. — Measles — Mumps — Varicella, or Chicken-Pox . 440 
 
 LIV. — Second Dentition 447 
 
PART I. 
 
 MOTHER. 
 
 BY 
 
 E. P. DAVIS, A.M., M.D. 
 
MOTHER AND CHILD. 
 
 CHAPTBE I. 
 
 GIRLHOOD. 
 
 It has been truly said that " the boy is father of the man," 
 and it is not less true that the girl is mother of the woman. 
 The foundations then for sound and healthy womanhood must 
 be laid in girlhood, and the system thus begun must be con- 
 tinued faithfully, yet with wise moderation, if it is to be of 
 permanent usefulness. ISTo subject is of greater importance in 
 this connection than the hygiene of the girl's life. For the 
 first ten or twelve years, her capacity for physical exertion 
 and endurance is practically that of a boy of the same age. 
 Although naturally inferior in muscular development later in 
 life, during these first years she should be fully his equal in 
 strength, endurance, and dexterity. At this time tastes should 
 be encouraged and habits formed which may eventually prove 
 most important in the maintenance of health. Girls should 
 be allowed to become interested in out-door sports during the 
 first ten or twelve years of life, and habits of out-door ex- 
 ercise should be fostered in every way. This plan must of 
 course often be modified to suit individual cases, and excess of 
 exercise is to be deprecated. Parents and teachers should 
 watch children carefully to see that lasting injury is not done 
 to the latter by over exertion. Tennis is a game that lends 
 itself admirably to the vigorous and healthful use of the mus- 
 cles, but what benefit can possibly come to a girl of twelve 
 who plays so many sets that she finally drops fainting on the 
 grass ? Emulation and the desire not to spoil the game for 
 
 9 
 
10 MOTHER AND CHILD. 
 
 tlie companions who depended on her to complete the necessary 
 number of players, was the motive for this fortitude, but her 
 young friends could better bear to be disappointed once than 
 she could to injure herself physically for life. 
 
 A love for animals, which is not uncommon in childhood, 
 may be advantageously encouraged, and often gives increased 
 zest to open-air enjoyments. When possible, a girl shoulH be 
 taught at the earliest opportunity to ride and drive. Skating, 
 running, jumping, and climbing are quite appropriate exercises 
 for girls of this age, while there can be no better time to per- 
 fect the art of swimming than in the years from eight to 
 twelve. The girl then knows little fear of the water, and 
 swims readily, whereas later in life timidity often prevents 
 the acquirement of such knowledge. She can be taught even 
 at this early period to save a life in danger from drowning, 
 and such instruction has not infrequently borne fruit in suc- 
 ceeding years. The writer recalls two women who learned to 
 swim in early girlhood, each of whom has saved lives by ability 
 in this accomplishment, and one of whom has been honored by 
 a medal from a Humane Society. There has also been great 
 harm done, however, to girls by immoderate exertion in gym- 
 nasium and swimming-school, especially in jumping from a 
 height of many feet into the water beneath, and it must there- 
 fore be remembered that it is the " use, and not the abuse," 
 of these aids to physical development that makes the healthy 
 girl and woman. 
 
 There can be no objection to teaching the girl the use of 
 the rifle and shot-gun, and giving her a taste for hunting and 
 fishing, and many a husband has been delighted to find his 
 wife capable of sharing in his sports by reason of an educa- 
 tion given in her girlhood. The idea that it is hoidenish for 
 a girl to practise physical exercise and enjoy out-door sports is 
 one of the prudish superstitions which has done much to re- 
 tard the physical development of American women. A knowl- 
 edge of the use of fire-arms is also of decided value to a girl 
 in enabling her to be calm and courageous under various con- 
 
GIRLHOOD. 11 
 
 ditions of threatening danger. The tortures suffered by many- 
 girls and women in the thought of a possible attack by burglars 
 would probably disappear, certainly be much lessened, by the 
 assurance of possessing the power of self-defence. America 
 might not be now the land " of the free and the brave" if the 
 " women of the first century" (unlike their sisters of a later 
 date) had not cultivated the use of weapons, and nerved them- 
 selves to feats of personal heroism in order to resist the onset 
 of treacherous or desperate Indians. There is no fear that the 
 pursuit of such qualifications will detract from the gentleness 
 and delicacy of feeling which should characterize girlhood, for 
 it is a well-known fact that the pioneer women just alluded to 
 were as remarkable for feminine charms as for the undaunted 
 bravery which was formerly thought the distinctive mark of 
 the stronger sex. 
 
 The domestic nature of the girl rarely needs stimulus ; she 
 is usually willing to learn to sew, and to acquire familiarity 
 with the household arts essential to a truly useful woman. 
 Many children exhibit also a decided taste for music or draw- 
 ing ; if an ability for the latter is manifest, the child will enjoy 
 reproducing to the best of her power some favorite bit of 
 scenery, or the head of a pet animal, and thus a knowledge of 
 out-door life will directly foster an artistic instinct. Too much 
 importance can scarcely be laid upon the out-door element in 
 the girl's life, for there can be no more potent factor in laying 
 the foundations for healthy womanhood than the vigor attained 
 through out-door exercise. 
 
 The dress of the girl should be adapted to permit the freest 
 possible movement ; she should be supplied with thick-soled, 
 low-heeled shoes, well fitting, but sufficiently large to encour- 
 age walking and running. Fashion should be subservient en- 
 tirely to health, comfort, and encouragement of exercise. The 
 nutrition of a child so educated will require little attention be- 
 yond the furnishing of an ample supply of thoroughly nutri- 
 tious food, but this point of properly ^nourishing growing girls 
 needs much more care and thought than the average American 
 
12 MOTHER AND CHILD. 
 
 mother seems inclined to bestow upon it. The nervous waste 
 occasioned by constant exercise must be repaired by abundant 
 and wholesome food, if the girl is to develop into a thoroughly 
 healthy personality. Ten hours of sleep should be the rule, 
 and sponge-bathing in either warm or cold water should be 
 practised daily. It is well known among athletes that exercise 
 and cold sponging produce a marvellously clear complexion, 
 and as the foundation of woman's beauty is laid in girlhood, a 
 hint may be taken from athletes in this respect. Complete 
 sponging, followed by energetic rubbing with the rough towel, 
 produces a delightful feeling of exhilaration, and is succeeded 
 by improved circulation. 
 
 The girl should be carefully guarded from stimulants and 
 narcotics in every form. Neither tea, coffee, nor alcohol should 
 be given, nor should opium or other narcotics be administered 
 for trivial ailments unless by the direct prescription of the 
 physician. An excessive use of tea in this country is doing 
 much to weaken the nerves of women, and is an evil tendency 
 that may lead to serious consequences in producing permanent 
 feebleness of constitution. A morbid appetite for candy, 
 pickles, and other abnormal articles of food should be promptly 
 suppressed in girls, and the helpful effects of really nutritious 
 articles carefully explained, as these vagaries of appetite often 
 arise from thoughtless ignorance of the laws of health and 
 strength. 
 
 The mental education of the girl should not be made a mat- 
 ter of routine memorizing ; the child should learn to read, to 
 write, and to count, but beyond this it is quite unnecessary to 
 go until young womanhood is attained. An education, how- 
 ever, of the best sort is to be gained during this period by ob- 
 servation of the external world, and by the conversation and 
 example of older persons with whom the child is thrown. How 
 often a girl of twelve or thirteen accompanies her parents 
 through Europe, and instead of using her eyes and brain, while 
 travelling in the railway carriage, to note the interesting and 
 novel objects around her, is buried deep in a romantic tale, use- 
 
GIRLHOOD. 13 
 
 ful and entertaining in its proper season, but not to be com- 
 pared in its educational power, at such a time, with the devel- 
 oping force of observation of nature and human character ! 
 While habits of regularity can be formed by certain definite 
 times for study, yet application to books in-doors should never 
 exceed a half-hour at any time. If the girl is to grow to 
 w^omanhood with sound eyes and healthy nerves, she should 
 not be obliged to apply herself assiduously to books in-doors. 
 These statements may seem to the reader dogmatic and ex- 
 treme, but they are founded upon the observation of women 
 suffering fi'om physical imperfections which began during the 
 period of girlhood. It would probably be difiicult to find a 
 school, college, or institution of instruction for girls anywhere, 
 in this country, which is based upon this plan of study of 
 books at school and dispensing of books at home; but if such 
 a system were to be adopted, there is little doubt that there 
 would result a vast improvement in the health of the Ameri- 
 can girl. When it is remembered that without individual 
 vigor, a knowledge of all the sciences that exist will be of 
 very slight value in rendering a woman happy and useful, it 
 seems as if it might be worth while to sacrifice an acquaint- 
 ance with Grreek and trigonometry if the girl by such study is 
 losing the opportunity of cultivating physical strength and 
 endurance. 
 
 The life of the healthy girl is an exceedingly happy one ; 
 she finds no better friend or companion than kind j)ai"ents or a 
 congenial brother : prudery and tradition have not yet taught 
 her that she is to be hedged about with many restrictions upon 
 her taste and ambitions, and the happiest days of life in mind 
 and body are often passed at this period. 
 
14 MOTHER AND CHILD. 
 
 CHAPTEE 11. 
 
 THE PERIOD OP PUBERTY. 
 
 The development of the girl to womanhood exposes her to 
 dangers which demand carefal consideration. If it be remem- 
 bered that the normal performance of the function of menstru- 
 ation is almost directly dejDendent upon the general physical de- 
 velopment of the woman, it will be seen that the hygiene of 
 girlhood is the best preparation for healthy womanhood. The 
 establishment of the functions of womanhood occurs at different 
 ages, varying with the climate in which the girl lives and her 
 individual peculiarities of temperament. If a warm climate 
 and an out-door life have predisposed to early performance of 
 physical functions, this may be established in the twelfth or 
 thirteenth year ; on the contrary, if climatic influences are ad- 
 verse, if the individual be naturally slow in maturing, and if 
 those influences which stimulate unduly the nervous system 
 be kept from the girl, the establishment of menstruation will 
 occur as late as the fourteenth year or subsequently. As a 
 preparation for this important function, all extra strain upon 
 the nervous s^-stem should be assiduously avoided in this cli- 
 mate after the years of twelve and thirteen. The girl need 
 not be told the reason for this, except, in a general way, that 
 she is growing older, and ought not to do as she has done 
 three years previous. It is her mother's duty, however, to see 
 to it that at this time she leads as tranquil and healthy a life 
 as possible, in which the emotional nature is little disturbed, 
 while abundant sleep, fresh air, and freedom from nervous 
 strain are jealously secured for her. If the girl loses appetite 
 and seems generally depressed, a physician should be consulted ; 
 he may discover some poverty of blood, or deficiency in general 
 vigor, which may be easily remedied by an appropriate tonic. 
 It is most unwise, however, for mothers to select at random 
 
THE PERIOD OF PUBERTY. 15 
 
 one of the many patent medicines advertised in the marl<et as 
 specifics in this condition ; it should also be remembered that 
 menstruation is rarely established with regularity for several 
 months after its first appearance. A period of six months or 
 a year is often observed before this function is performed at 
 regular periods. Irregularity, then, at first need occasion no 
 alarm provided the general health remains good. When the 
 first symptoms of menstruation appear, especial caution should 
 be exercised that the girl's clothing be wai'm, loose, and com- 
 fortable. The administration of a simple laxative is often of 
 value, while the use of the hot mustard foot-bath, absolute 
 rest in a warm bed, the application of warm cloths to the 
 abdomen, and the moderate use of hot but not stimulating 
 drinks, have been often found of value. Although alcoholic 
 liquors, either gin, rum, whiskey, or brandy, are often taken 
 by adults to relieve distress at this time, yet the mother will 
 do well to avoid these stimulants in caring for her daughters ; 
 a taste for alcohol is too easily formed to render it safe to ad- 
 minister these substances to secure the performance of a natu- 
 ral function. There is no drug or medicine which a mother 
 may safely give to her child at this time without the advice 
 of a physician. Those nostrums in the market which arc 
 potent for good owe their value to some familiar drug which 
 should be prescribed by a physician only : the vast majority 
 of these medicines are inert, and of no value whatever. It is 
 most important that absolute rest be enjoined during the first 
 day or days of this period while it is about to be established, 
 and the neglect of this simple precaution has often resulted in 
 exposure, and in laying the foundations of lasting disease. The 
 wetting of the feet, sitting in damp clothing, and the incurring 
 of great fatigue at this season, are perils which, if thoroughly 
 understood, would be shunned as serious dangers. Circum- 
 stances point plainly to this period in the life of the woman 
 as a time in which she is poorly fitted to assume active duties. 
 The girl loses the freedom of motion and the careless good 
 health of happy childhood : she becomes easily embarrassed, 
 
IQ MOTHER AND CHILD. 
 
 awkward in action, and often shy in disposition. At the same 
 time, new matters and ideas are developing in the mind, and 
 need wise guidance into proper channels. At this period the 
 girl should have the best and wisest nurses : one of those is 
 her mother, the other is ^N'ature, or the world about her. As 
 the flowers mature best under the influence of the quiet forces 
 of sunshine and moisture, so the phj^sical and mental being is 
 best unfolded to the stimulus of a simple life and the compan- 
 ionship of maternal affection. No more injurious course of 
 action can be taken than to urge a girl at this period to enter 
 general society, to apply herself assiduously in any occupation 
 or study which taxes the nervous system, or to indulge in 
 those romances, which often end in laying the foundations for 
 future sorrow, if the girl be not protected by those wiser than 
 she. It is a false and foolish parental ambition or indifference 
 which refuses to listen to the growing girl's complaint of lassi- 
 tude and disinclination to exertion at this time ; this is not the 
 period when such desires are the result of hypochondriasis or 
 indolence ; but the disposition to avoid great exertion and to 
 husband the strength as much as possible is natural and right. 
 Such tendencies should be met by careful scrutiny and a sym- 
 pathetic, intelligent apprehension of the needs of the individual. 
 While there are man}' boarding-schools which are presided 
 over by wise teachers and guardians, it is far better for the 
 girl at this time if she can be under the tranquillizing influences 
 of a congenial home; class rules which cannot be infringed 
 upon for the sake of any one pupil (unless she be wholly in- 
 capacitated) often oblige her to undergo more exertion than 
 she is physically qualified to meet ; neither does she always 
 receive the right kind of nourishment, nor has the teacher 
 time to note and remedy a failure of appetite or vigor. 
 
THE HYGIENE OF WOMANHOOD. 17 
 
 CHAPTEE IIT. 
 
 THE HYGIENE OF WOMANHOOD. 
 
 In the climate of the United States, and under average cir- 
 cumstances, womanhood may be said to begin at from eighteen 
 to twenty years of age. If her previous years have been 
 spent in surroundings calculated to secure good health, the girl 
 will find herself possessed of strength sufficient not only for 
 the ordinary- domestic duties of life, but, should necessity de- 
 mand it, to engage in some occupation for her livelihood. ISTo 
 matter whether she is obliged to maintain herself, or whether 
 her ambition leads her into the arduous idleness of fashion, if 
 the health and strength are to be preserved, the same precau- 
 tions must continue which were enjoined during childhood. 
 The clothing should remain well fitting, loose, and comfortable. 
 Corsets should be left to those more ignorant and stupid than 
 herself, and habits of exercise out of doors, the use of nutri- 
 tious and easily-digested food, and the securing of a sufficient 
 supply of sleep are still of vital importance. The most suc- 
 cessful women understand perfectly the need for constant care 
 in the preservation of health and beauty. The popularity of 
 massage, the increased number of attractive health resorts, 
 and the wide-spread interest in out-door athletics for women, 
 as well as physical culture in-doors during the winter, give 
 ample evidence of this fact. The additional suppleness, grace 
 of movement, and elasticity of the whole body, attained by 
 conscientious practise of the physical culture exercises, prove 
 a more than sufficient reward for the time and energy bestowed 
 upon them. 
 
 An opportunity is given in the early spring, with the sanc- 
 tion of the church, to avoid overtaxing in the loss of sleep 
 and bad eating which the fashionable season imposes. The 
 great desire to possess homes in the country, in addition to 
 b 2* 
 
18 MOTHER AND CHILD. 
 
 city houses, has resulted in shortening the period of city life, 
 so that, at the present time, many live in town but a third of 
 the entire year. This is a distinct gain in the health and com- 
 fort of those who are fortunately able to follow this custom. 
 
 Among those who are obliged to work for a livelihood, suita- 
 ble materials for proper clothing can be obtained at lower prices 
 than formerly, and light woollen stuffs, which are so essential 
 to health, are far more available than in former times. Food 
 is better cooked in the average boarding-house and restaurant, 
 to which women have access, than was the case ten or twenty 
 years ago. A gi*eater variety is afforded for a moderate price, 
 and the maintenance of a fair condition of nutrition is thus 
 within the reach of nearly all. 
 
 Very few workers in any pursuit are unable to obtain a 
 summer holiday, however brief. Women are now offered 
 lodgings, food, and care in various homes and hotels maintained 
 for w^orking-women, which give them the conditions necessary 
 for health at the lowest possible prices. The heating and ven- 
 tilation of shops and factories are better than formerly (although 
 there is much still to be desired in this respect), and the use 
 of machinery, of elevators, and other labor-saving devices, 
 has reduced some injurious forms of muscular exertion very 
 greatly. 
 
 The increased opportunities for practising stenography and 
 type-writing have given women an occupation which, under 
 favorable circumstances, is not hurtful to those of average 
 strength. 
 
 Training-schools for nurses offer a safe, honorable, and lucra- 
 tive employment, for which women are especially well fitted, 
 to those of good constitution and sound nervous system. ]^o 
 others can become successful nurses, but such can derive good 
 incomes, and if they possess sufficient education and executive 
 ability, can secure, as superintendents of schools and hospitals, 
 those medical positions for which women are best adapted. 
 
 When American civilization advances sufficiently to furnish 
 a class of properly-trained women for house service, one of 
 
CONCEPTION. 19 
 
 the most puzzling problems in securing healthy occupations 
 for women will be solved. At present, the young woman 
 coming to the city often prefers to stand behind a counter, 
 adorned with cheap jewelry, as a " saleslady," when she could 
 earn more money at less expense to herself and under condi- 
 tions favorable to health as a trained waitress, child's nurse, 
 seamstress, or maid. American democracy has placed these 
 pursuits in an unfavorable light in the minds of women, and 
 they are regarded as menial and undignified. A change in this 
 can of course result but gradually, hut when it shall come, the 
 lives and health of many women will be preserved, which are 
 now injured or lost by the disadvantageous surroundings found 
 in many large shops and factories. 
 
 CHAPTBE lY. 
 
 CONCEPTION. 
 
 The conditions influencing conception are so many and so 
 different that a brief consideration of them can hardly fail to 
 be of interest. It has been asserted by some authorities that 
 conception occurs more frequently in the months of spring 
 than in midsummer or midwinter. Next in frequency the 
 autumnal months are given. It is well known that the gen- 
 eral condition of a nation as regards plenty or famine, pros- 
 perity or adversity, war or peace, freedom from excessive labor 
 or necessity for toil, influences in a very marked degree the 
 increase of population. In a general way climate also has 
 something to do with the growth of the human family. The 
 portions of the globe where man survives under the greatest 
 difficulties by reason of the severity of heat or cold show, as a 
 rule, less flourishing families than the more temperate regions. 
 Eegarding the age at which conception is possible, we find 
 that it varies from the period of puberty to several months 
 
20 MOTHER AND CHILD. 
 
 and, in some rare cases, several years after the cessation of 
 menstruation. Conception often occurs about the " change of 
 life." 
 
 So far as age in years is concerned, this changes in different 
 races and different climates, but the fact is familiar that in the 
 tropics women bear children earlier and cease reproduction 
 sooner than in temj^erate or cold climates. So far as the con- 
 ditions favoring conception in individual cases are concerned, 
 the many circumstances which make uj) the life of the wife 
 have considerable influence. The years of greatest fecundity, 
 when reproduction is least injurious to the woman and when 
 children are born best developed, are between the years of 
 twenty and thirty. Great unhappiness, severe nervous shock, 
 prolonged ill health, and, in general, any excessively depressing 
 and persistently acting influence may result in the suspension 
 of the reproductive function. So far as the estimation of the 
 time between the periods of menstruation when conception is 
 most likely to occur, the former belief has been that immedi- 
 ately after the cessation of the monthly period liabilitj^ was 
 greatest. 
 
 More recent investigations have led us to believe that the 
 four weeks or thirty days between the menstrual epochs may 
 be divided into three periods of ten days each. During the 
 first ten days after menstruation and during the ten days im- 
 mediately preceding the next period, liability to conception is 
 gi-eatest. In the ten days between these periods, liability is 
 less. Exceptions, however, to all rules and estimates, and to 
 all methods of computation, are so frequent that no fixed rule 
 can be given, and it must be understood that hability is always 
 present, whatever may be the time, during the inter-menstrual 
 period. 
 
SYMPTOMS OF PREGNANCY. 21 
 
 CHAPTEE y. 
 
 SYMPTOMS OF PREGNANCY. 
 
 The symptoms of pregnancy are naturally divided into the 
 presumptive and the positive. The most frequent presumptive 
 symptom is cessation of menstruation, and yet, when we con- 
 sider the many causes which may disturb the regular course 
 of this function, it can readily be seen that this is far from 
 being a positive symptom, and is, in fact, only the most com- 
 monly-observed presumptive symptom. Any unusual strain 
 upon the vital powers, change of climate and residence, expo- 
 sure to cold or to extreme heat, the disturbances incident to 
 marriage, and, in general, any great depression of the woman's 
 physical economy, or any sudden change in her environment, 
 may result in the temporary suspension of menstruation. 
 This may persist for several months without serious disease 
 being present, and as the general balance of the economy is 
 restored, so the function becomes re-established. Other pre- 
 sumptive symptoms of pregnancy are a sensation of weight 
 and fulness in the abdomen, enlargement of the breasts, with 
 tenderness about the nipples, marked variation in the appetite, 
 with desires for unusual sorts of food, all intensified by a 
 strong desire for, and belief in, the occurrence of pregnancy. 
 
 In rare cases, abdominal enlargement may even proceed to 
 the size attained at the end of normal pregnane}^, and still 
 pregnancy may not exist. While too much stress should not 
 be laid upon the presumptive symptoms of pregnancy, yet 
 disturbance of menstruation and variation in the general 
 health should arouse the woman's suspicions, and should lead 
 her to consult her physician at once. He may be able to de- 
 tect some temporary disorder which treatment may remedy, 
 or his experienced scrutiny may determine tlie existence of 
 pregnancy. So soon as presumptive evidence of pregnancy is 
 
22 MOTHER AND CHILD. 
 
 observed, the Tvoman should avoid fatigue and extremes of 
 every sort, and maintain the best possible general condition 
 of health until her condidon can be definitely ascertained. 
 
 The positive symptoms of pregnancy are present when the 
 child is sufficiently advanced so that its existence can be appre- 
 ciated by the phj-sieian by the senses of hearing, of touch, or 
 of sight. By these we mean that when the physician can 
 hear the heart-beat of the child within the womb ; when by 
 placing his hand upon the abdomen he can feel distinctlj- the 
 movements of the child, and by watching closely the surface 
 of the abdomen as the mother is resting quietly in a recum- 
 bent position, can observe slight movements which are occa- 
 sioned by the motions of the child's limbs within the womb, 
 then the positive existence of pregnancy is established beyond 
 doubt. Ordinarily, however, it is quite sufficient for the physi- 
 cian to hear the beating of the child's heart, and this can 
 usually be done soon after the fourth month of the child's ex- 
 istence. In repeated pregnancies, the mother can often from 
 experience assert positively regarding her condition ; but even 
 the sensations of an experienced mother are occasionally at 
 fault, and so a positive vei'dict must be deferred until the 
 physician can demonstrate the existence of the child. 
 
 CHAPTEE VI. 
 
 DURATIOX OP PREGNANCY. 
 
 It is well to define the terms used to express the premature 
 birth of the child, and also the limits to the time in which a 
 child may be born and survive. By the word viability we un- 
 derstand the child's ability to survive when expelled from the 
 womb. Modern methods of treatment have made it possible 
 for children to live and thrive when born between six and 
 seven months after conception. If a child is expelled from 
 
DURATION OF PREGNANCY. 23 
 
 the womb in the first four months of pregnancy, it is com- 
 monly called an abortion. If the expulsion takes place after 
 the fourth month, but before the time when the child is viable, 
 it is known as a miscarriage, and if the child is born after the 
 period of viability, and yet before the usual limit of pregnancy, 
 it is known as premature labor. 
 
 This brings us to consider the natural limit of pregnancy in 
 the human species. It was formerly supposed that from two 
 hundred and seventy to two hundred and eighty days was the 
 usual period of gestation, but recent study has shown that 
 while it is true in the majority of cases, yet occasionally gesta- 
 tion may be prolonged to three hundred days, and even more, 
 and still a perfectly healthy child be born after a safe and 
 speedy labor. 
 
 On the other hand, it is not infrequent for children to be 
 born at any time between the two hundredth and two hun- 
 dred and eightieth day after conception, and survive and flour- 
 ish. Keeping these facts in mind, we can readily explain the 
 miscalculations which occasionally arise, and the fact that 
 children are sometimes born before their mothers are ready for 
 them, before the arrival of the nurse, and when they are quite 
 unexpected ; and again, a delay of several weeks may occur, 
 giving rise to much annoyance and anxiety, and yet the whole 
 be simply a delayed j)rocess. If we ask ourselves in what 
 consists a perfectly healthy pregnancy, we may define it some- 
 what as follows : It is the natural growth and development of 
 the child in the womb, extending through a period, on the 
 average, of nine months, and resulting in the birth of a child 
 sufficiently strong to subsist with the aid of the mother's care. 
 
 During this time, changes go on in the body of the mother as 
 the child grows and develops. She frequently gains somewhat 
 in weight, and increase in all of the tissues of her bod}^ takes 
 place. As pregnancy progresses, the organs of respiration 
 and digestion become encroached upon by the growing child, 
 and hence modifications in every function result, which are 
 adapted to the increased demand maiJe upon her respiratory 
 
24 MOTHER AND CHILD. 
 
 and digestive functions. She is obliged to breathe and to 
 digest for two, and hence in many instances a feeling of well- 
 being and an increase of appetite take place. In other cases 
 the burden of the new life seems excessive, and weakness and 
 prostration may denote that her powers are unequal to the 
 task ; but in the main, among healthy women, after the first 
 months are past, the general health is in a condition of com- 
 parative vigor. The wonderful changes which go on during 
 these nine months are but imperfectly understood by even 
 scientists. It is sufficient to say that if the mother remembers 
 the dual life which she is leading, and that there is developing 
 within her abeing which not only breathes through the oxygen 
 contained in her blood, but in addition is forming a nervous 
 system, and receiving through her nervous system the trans- 
 mission of some of the sensations which she experiences, the 
 meaning and scope of what is meant by a natural pregnancy 
 become more apparent. 
 
 We introduce these apparently abstract scientific remarks to 
 impress upon the minds of mothers the fact that their habits 
 and environment during the period of pregnancy are forming 
 not only the shape and size and health of the unborn child, 
 but also its mental and physical peculiarities. It should be 
 remembered that a normal pregnancy is a distinctlj^ natural 
 and physiological process ; that certain tissues and develop- 
 mental forces resident in the woman's body have been given 
 to her for this purpose, and that her forebodings and dread are 
 to be tempered by the thought that she is thus fulfilling a 
 design which results, in the healthy person, not in disease nor 
 in death, but in the performance of a function which is part 
 of her healthy life. 
 
MISCARRIAGE. 25 
 
 CHAPTEE VII. 
 
 MISCARRIAGE. 
 
 It is necessary that we should also describe abortion and 
 miscarriage, and draw attention to dangers which attend them. 
 The two symptoms of abortion and miscarriage, which should 
 at once arouse solicitude, are flooding and pain. They denote 
 that the child is in danger of being separated from the womb, 
 or that such separation has already occurred. This may be 
 caused by disease on the part of the mother, and especially 
 frequently by undue exertion or violence. Thus, as in a case 
 which we recall, the use of a sewing-machine for half a day, in 
 a woman who was not accustomed to active work, resulted in 
 abortion. Thoughtless lifting or undue exertion in reaching 
 up to high shelves, or hanging up clothing, has also caused 
 abortion. A sudden shock, as falling down stairs, or being 
 thrown from a carriage, or severely jolted upon a rough road, 
 or in an elevator, or upon a railway train, has resulted in this 
 accident. 
 
 Occasionally, in persons who seem predisposed to abortion 
 or miscarriage, a very slight jar will bring on this misfortune. 
 Thus, a mis-step in the street has caused abortion. Sudden 
 nervous or mental shock, grief and terror, have been repeatedly 
 effectual ; in great disasters, where a city has been burned, or 
 where a section of country has been suddenly attacked by a 
 hostile army, or in time of sudden disaster of any sort, as 
 during the Johnstown culamity, large numbers of women suf- 
 fered from abortion or miscarriage. 
 
 The occurrence of flooding and pain in a woman who is preg- 
 nant should lead to her placing herself instantly at perfect 
 rest, and sending for her physician. She should lie down, 
 loosen her clothing, keep absolutely quiet, and summon medical 
 aid as soon as possible. The dangers of such accidents are the 
 B 3 
 
26 MOTHER AXD CHILD. 
 
 bleeding whicli accompanies them, and the fact that, unless 
 especial care is taken, women frequently do not recover health 
 promptly, but suffer from various disorders afterwards. The 
 physician's treatment and orders should be strictly carried out, 
 and especially in the matter of remaining absolutely quiet 
 until he gives permission to move about. Women not infre- 
 quently think that rest in bed for a week or ten days after 
 hemorrhage has ceased is quite sufl&cient for perfect recovery. 
 This, however, is very rarely true, and frequently the avoid- 
 ance of exertion from eight weeks to three or four months is 
 needed to result in perfect restoration to health. If the physi- 
 cian's limit as to remaining recuriibent were more generally 
 observed, women would suffer far less frequentlj- from the con- 
 sequences of these accidents. 
 
 If women are so situated that they cannot obtain medical aid 
 promptly, and flooding and pain continue, b}- keeping absolutely 
 recumbent, the head low upon the bed, possibly without a pil- 
 low, and by the exercise of the greatest cleanliness while the 
 hemorrhage persists, they will do all that they can to favor 
 a good recovery. It is especially important that, should a friend 
 be present sufficiently experienced to understand what is going 
 on, she should abstain in any way from touching the bag of 
 fluid in which the child is contained until it has been expelled 
 from the mother's body. Otherwise, she may precipitate a 
 dangerous complication. 
 
 CHAPTEE YIII. 
 
 DISEASES AFFECTING THE WOMAN DURING PHEGXANCT. 
 
 Diseases occuri'ing in pregnant women commonly occasion 
 more than usual anxiety on the part of the patient and her 
 friends. This anxiety is based upon good grounds, for if a 
 pregnant woman becomes ill with some acute disease, her 
 
DISEASES DURING PREGNANCY. 27 
 
 pregnancy adds greatly to her danger. In fevers, occurring In 
 such patients, the danger to mother and child becomes great 
 in proportion as the patient's temperature is high and remains 
 considerably elevated. Thus, in typhoid fever, in malarial 
 fever, in rheumatic fever, and in pneumonia, often known as 
 lung fever, if the patient's temperature does not rise very 
 high nor remain elevated for a considerable time, the patient's 
 chances for recovery and those of her child are much better 
 than if the fever is severe and prolonged. If abortion should 
 occur during an illness, it is an injurious accident for the 
 mother. She is apt to have severe flooding, and there is danger 
 that some form of inflammation will attack the womb. 
 
 It sometimes happens that the organs in the body which 
 remove waste materials from the blood fail to properl}^ perform 
 their functions during pregnancy. This results in the storing 
 up of poisonous material in the patient's body, and when this 
 poisonous matter becomes sufficiently abundant, it poisons the 
 brain and spinal cord, and causes convulsions. This is known 
 as eclampsia, or convulsions occurring in pregnane}'. They 
 are likely to come on sometimes without warning, and more 
 often after the patient has suffered with headache, dimness of 
 vision, a sense of heaviness and lassitude, accompanied by a 
 gradual diminution of the product of the kidneys. Symptoms 
 such as these, when observed by a nurse or by the patient her- 
 self, should cause her to instantly consult her physician. 
 
 Eclamptic convulsions occurring during pregnancy resemble 
 epileptic fits ; they are more dangerous than epileptic fits, for 
 many patients die in this condition. The convulsions usually 
 bring on the labor, and the child sometimes survives and often 
 perishes. If the patient sufl'ers from headache, lack of vision, 
 and diminished amount of kidney secretion, no time should be 
 lost in communicating with her physician. 
 
 It has long been a tradition that women who have incipient 
 consumption become better in health if they marry and bear 
 children ; this is one of the many groundless beliefs extant. 
 It is true that during the pregnancy the mother's health and 
 
28 MOTHER AND CHILD. 
 
 strength may improve under the influence of the increased nu- 
 trition which pregnancy brings : so soon, however, as the preg- 
 nancy ends, the disease which existed before pregnancy began 
 goes on with increased severity. It is wrong for women who 
 have incipient consumption, or for women who have a strong 
 hereditary tendency to consumption and are themselves not 
 robust, to marry and bear children. If this truth were ac- 
 knowledged, much would be accomplished to check the spread 
 of consumption. There is also a possibility that the child, 
 when born, will be found affected by the same disease. A 
 woman suffering from consumption should by no means nurse 
 her child, as there is danger of convej'ing tuberculosis through 
 her milk. 
 
 Nervous diseases sometimes develop during pregnancy, and 
 among these, St. Yitus's dance is not uncommon. Insanity is 
 sometimes precipitated by pregnancy and the puerperal state. 
 Where the mother has been healthy before she became preg- 
 nant, she will probably recover her mental condition in a short 
 time after the child is born. Where, however, the mother has 
 a strong tendency to insanity, the chance for her permanent 
 recovery is not so good. 
 
 It has alwa^-s been thought that pregnant women were 
 especially liable to those diseases which are accompanied by 
 eruptions : this opinion is well founded. The danger in these 
 cases arises from the fever which accompanies them, from the 
 liability to interruption of the pregnancy, and the danger of 
 blood-poisoning which complicates such an accident. Cases of 
 extraordinary resistance to such contagion are occasionally 
 observed, and women have been known to nurse a child 
 suffering from scarlatina without themselves contractino- it. 
 Such could scarcely be the case if the woman were pregnant 
 and cared for another child ill with scarlatina. Where abortion 
 or labor occurs in these cases, especial precautions regarding 
 cleanliness should be observed, as the danger of blood-poison- 
 ing is much greater than ordinarily. 
 
 Women who have disease of the heart are often exceedingly 
 
HYGIENE OF PREGNANCY— DIET. 29 
 
 anxious lest pregnancy should terminate in a dangerous and 
 severe labor. Fortunately, such fears have no great basis for 
 their existence. It is remarkable how women who have 
 suffered from heart-disease for many years will pass' through 
 a pregnancy and labor not only without growing worse, but 
 oftentimes with apparent improvement. A patient's fears 
 upon this point are happily generally without foundation, for 
 when pregnancy terminates in labor, a remarkable degree of 
 strength is often developed in the action of the heart. Women 
 may receive severe injury during pregnancy from accidents, or 
 from assault in Occasional cases ; it is the rule, however, that 
 if the mother be healthy, the pregnancy is often not inter- 
 rupted, but the mother may recover, and the child continue to 
 live until term. 
 
 CHAPTEE IX. 
 
 HYGIENE OF PREGNANCY — DIET. 
 
 There can be no more important subject than the hygiene of 
 pregnancy, and, as would be naturally inferred, the question of 
 food is of the greatest interest. There are prevailing certain 
 absurd ideas regarding the influence of the mother's diet upon 
 the size and development of the child. It is alleged that by 
 maintaining a continuous diet of fruit, and by carefully avoiding 
 such articles of food as would contain matter nutritious for 
 the child's skeleton, that children of small size and with easily- 
 moulded and soft heads will be born as a consequence. While 
 it may be possible by starving the mother to starve her child, 
 yet no more injurious practice could be followed than one 
 which diminishes the strength of the mother, and brings her 
 to face the ordeal of labor with impoverished blood and de- 
 pressed nervous system. 
 
 The contrary is true, — that the patient needs a most abundant 
 and eat<ily-digested diet which shall be rich in nutrient material 
 
 3* 
 
30 MOTHER AND CHILD, 
 
 in proportion to the demands upon her for her own nourish- 
 ment and that of her child. The question of drink during 
 pregnancy is one which must be determined by reference to 
 the usual habits of the patient. If she has been accustomed 
 to drinls wine and beer, there would be no objection to her 
 continuing the practice in moderation. But if not, she will 
 do well not to commence the use of stimulants while pregnant. 
 The question of diet, however, is greatly influenced by the 
 irritability of the patient's stomach and her incapacity to 
 digest large quantities of food, which are especially pronounced 
 during the first four months. 
 
 The phenomenon known as morning sickness may be de- 
 scribed as follows: Soon after waking in the morning, and 
 usually as soon as the head is raised from the pillow, the 
 patient is suddenly seized with a desire to empty the stomach. 
 When this desire is gratified, the sensation of nausea disap- 
 pears, and soon after the patient is able to take a little food. 
 In perfectly healthy women, where this derangement does 
 not become severe, no treatment is necessary ; if the patient 
 drinks a glass of water and then ejects it at once, no harm is 
 done, and in a few moments she will often be able to retain 
 food. Very frequently, this disagreeable symptom may be 
 avoided by taking a small quantitj^ of very easily digested 
 food before the head is raised from the pillow. A little stimu- 
 lant will prove effectual when food does not. Thus, a cup of 
 well-made broth, rather highly seasoned and hot; a small cup 
 of cocoa, tea, or coffee, especially black coffee ; a small glass 
 of champagne, other wines, or bitter ale or beer ; sometimes a 
 little cordial, as Chartreuse ; brandy and soda, koumiss, and in 
 hot weather a very little ice-cream, — all these are occasionally 
 successful in giving relief, and in promoting an appetite for a 
 subsequent breakfast. 
 
 The patient must understand that the trouble is what is 
 known as reflex ; that the growing of the child in the womb 
 produces some irritation about the womb which is transmitted 
 along its nerves to the nerves of the stomach. As a rule, 
 
 P 
 
HYGIENE OF PREGNANCY— DIET. 31 
 
 when four months of pregnancy have passed, this disorder 
 ceases, and usually a good appetiie is enjoyed for the remainder 
 of the time. 
 
 "We desire to warn the patient against using drugs of any 
 sort for morning sickness. When excessive acidity of the 
 stomach is present, bicarbonate of sodium, or the soda-mint 
 sold in the shops will be of use, but narcotics and remedies 
 addressed to the nervous system should be taken upon a 
 phj'sician's prescription only. The appelite of the pregnant 
 woman is likely to be peculiar, and, in fact, a number of cases 
 are on record whei*e the first intimation that the woman had 
 of her condition was a sense of delight or of loathing at the 
 existence of some especial article of diet, generally a reversal 
 of the usual appetite. 
 
 Pregnant women frequently seem to have excessively abnor- 
 mal appetites, which are known as " longings." If these be 
 analyzed, they will usually bo found to be expressions of de- 
 sire for the sort of food which will best nourish herself and 
 her unborn child. A hint ma}' often be taken from these long- 
 ings, and the needed article of diet may thus be supplied to 
 the patient. 
 
 If food is important during pregnancy, it must be remem- 
 bered that digestive power is commonly so lessened that a 
 smaller amount than usual can be digested at any one time. 
 Hence it is often necessary not to take three full meals in 
 twenty-four hours, but to have five or six lunches or lighter 
 meals instead. These may be taken at intervals of four or 
 five hours, and are often admissible at such intervals as to come 
 after the patient has lain down and slept for a short time. 
 
32 MOTHER AND CHILD. 
 
 OHAPTBE X. 
 
 HYGIENE OF PREGNANCY — EXERCISE AND CLOTHING. 
 
 If proper nutrition is imporiaat for the pregnant woman, 
 it must be remembered that there is no agent so efficient in 
 producing this as sleep. Eest and sleep should be taken with 
 regularity and abundance; eight or nine hours at night, and 
 from one to three during the daytime, are not too much for a 
 person of average development. If sleep is interrupted, rest 
 can often be taken at intervals most convenient. This should 
 consist not only in the semi-recumbent position in a chair, but 
 also in lying on a comfortable couch or bed. It quite often 
 happens that if the child be vigorous, its movements within the 
 womb may prevent sleep at night, and then rest in the day 
 may be substituted. 
 
 To keep up the condition of comfortable health, exercise is 
 fully as important as food and sleep. Best of all is walking 
 in moderation. Climbing stairs, lifting, running a sewing- 
 machine, moving the arms rapidly, and excessively long walks 
 are all extremely injurious, and likely to pi'oduce subsequent 
 trouble; but a walk carefully graduated to the patient's 
 strength and sensations in the earlier months of pregnancy, 
 and driving in a comfortable vehicle in the latter months are 
 especially indicated. The amount of housework incumbent 
 upon a woman in comfortable circumstances usually suffices in 
 ordinary cases. 
 
 Exercise, however, will be uncomfortable and impossible 
 without injury unless the patient is properly dressed. The 
 very word enceinte denotes a person who is not wearing clothing 
 closely belted about her. So soon as pregnancy is discovered, 
 the ordinary corset should be laid aside. Some form of clothing 
 should be adopted which supports the skirts upon the shoul- 
 ders. There are a number of these devices in the market. 
 
BATHING— CARE OF NERVOUS SYSTEM. 33 
 
 and the patient must choose that which fits her most com- 
 fortably. 
 
 Even in moderately warm weather, woollen underclothing 
 should be worn. In winter, the Jaeger system of woollen 
 underwear, and in warm weather, the finer and thinner goods 
 similar are best, and should cover the body to the wrists and 
 ankles. Garters should be made as loose as possible, or, better, 
 discarded for some other device. No portion of the clothing 
 should fit tightly, and should support for the abdomen be de- 
 manded, an abdominal bandage, or „ , 
 waist coming from the shoulders 
 over the abdomen, may be em= 
 ployed. In drivini;, great care 
 should be taken that wraps are 
 always within reach to avoid chill- 
 ing the surface of the body. Easy 
 shoes, loose-fitting wraps, and those 
 forms of clothing which allow the Abdominal bandage for support 
 freest movement of the chest should 
 
 be worn. It is almost needless to say that, in the changeful 
 climates of this country, thin woollen should be worn next to 
 the skin for at least ten months of the year. 
 
 CHAPTEE XL 
 
 HYGIENE OP PREGNANCY — BATHING — CARE OP NERVOUS SYSTEM. 
 
 The care of the skin is a very important detail ; the bath 
 should be daily, avoiding extremes of hot or cold water, to be 
 taken in the manner least likely to fatigue the patient, fol- 
 lowed by gentle friction, and by repose in a recumbent posture 
 for at least half an hour. A very disagreeable itching and 
 burning in some parts of the body frequently occur during 
 
34 MOTHER AND CHILD. 
 
 pregnancy. The advice of the physician should be at once 
 sought, and occasionally the patient can do much to relieve 
 herself by dissolving in the water of the bath sufficient sodium 
 bicarhonate to give a smooth feeling to the fingers, or, occa- 
 sionally, a warm bath into which bran has been mixed will be 
 found an advantage. 
 
 The nervous system of the patient undergoes modifications 
 fully as groat as those of other organs. In the beginning, a 
 period of despondency may occasion great anxiety on the part 
 of the patient and her friends. She will often urge her physi- 
 cian to relieve her from the continuation of her condition, 
 fearing its results for the child and herself. Other women 
 feel much better than usually when in this condition, and are 
 hopeful and courageous from the first. It should be remem- 
 bered til at forebodings and despondency have no basis of fact 
 whatever, but are simply manifestations of the physical con- 
 dition of the patient. They should be disregarded by her, 
 her mind occupied as pleasantly and constantly as possible, and 
 she should train herself to look forward to the termination of 
 this trial with anticipations not of disaster, but of great hap- 
 piness subsequently. Those about her should be careful to 
 encourage her in this belief, and especially nurses, and women 
 who have already had children, with whom she may come in 
 contact, should forbear from relating accounts of dangers and 
 complicated cases which they have seen or experienced. Such 
 is the heartless idiocy of gossips, whether professional or other- 
 wise, that they seem never happy unless relating some chapter 
 of horrors in which they imagine that they have been heroines. 
 When we pause to consider, however, that these stories are 
 always exaggerated for the purpose of magnifying their own 
 exploits, we readily see on what slight basis of truth most of 
 them rest. The professional nurse wiio knows no better than 
 to alarm pregnant women with tales of dreadful confinements 
 should not receive a second engagement from any one. 
 
 Occasional peculiarities in temper and temperament, not 
 usually characteristic of the patient, should be kindly ascribed 
 
BATHING— CARE OF NERVOUS SYSTEM. 35 
 
 by her friends to her changed condition, and treated as purely 
 physical and transient, with the greatest kindness. The patient 
 herself and her friends should remember that the condition of 
 her mind and her nervous sj'stem has an important bearing 
 uj)on that of her unborn child. Intelligent women have fre- 
 quently surrounded themselves during this period with all that 
 was lofty, beautiful, and pleasing. It was the custom among 
 the Greeks to take especial pains that nothing should be pre- 
 sented to the view of such women except the most beautiful 
 scenery and the most artistic forms. The aid of music and 
 recitations from the poets were also invoked that the child's 
 brain might be tuned, as it were, while still in process of con- 
 struction, for that which was most beautiful. In modern 
 times, we recall an instance of an intelligent woman leading a 
 quiet life, who, during her pregnancy, chose such literature 
 for her reading and such associations as she judged most likely 
 to develop pure and good tastes in her child, and the result 
 fully justified her precautions. 
 
 It is commonly sujDposed that the sight of a dreadful object, 
 the receipt of sudden and dreadful news, great and horrible 
 danger, the witnessing of a crime, or any great shock, often 
 result in some permanent deformity or malformation in the 
 child. There is certainly a basis of truth for this belief suffi- 
 cient to cause a woman in this condition to carefully avoid 
 anything which is dangerous or terrifying. There can be no 
 doubt that the mother's previous habits and also those during 
 her pregnancy have a decided influence upon the formation of 
 those of her child. The responsibility devolving upon parents 
 can be readily appreciated on consideration of this fact. So 
 far as the formation of a healthy brain and nervous system of 
 the child go, regularity in habits upon the part of the mother, 
 and the avoidance of exciting and endangering causes, with 
 abstinence from stimulants, — in fact, a life as tranquil and 
 happy as possible during these nine months, — can hardly fail 
 to give the child the best possible chance for healthy develop- 
 ment. 
 
36 MOTHER AND CHILD. 
 
 CHAPTEE XII. 
 
 CONSTIPATION. 
 
 The most common trouble from which patients suffer during 
 this period is that of constipation. This is generally worse 
 during the first few months, and during the last six or eight 
 weeks. It is to be remedied so far as possible by a carefully- 
 arranged diet in which whole wheat flour, fresh vegetables, 
 fruits, and a free sujiply of water form a large part. Consti- 
 pation is especially dangerous in pregnancy, and the greatest 
 pains must be taken to avoid it. Drugs should be taken on 
 the advice of a physician only. The simplest remedies should 
 be employed as long as possible, and not abandoned hastily. 
 Thus, a regular habit in this matter is of the greatest impor- 
 tance. A glass of cold water, or of hot water, taken in the 
 morning as soon as the jDatient rises, a small glass of one of 
 the mineral waters, the gluten suppositories furnished by most 
 druggists, or, if this fail, glycerin suppositories may be em- 
 ployed. Enemata will generally succeed in the failure of the 
 other means which have been described, and should be com- 
 posed of water only, or white castile soapsuds to which castor oil 
 has been added, the whole beaten up together and administered 
 while wai'm. and, occasionally, enemata in which the yolk of 
 a raw egg and a few drops of spirits of turpentine have been 
 beaten up in the soapsuds. The best time for the use of such 
 an injection is usually before retiring, or soon after waking in 
 the morning. 
 
 Irritability of the bladder is also a source of great annoyance 
 to pregnant women, and is frequently relieved by assuming 
 the recumbent posture. It is caused by the pressure of the 
 enlarged womb, which is removed by such change in the posi- 
 tion. Salivation or excessive flow of saliva is occasionally a 
 
BREASTS— VARICOSE VEINS. 37 
 
 great annoyance, and can hardly be treated without the advice 
 of a physician. 
 
 The care of the teeth, however, is a matter which each 
 woman should look after herself. After the fourth or fifth 
 month of pregnancy she should visit her dentist, no matter 
 whether she have suspicions that all is not right with her 
 teeth or not. Her condition frequently gives rise to some 
 change in the teeth, and this should be taken in hand promptly 
 before it has gone sufficiently far to cause permanent trouble. 
 Certain disorders of the skin not infrequently arise, and among 
 them the curious formation known as the " mask of pregnancy." 
 This is a peculiar pigmentation, often of a brownish-yellow, 
 forming upon the forehead and face, and usually persisting 
 during this time. It is caused by a deposit of coloring matter 
 similar to that which is observed in other regions of the body 
 during pregnancy. As a rule, it gradually fades away after 
 the birth of the child, and it is not amenable to treatment. 
 Although unpleasant, it is not in the least harmful, and should 
 be let alone and disregarded as far as possible. The care of 
 the skin, however, is a matter of very considerable impor- 
 tance. The pregnant woman, in common with others, eliminates 
 from the body, through the skin, poisonous material which is 
 especially dangerous in her condition. 
 
 CHAPTEE XIII. 
 
 HYGIENE OF PREGNANCY — BREASTS — VARICOSE VEINS. 
 
 One of the most important matters for consideration is the 
 care of the breasts. As pregnancy advances they become 
 more prominent, firmer in consistence, and a deposit of color- 
 ing matter takes place about the nipple. Small projecting 
 bodies are also seen in the colored ring which surrounds the 
 nipple, and these are small and auxiliary glands. In some rare 
 
 4 
 
38 MOTHER AND CHILD. 
 
 cases the breasts become so turgid early in pregnancy as to 
 demand the use of a supporting bandage, or of some applica- 
 tions of a soothing character. The care of the nipple itself is 
 of extreme importance with regard to the subsequent nursing 
 of the child. It not infrequently happens that from a lack of 
 development the nipple is so flat and sunken that the child 
 cannot grasp it. Fissures and cracks of the nipple, occasion- 
 ing much distress when the child nurses, are also frequently 
 met with. 
 
 In cases of flat and retracted nipples, persistent efforts 
 should be made to draw out and develop them during the 
 months of pregnancy. This can be done by the thumb and 
 finger, and should never be made a painful process. Occa- 
 sionally a suction pump, called a breast-pump, and to be ob- 
 tained at druggists, may be employed to advantage. A healthy 
 nipple should stand upon the breast much as a raspberry stands 
 upon its stem, and if this relative situation be not present, the 
 child may have trouble subsequently in nursing. To avoid 
 cracks and painful fissures in the nipple it is better not to ap- 
 ply hardening agents which make its surface more brittle and 
 more apt to crack, but to use some soothing ointment instead. 
 The nipple should be washed at least once daily with warm 
 water and castile soap. Afterwards it should be gently 
 drawn out between the thumb and finger, and anointed Avith 
 cold cream or cocoa butter. If fissures and cracks occur, the 
 attention of the physician should be immediately called to 
 them. If the breasts become uncomfortably heavy during 
 pregnancy, they may be supported by a breast bandage, to be 
 described later. Should great turgidity, sharp pain, and some 
 fever be present, inflammation of the breasts is threatened, 
 and the physician should be summoned at once. Yery fre- 
 quently, the use of borax-water, one tablespoonful to the pint 
 or half-pint, is of great service in bathing the nipple, in pre- 
 venting soreness and fissures. 
 
 The chronic consfpation of which we have spoken, together 
 with the pressure of the womb upon the intestines, not infre- 
 
BREASTS— VA RICOSE VEINS. 
 
 39 
 
 quently results in tlie development of hemorrhoids, or in 
 aggravating such as may be already present. Care should be 
 taken to avoid constipation, and the physician's advice promptly 
 summoned in such cases. 
 
 Varicose veins in the legs, and sometimes about the lower 
 portion of the abdomen, may occasion great distress, and in 
 the case of repeated 
 
 pregnancy may become " " 
 
 so greatly distended as 
 to threaten rupture. 
 They often cause great 
 discomfort by reason 
 of a sensation of weight 
 and heaviness in the 
 legs, and occasionally 
 they are accompanied 
 by intense itching. 
 
 The most convenient 
 and comfortable means 
 of support for varicose 
 veins is a bandage 
 three inches wide, made 
 of old, soft flannel. 
 This should be applied 
 in the morning before 
 rising, while the patient 
 is recumbent. It should 
 begin at the toes and 
 extend to the groin. 
 Several of these band- 
 ages should be pro- 
 vided, and washed repeatedly, and thus a convenient and neat 
 form of support is furnished. When once the knack of apply- 
 ing them is acquired, they are more convenient than silk and 
 rubber stockings, which are frequently used, as they can be 
 varied in the tightness and looseness of application, and so 
 
40 MOTHER AND CHILD. 
 
 meet the individual needs of each case better than a less easily 
 adjusted support. It is well to powder the skin over the vari- 
 cose vein with finely -powdered borax, or with common rice- 
 powder. 
 
 Yaricose veins occasionally become excessively distended, and 
 rupture causes serious hemorrhage. Should this accident 
 occur, the patient should lie flat at once upon the nearest con- 
 venient support. The person aiding her may take a clean 
 handkerchief, fold it into a square pad about two inches or 
 so, and place the pad directly over the jwint of rupture. A 
 bandage should be taken, and the limb bandaged from the toes 
 up over the pad at the point of rupture. The leg should then 
 be elevated upon a pillow, and a physician summoned (Fig. 2). 
 It must be remembered that a bandage or string, simply tied 
 about the leg above or at the point of rupture may not only 
 fail to check the hemorrhage, but may cause dangerous com- 
 pression of the vein, increasing the bleeding; so the whole leg 
 must be included in a compression-bandage, to be effectual. If 
 a bandage is not available, an old sheet may be torn up and 
 one hastily improvised. Moderate pressure may be made with 
 the hand upon the folded handkerchief, at the point of rupture, 
 until assistance can arrive and the leg be bandaged. 
 
 CHAPTBE XIV. 
 
 GENERAL HYGIENE OF PREGNANCY -^CLIMATE. 
 
 So far as the general hygiene of pregnancy is concerned, 
 whatever conduces to the tranquillity and general health of 
 the patient is advisable. The claims of society should give 
 way entirely to the patient's condition. Such social pleasures 
 as are productive of rest and diversion may be enjoyed so long 
 as the point of fatigue is not reached. But no restriction of 
 dress and no positive engagements should be made which 
 
GENERAL HYGIENE OF PREGNANCY^CLIMATE. 41 
 
 might necessitate the patient's discomfort and cause a tax 
 upon her strength. So far as society has claims they are ut- 
 terly insignificant compared with the claims of the patient's 
 own necessities and those of her unborn child. 
 
 In persons who are able to vary their residence at will to 
 secure the best possible climate at each season of the year, it 
 may be advised that extremes of heat and cold and rigorous 
 climates be carefully avoided. It would be best for the period 
 of pregnancy to be passed in a temperate and equable climate 
 where a large percentage of the days were fair, where extremes 
 of temperature did not occur, and where severe storms were 
 very infrequent. Such a climate would permit of the greatest 
 amount of out-door exercise, and be the most favorable for the 
 patient. This, however, is rarely obtainable in our latitude, and 
 the fatigue and risk of a long journey to obtain such a climate 
 might overbalance the advantages to be gained by it. How- 
 ever, the modern luxuries of travel are making it more easily 
 possible for frail and invalid persons to seek suitable climates, 
 and hence the pregnant woman who has the necessary means 
 may choose a suitable climate at will. As a general thing, 
 long journeys are to be avoideJ, not only because of the danger 
 of abortion caused by the jolting of railway cars and the mo- 
 tion of a steamer, but on account also of ihe difficulty of carry- 
 ing out that regular and systematic care which the patient's 
 daily life demands. Amusements of various kinds often serve 
 an important purpose in lessening the tedium of the patient's 
 enforced retirement and in diverting her mind, and so long as 
 fatigue and annoyance are avoided, they are a valuable adjunct 
 in securing her well-being. 
 
 It cannot be impressed upon the patient too strongly that 
 she should consult her phj^sician as soon as her condition is 
 suspected or known. Modern obstetric science does not wait 
 for complications to occur at labor, but endeavors by a careful 
 scrutiny of the mother to anticipate and prevent them. It is 
 possible for the physician to ascertain with comparative ease 
 whether the mother is naturally shaped and developed, the 
 
 4* 
 
42 MOTHER AND CHILD. 
 
 position which her child occupies in the womb, its comparative 
 vigor and development, and whether the general conditions 
 favorable to a successful labor are present. Should the chUd 
 be of excessive size in pi-oportion to the mother ; should the 
 mother be smaller than the average, or deformed, or the victim 
 of a dangerous and chronic illness, it is possible to so treat her 
 as to give tbe best possible chance for the life of her child and 
 her own recovery. This must be done, however, some time 
 before the termination of the ninth month of gestation, and 
 hence the necessity for a careful examination of the patient 
 as early as possible. Certain grave diseases which' often 
 threaten the pregnant woman can be detected and so treated 
 as to give her child and herself the best chance for ultimate 
 recovery. This preliminary examination by the physician can 
 be conveniently made at the patient's house, the patient occu- 
 pying a recumbent position, and does not necessarily call for 
 anything painful or disagreeable. It is the physician's duty 
 to make this examination, and it should be, and has been found 
 to be, a source of comfort and encouragement to his patient. 
 
 CHAPTEE XY. 
 
 NURSE AND ROOM. 
 
 It is well to select a nurse early in this period, and to send 
 the nurse as soon as possible to call upon the physician. ~So 
 nurse should be taken in whom the physician has not confi- 
 dence or who is not personally acceptable to him. The patient 
 should remember that he is responsible for the nurse, and that, 
 in the event of injury through her carelessness, criticism would 
 fall not only upon the nurse, but also upon the physician. It 
 is well to send the nurse to the physician early in the case to 
 give him an opportunity to have any articles prepared for his 
 patient which his methods of treatment may demand. ISTo 
 
NURSE AND ROOM. 43 
 
 two physicians conduct a confinement in exactly the same 
 manner^ and physicians who are attentive to details, and who 
 study their patient's comfort, are constantly devising methods 
 and various appliances for her well-being. It is important for 
 these reasons that doctor and nurse have an early and distinct 
 understanding as to the way in which the patient is to be 
 treated. The nurse should take an inventory of what the 
 patient has prepared for her confinement, and the patient 
 should add such articles, if needed, as are deemed necessary 
 by the physician. In case of accident and premature termi- 
 nation of the pregnancy, the fact that the nurse is prepared 
 will be found a great comfort indeed. 
 
 In the selection of a nurse it is well to choose one who has 
 been thoroughly educated. It does not make so much differ- 
 ence how many confinements she has attended, or what doctors 
 she has nursed for, or who have had her previously. It is of 
 the greatest importance, however, that she understand the use 
 of antiseptics, and that she has been so thoroughly trained that 
 she will not meddle with the case, but will carry out the doctor's 
 orders. Ambitious nurses who anticipate the doctor's questions 
 by giving their own opinions, who always know that everything 
 is right, who do not mention the minor complications until the 
 doctor asks about them, but who treat them themselves, are 
 not to be chosen, nor are nurses who are so far superior to 
 their profession as to be ashamed to wear the uniform of the 
 school from which they come. 
 
 In choosing a room for the patient's use during confinement, 
 one which is quiet, sunny, airy, and clean should be chosen. 
 It is well that no plumbing should open into the room; in 
 other words, that no waste-pipe, connecting with the sewer, 
 should be in the room. This, of course, would include the 
 modern wash-stand and closet ; but cases have been observed 
 where these conveniences were sources of disease because of 
 the germs conveyed through them from the sewer. It is 
 better to have a room without carpets, in which rugs can be 
 employed, with but few hangings, and with no article which 
 
44 MOTHER AND CHILD. 
 
 cannot be thoroughly cleaned and, if necessary, fumigated 
 before the labor. An adjoining bedroom for the nurse and the 
 infant is a great convenience, and will do much to favor the 
 mother's repose. The furniture of the room should be com- 
 fortable, but all superfluous articles should be removed. The 
 bed should be a single bed, or three-quarters, not too low, and, 
 preferably, not placed against the wall. , It is ver\- essential 
 for the convenience of the nurse and the physician that the 
 bed should be easily accessible in all directions. It should not 
 have very elastic springs, although the ordinary woven wire 
 mattress is not objectionable. The mattress should be of hair, 
 and a liberal supply of linen and blankets should be provided. 
 An experienced nurse will understand thoroughly the prepara- 
 tion of a bed for confinement, and will tell her patient in ad- 
 vance the articles required. It may be stated, however, that, 
 in addition to the usual sheets, a half-dozen old sheets are an 
 advantage; several old blankets, and two pieces of white rubber 
 sheeting, one yard wide and covering the whole width of the 
 bed, should be provided. 
 
 The dress of the nurse is of imj)ortance not only as a matter 
 of discipline, but also from the fact that carelessness in her 
 dress may be a source of danger to her patient. The uniform 
 of training schools consists of a " wash" dress, covered b}^ a 
 large apron and by linen over-sleeves, which can be frequently 
 renewed. As it is essential that nothing come in contact with 
 the patient, or come near her, which is not perfectly clean, it 
 will readily be seen that untidy dress on the part of the nurse 
 is a positive source of danger to the patient. If the nurse's 
 washing is done in the house, the necessity for frequent changes 
 of dresses and aprons should be kept in mind, and fulfilled as 
 far as possible. The nurse's apron may contain but little 
 starch to advantage, as it is thus less noisy about the patient. 
 She should wear noiseless shoes; at night, felt slippers are 
 useful, and during the daj', slippers or pumps with over-gaiters, 
 or a shoe made of some noiseless leather, as kangaroo-skin, are 
 indicated. 
 
APPLIANCES FOR THE MOTHER. 45 
 
 CHAPTEE XYI. 
 
 APPLIANCES FOR THE MOTHER. 
 
 There are a number of appliances which can be employed 
 to advantage in making the mother comfortable, and in pro- 
 moting her recovery. She will need a certain number of nap- 
 kins for the reception of what is known as the loehial discharge. 
 It has been customary to use those which were washed and 
 used repeatedly, but for many reasons it is better, if possible, 
 to have them so made that they can be burned as soon as they 
 are soiled. Any simple absorbent material, which the nurse 
 may dip into an antiseptic solution previously and then wring 
 out and dry, will be suitable for this purpose. The cheapest 
 quality of cheese-cloth sold in the shops is an excellent material. 
 The absorbent substance may be enclosed between two layers 
 of cheese-cloth and loosely stitched at the edges. We have 
 found that a napkin may be made by taking a piece of oakum 
 about three inches wide and eight or nine inches long and an 
 inch thick. On each side of this is placed the cheapest quality 
 of cotton batting an inch thick. The whole is then enclosed 
 between the two layers of a jDiece of cheese-cloth twelve or 
 fifteen inches long and sufficiently wide to cover them. The 
 cut edge of the cheese-cloth is closed with cheap cotton thread, 
 the whole napkin is dipped in a solution of bichloride of mer- 
 cury (one to two thousand) and is wrung out and dried. Ti^e 
 cost of these napkins, when all the material is purchased at 
 wholesale, is a cent and a quarter each. When purchased at 
 retail, between two and three cents. The ordinary patient 
 will need six daily for the first three or four days, and four 
 afterwards for a period of ten days or two weeks. It makes 
 no difference whether they are made precisely after this de- 
 scription, so long as the principle is carried out of an absorbent 
 
46 MOTHER AND CHILD. 
 
 substance which can be made antiseptic, and which is cheap 
 and easily destroyed. 
 
 It is customary among most women to wear after confine- 
 ment an abdominal bandage or binder. In the case of strong 
 and healthy women, this is not a necessity, but it is a means of 
 comfort to all, as a rule, and as such it may be employed. The 
 
 Fig. 3. 
 
 Buttoned binder. 
 
 common belief, that it has much to do with restoring the 
 woman's figure to its former proportions, has not much foun- 
 dation in fact. If the patient be strong and well developed, 
 the abdominal muscles will regain their former firmness, and 
 thus the shape of the body will be restored. There are various 
 sorts of binders, the simplest being a strip of hemmed muslin 
 
APPLIANCES FOR THE MOTHER. 47 
 
 about a foot wide and from twenty-four inches to a yard in 
 length. Whatever form be employed, they must be so made 
 that they can be frequently washed. The binder which we 
 illustrate was devised originally in England, and has met with 
 great acceptance in that and other countries. This binder is 
 nine and a half inches wide and a yard long. Twelve inches 
 from either end is a gusset four and a half inches deep and 
 four inches wide at the bottom, its widest part. The binder is 
 made of two thicknesses of cloth, preferably, light canvas or 
 muslin. At one end of the binder are two rows of button- 
 holes, one row at the edge, seven in number, one and one-half 
 inches apart, and a second row parallel to the first, one and a 
 half inches distant from it. At the other end of the binder 
 are three rows of linen buttons, one inch and three-quarters 
 apart. At the lower edge of the binder, and midway between 
 the two gussets, are two pairs of buttons to which a napkin 
 may be fastened from below. The application of the binder is 
 as follows : Immediately after confinement, when the abdomen 
 is large, the row of buttons nearest the edge is buttoned into 
 the row of button-holes also nearest the edge. As the abdomen 
 becomes smaller, the rows of buttons are advanced successively 
 to the rows of button-holes, and thus the length of the bandage 
 may be varied to suit the needs of the ease. A useful binder 
 may also be prepared by putting gussets in an ordinary strip 
 of hemmed muslin, and fastening the binder by pinning from 
 above downward. The napkin worn by the patient sljould 
 be pinned to the lower edge of ihe binder behind, and brought 
 up and pinned to the lower edge of the binder in front. 
 
 In addition to the binder, a skilful nurse may prepare pil- 
 lows and cushions of various sizes, made of cotton and cheese- 
 cloth, which are cheap and can be readily burned when soiled. 
 They may be placed under the patient's hips, and will add to 
 her comfort b}'' aiding her to change her position in bed 
 (Figs. 4 and 5). 
 
 For use upon the breasts, a breast-binder or compression- 
 bandage may be prepared as follows : 
 
48 
 
 MOTHER AND CHILD. 
 Pig. 4. 
 
 ~f -f 
 
 J-1 
 
 I 0, 
 
 "-"i -~^ -? —k — . 
 
APPLIANCES FOR THE MOTHER. 
 
 49 
 
 It is twenty-nine inches long by eight wide; three and a 
 half inches from either extremity, and in the centre of the 
 bandage, two holes have been cut the size of a quarter of a 
 dollar, the edges of which are carefully overscamed to prevent 
 the apertures from tearing out, the distance between them 
 being the distance measured between the nipples. At the 
 upper edge of the bandage, five inches from the end, two 
 shoulder-straps are attached, two inches wide. The bandage 
 is so applied that it pins over the centre of the chest between 
 the breasts, the apertures giving room for the nipyjles. through 
 which the child may nurse. The shoulder-straps come over 
 the shoulders and may cross in front, or be pinned, without 
 crossing, to the upper edge of the bandage after it has been 
 
 Fig. 6. 
 
 fastened about the body. The purpose of this bandage is to 
 draw the breasts upward and inward, thus relieving the pain 
 caused by engorgement. This bandage may be made of can- 
 ton flannel or of firm muslin, as desired (Fig. 6). 
 
 A plentiful supply of old, soft linen is also desirable. Besides 
 the articles already described, the nurse should see that the 
 patient has ready in her possession such antiseptics as the 
 c d 5 
 
50 MOTHER AND CHILD. 
 
 doctor may select, two ounces of the fluid extract of ergot 
 brandy or whiskey, a nipple-shield, and be sure that an abun- 
 dance of hot water can be procured conveniently and imme- 
 diately, if desired, in the room which the patient will occupy. 
 There should be, if possible, no question regarding the burning 
 of any bandage or inexpensive appliance which becomes soiled. 
 Xapkins can usually be rolled in a piece of newspaper and 
 burned in the kitchen range or an open fli'e. Gld night-dresses 
 should be chosen for the patient's use while in bed, as it is 
 sometimes convenient to tear tliem down the centre in front 
 instead of slipping them off in the usual way. 
 
 CHAPTEE XYII. 
 
 APPLIANCES FOR THE CHILD. 
 
 For the child, the elaborate and extensive wardrobes fre- 
 quently purchased are worse than useless. Money is spent 
 unnecessarily in what can hardly be, from the nature of the 
 case, in good taste, and for what is often improperly made. 
 The child's clothing should be warm, soft, compressing the 
 body in no du'ection. and its weight, like the weight of its 
 mother's clothing, should be sujDported from the shoulders. It 
 has been the custom among Indians to pack the new-born 
 child in moss, and some soft and warm material like moss 
 would certainly represent an excellent dress for a child. The 
 finest quahty of flannel, or garments knit of the finest worsted, 
 are usually the best. The wardrobe of the new-born child 
 should consist, first, of a dressing for the umbilical cord, then 
 of an abdominal band or belly-band over that; a diaper; a 
 woollen or knit shirt with long sleeves, a woollen skirt, and a 
 white shirt and skirt combined, over the whole. For the feet, 
 worsted socks can be readily knit, which are not only most 
 comfortable and suitable, but also pretty. 
 
APPLIANCES FOR THE CHILD. 51 
 
 The best method of dressing the umbilical cord will be 
 selected by the doctor, und will be outlined in the description 
 of the conduct of labor. 
 
 Not more than a half-dozen changes of clothing are needed 
 for the child in the beginning, as its size cannot, of course, be 
 known before birth. The making of its later wardrobe fur- 
 nishes a most agreeable occupation for its mother and friends. 
 If the baby's clothing be properly made, there need be but one 
 pin employed in the whole dressing, and that a diaper-pin. 
 Other garments should be fastened by strings or buttons. 
 An abundance of diapers should be provided for the child, of 
 cotton or linen, of such a size that when folded once they are 
 less than a half-yar.l square; and doubtless before many years 
 some cheap, soft, and absorbent material, like Japanese paper, 
 may be found which can be destroyed as soon as it has become 
 soiled, thus obviating the necessity for washing. 
 
 A description of the various babies' wardrobes devised by 
 different nations would furnish an extensive catalogue of such 
 articles : the pappoose of the Indian mother is familiar as a 
 national relic, and her Scandinavian and German friends hav^e 
 embodied the same principle in what is known as the " child's 
 mattress." This consists of a soft and thin mattress quilted 
 and heavily wadded, but sufficiently large to contain the child, 
 and permit of its being folded over its body. The child is 
 thinly dressed, laid upon the mattress, and the mattress folded 
 over it and held in place by an embroidered band about three 
 inches in width, which is crossed and recrossed over the child 
 diagonally. The child thus becomes virtually a little bundle, 
 and can be transported with great ease (Fig. 7). Such a de- 
 vice, however, is only of use during journej's, and, in the main, 
 the mattress is too warm to be constantlj- worn. It is some- 
 times advantageous, however, either to employ something like 
 the mattress if the child goes out in its carriage, or to take 
 especial pains that the child's limbs and body are protected by 
 a warm mattress in the bottom of the carriage, and by a thick, 
 soft afghan or lap robe. 
 
52 MOTHER AND CHILD. 
 
 Former generations of American children were dressed upon 
 the principle of low neck and short sleeves, and those who re- 
 member this usage will assert in support of it that children so 
 dressed were certainly as robust and well developed as any at 
 the present day. While that may be true, experience proves 
 that to-day the best clothing for the infant child is woollen or 
 silk of various grades of thicknesses, covering the entire body. 
 Thus, an exceptionally fine and robust infant has been dressed 
 in a silk undershirt and two petticoats sewed upon one waist or 
 body, the whole so arranged that the child is dressed practi- 
 cally simultaneously. 
 
 Fig. 7. 
 
 During the heated term it is especially desirable that the 
 infant live as much in the open air as possible, and that the 
 surface of its body be protected from sudden changes of tem- 
 perature, from moisture, and from draughts. This is best 
 accomplished by removing all superfluous wraps and coverings, 
 and dressing the child from neck to heels in the lightest and 
 finest flannel. The difference in the customs of heating dwell- 
 ings has also necessitated some difference in the clothing of 
 children. The house clothing of the child must be propor- 
 tionately much lighter than the clothing which it wears out 
 of doors, because the average house is overheated, and the 
 change is thereby greatly exaggerated from the air in-doors to 
 the out-door atmosphere. 
 
 The ordinary baby's cap, which covers the back of the head 
 and the ears, is wisely planned, for the infant child has thus 
 portions of the head carefully protected which are easily 
 injured. It must be remembered also that the infant's eyes 
 
CHILD'S CRADLE AND BASKET. 53 
 
 are extremely sensitive, and hence its face should be shielded 
 from the light by a veil or some suitable covering. The igno- 
 rance and stupidity of the average child's maid who takes the 
 baby upon the street in a carriage, its face ujjturned and 
 frequently exjDosed to bright sunshine while she go?sij)s with 
 some other servant or with the traditional park policeman, 
 cannot fail to result in some injury to the infant's sight. 
 
 CHAPTEE XYIII. 
 
 child's cradle and basket. 
 
 The cradle or sleeping-place of the child has been made 
 the centre of most of the poetry of infancy. Whether the 
 baby be rocked on the tree-top, carried on the back of its 
 mother, or rolled up in a bundle with other baggage, it is still 
 cradled in some fashion or other, even when lying upon her 
 arm in bed. It is needless to say that from the day of birth 
 the infant is entitled to its own separate, undisturbed sleeping- 
 place. It should not sleep with the mother, it should not be 
 rocked and jolted while asleep, and if it is expected to become 
 a rational and thinking person, it should be accorded those 
 opportunities for undisturbed repose which are necessary to 
 the nourishment of any normal brain. Despite the desire of 
 mothers to keep the t-hild with them, of grandmothers and 
 nurses to trot the baby and sing the baby to sleep, it is 
 far better that the child, soon after its birth, should be taken 
 to its place of sleep, placed comfortably upon a suitable bed, 
 properly covered, and left entirely alone. Such is the un- 
 thinking zeal of many nurses and friends of mothers that 
 such an education for the child is possible only among the 
 most intelligent people, in whom reason predominates over 
 tradition and prejudice. The objections to placing the child 
 in bed with the mother, among people of the better class, are 
 
 5* 
 
54 MOTHER AND CHILD. 
 
 that the child inspires the air contaminated by the mother's 
 secreiions and excretions; that the constant tendency is for 
 the child to nurse too frequently, and that the repose of the 
 mother and child is mutually disturbed. Among people of the 
 poorer class and among the vicious, carelessness, excessive 
 fatigue, and drunkenness on the part of the mother result in a 
 considerable mortality among infants from what is known as 
 overlaying. Owing to the mother's carelessness, or during the 
 profound sleep of exhaustion or drunkenness, the child slips 
 down beneath the mother's side, she rolls over upon it, and it 
 dies from pressure and asphyxia. If the mother is without 
 assistance, she may place the infant alongside of her bed in 
 any suitable receptacle, but not in the bed with herself. We 
 recently visited a happy mother, fertile in expedients, not rich 
 in this world's goods, but rich in the possession of a fine baby, 
 who took a clean, dry wash-tub, filled it full of blankets, and 
 placed her baby in it upon a pillow. The baby slept peacefully 
 beside the mother, and both were happy and contented. Ordi- 
 narily, a solidly-built crib without rockers will be found most 
 convenient and advantageous. This, of course, should be sur- 
 rounded by sides sufficiently high to obviate any danger of 
 the child's falling out. The mattress should be moderately 
 firm, the child's pillow low, and when put to sleep, the child 
 should be carefully guarded from the light. 
 
 The contents of the bassinet (or baby-basket) should consist 
 of the baby's toilet articles : simple rice powder, a little pot of 
 white vaseline or cold cream, white Castile or spermaceti soap, 
 and such other articles as an experienced nurse or mother may 
 deem necessary. Appended is a list of an outfit which has 
 been found of practical use : brush and comb, skein of white 
 twisted embroidery silk, soft, fine sponge, bottle of 'white vase- 
 line, sharp pair of pointed scissors, powder-box and puff, with 
 talc powder; pin-cushion, small and large safety-pins, pure 
 Castile soap, pair of socks, some old, fine linen, fiannel or 
 knitted band, flannel shirt, a petticoat and night-gown for in- 
 fant ; an afghan or piece of extra flannel, in which to wrap the 
 
CHILD'S CRADLE AND BASKET. 55 
 
 child ; also piece of flannel, or old blanket, to receive it in ; in 
 addition, the baby will require eight day-dresses, eight night- 
 gowns, eight white skirts, four day-flannel skirts, four night- 
 flannel skirts, four pairs of day-socks, four pairs of night-socks, 
 six flannel shirts, six flannel bands, three dozen small, soft, linen 
 diapers, three dozen larger, cotton ones, at least two little 
 knitted sacks. 
 
 The following description of a crocheted baby -band is taken 
 from " Babyhood," vol. iii. page 33 : Single zephyr in ridge 
 stitch, — that is, half stitch, in which, going back and forth, only 
 the back half of the stitches in the lower row are picked up. 
 Begin on a chain of fifty and crochet forty-eight ridges, hence 
 ninety-six rows. Join by a row of plain stitches, and at top 
 by a picot edging (five chains and a tight stitch back into the 
 first). 
 
 To prevent chafing and excoriation of the infant skin, many 
 mothers employ some favorite dusting-powder, and others who 
 are very fond of the perfume of violet, have used j)owdered 
 orris-root, and, as we have had occasion to remark, some of the 
 finest babies we have ever seen were not powdered at all, but 
 anointed with simple ointment. It is of 
 the greatest importance that the mother Fig. 
 
 prepare not only the clothing for the child 
 and articles intended for herself, but also 
 that she prepare herself to nurse the 
 child. We have described the care of 
 the nijjple, and this should be persistently 
 kept up until the day of confinement. A 
 nipple-shield (Fig. 8) should be included 
 in her outfit, and if there has been trouble 
 in drawing out the nipple, the simplest 
 form of breast-pump should also be at isippie shield. 
 
 hand. Unless she be the victim of some 
 
 infection, she should have no other idea but that of nursing 
 the child. She will remember that while a substance resem- 
 bling milk may be present in the breast for some months prior 
 
56 MOTHER AND CHILD 
 
 to the birth of the child, yet the formation of fully-formed 
 milk will not take place until several days after continement, 
 and that fully-established lactation is a portion of the process 
 of childbirth. 
 
 CHAPTEE XIX. 
 
 LABOR. 
 
 A BRIEF description of what is meant by normal labor may 
 be of service to the patient in understanding the preparations 
 to be made for it and the care to be given her during that 
 time. Labor may be divided into three stages or divisions. 
 The first of these is the period occupied in the gradual open- 
 ing of the womb, and is a preparatory stage to the expulsion 
 of the child. This stage lasts in first confinements a number 
 of hours, .varying greatly with the individual case. It is, as a 
 rule, shorter in repeated confinements, and also attended with 
 less pain. The pain which is present during this stage is gen- 
 erally characterized as grinding, or bearing down, oftentimes 
 commencing in the back and extending downward over the 
 abdomen. It is most annoying and difficult to endure, as the 
 patient cannot appreciate that progress is making, and realizes 
 only what seems to be useless suffering. 
 
 When, however, the w^omb is open, ready for the expulsion 
 of the child, the membranes in which the child is contained 
 rupture, there is an escape of fluid, and the birth of the child 
 begins. This is a comparatively short interval in normal cases, 
 compared with the first stage, and is usually completed under 
 the care of a physician, and oftentimes with the use of anes- 
 thetics. After the birth of the child, the after-birth or placenta 
 still remains, and is expelled after a brief interval resembling 
 the first period. 
 
 It is of especial interest to know the symptoms which indi- 
 cate that labor has actually begun. For some days before, the 
 
LABOR. 57 
 
 patient frequently suifers from pain in the back and in the 
 thighs, from a feeling of weight or heaviness about the lower 
 portion of the body, and is often extremely uncomfortable. 
 These pains may be worse at night, and become so severe that 
 the physician may be sent for, under the impression that birth 
 has actually commenced. Subsequently, however, such pains 
 die away, and there is a gradual return to a condition of com- 
 parative comfort. There is this difference between so-called 
 false and true labor pains, Ibhat the false or fugitive pains are 
 irregular, coming and then going, and diminishing instead of 
 increasing in intensity, while true pains at the beginning of 
 labor grow steadily stronger, and are located more and more 
 in the abdomen. This will enable the patient to distinguish 
 between these two classes of pains. 
 
 During the first stage of labor, all that can be done for the 
 patient is to place her in the most comfortable position pos- 
 sible, to sustain her strength, and to assist her to have patience 
 until the more active progress of labor begins. It is best for 
 her not to lie down at once in first labor, but to continue in 
 the erect or semi-erect ])Osition, walking about the room, sit- 
 ting, standing, or kneeling, as may be most comforting to her- 
 self. If the nurse be present, she will look after certain mat- 
 ters of importance at this stage. If the woman be without 
 a nurse, she will do well to see that everything is in readiness, 
 and also, if possible, to secure a movement of the bowels, and 
 to see that water is passed freely. In women in repeated labors, 
 who have borne many children, the first stage may be so short 
 that the patient has to lie down at once, and if her labor come 
 on suddenly when she is alone, it is not safe for her to continue 
 upon her feet, as the danger is that the labor will be too rapid 
 for the mother, and the child be injured (Fig. 9). She should 
 lie down at once, preferably upon her left side, and remain as 
 quietly as possible until assistance arrives. 
 
 The second and third stages of labor are almost invariably 
 conducted by some competent physician, but occasionally it 
 happens, especially in strong and healthy women who have 
 
58 
 
 MOTHER AND CHILD. 
 
 borne children repeatedly, that labor may be completed fso 
 quickly that assistance does not arrive until all is over. A 
 neighbor or friend can always be summoned, and with such 
 assistance — so perfect are the provisions of nature — it is quite 
 possible for a woman to have a perfectly successful labor with- 
 out skilled service. It is well for whoever is with her to see 
 
 Fig 
 
 Patient's Bed, peepaeed foe Laboe. — a, folded sheet; h, c, sheet and rubber 
 sheet, which are removed with a, when soiled during labor ; d, clean sheet, on 
 which patient lies after labor. 
 
 that during the birth of the child she lies upon the left side, 
 with the thighs bent up towards the abdomen. The person 
 who helps her should wash her hands carefully, and as the 
 head of the child is born should endeavor to support it, press- 
 ing it gently upward between the thighs towards the mother's 
 abdomen. When the child is born, the cord should be grasped 
 between the thumb and finger, when it will be felt to pul- 
 sate, and when this beating ceases, it should be tied firmly 
 with a bit of strong thread, three fingers'-breadth from the 
 child's navel. It should be tied a second time, half an inch 
 nearer the mother than the first tie, and cut between the two 
 threads. The mother should then be kept perfectly quiet 
 while her helper may place her hand over the abdomen and 
 make gentle pressure. After a few moments, pains resembling 
 
LABOR. 
 
 59 
 
 those experienced during the birth of the child will return, 
 and the after-birth will be expelled. The assistant should be 
 very careful that she does not break the afier-birth, but as she 
 lifts it away it should be received very carefully in both hands 
 and removed. The patient can then be bathed with warm 
 water and soap and left quietly in bed, a clean towel and 
 folded sheet (Fig. 10) having been placed beneath her. 
 
 Should flooding come on after the birth of the child, the pa- 
 tient's assistant should place the hand upon the abdomen and 
 rub it gently but rapidly. She will then feel the enlarged womb 
 
 Fig. 10. 
 
 Bed after Labor,— soiled linen removed and patient's tandage and napkin 
 ready for Use. — a, h, napkin ; c, binder. 
 
 like a hard ball, the size of the baby's head, just beneath her 
 hand. So long as this ball remains hard, there is not much dan- 
 ger of severe bleeding. When it becomes large and soft, then 
 the rubbing should be repeated until contraction recurs These 
 simple directions may prove of value in case a physician or 
 experienced nurse cannot be obtained, but it must be distinctly 
 understood that the conduct of labor is a matter requiring the 
 greatest skill and wisdom, and should never be undertaken 
 without the supervision of an intelligent physician. Even if 
 the labor have proceeded normally without assistance, a doctor 
 
60 MOTHER AND CHILD. 
 
 should be summoned as soon as possible, and should be asked 
 to examine the patient thoroughly, as some injury may have 
 happened, or some complication resulted which makes his ser- 
 vices of the greatest importance, even although the child has 
 been born. 
 
 But returning to the care of the patient during her labor 
 ■when she has the advantage of the assistance of a physician 
 and nurse, it must be remembered that the process is one which 
 taxes her strength severely, and that she needs all which can 
 support and sustain. "While a large quantity of food cannot 
 be advantageously taken at any one time, yet nourishment in 
 the form of broth, milk, egg beaten up with wine, cocoa, and 
 any easily-digested article of food is much needed if the case 
 be prolonged. Occasionally, stimulation is requii^ed, but that 
 should be limited to tea or coffee, except by the doctor's orders. 
 There is danger of the patient taking cold if care be not exer- 
 cised to keep her room warm enough, and to look carefully after 
 her clothing. The directions which have been given already 
 to the patient without assistance,- will be carried out, of 
 course, by the nurse. 
 
 CHAPTEE XX. 
 
 PUERPERAL FEVER. 
 
 The care of the patient during the latter part of labor, and 
 afterwards, cannot be intelligently understood unless something 
 be said regarding what is meant by blood-poisoning, puerperal 
 fever, and antisepsis. It is within the present century that 
 the two prominent teachers of obstetrics in the city of Phila- 
 delphia declared that puerperal fever was in no way caused by 
 the physician or nurse, but was entirely beyond their control. 
 Puerperal fever, they taught, occurred as typhoid, malaria, 
 rheumatism, and other diseases which were not contagious, 
 
PUERPERAL FEVER. 61 
 
 but depended upon some unknown condition of the atmos- 
 phere or the influence of the soil for their existence. Mean- 
 while, in Austria, the discovery had been made that puerperal 
 fever generally resulted when the physician had been dissect- 
 ing or making a post-mortem examination, and then immedi- 
 ately attended an obstetric case. When disinfectants were 
 used by such a physician, and especially when his hands were 
 carefully scrubbed and then disinfected, his patients escaped 
 puerperal fever. One of the brightest honors of the many 
 which Oliver Wendell Holmes has won is the fact that at this 
 time, and while he stood practically alone in the American 
 profession in his opinions upon this point, he answered in a 
 most trenchant article the teachings of the Philadelphia pro- 
 fessors to whom allusion has been made, proving that they 
 were wrong, and asserting positively that the Austrian discov- 
 eries were correct,, and that puerperal fever was contagious, 
 or, according to a popular phrase, " catching." We think com- 
 monlj^ of Pr. Holmes as a poet, a wit, a literary man, but the 
 services which he rendered in urging the truth regarding this 
 matter upon the profession in his country, and the number 
 of lives which have been saved by the knowledge of the true 
 nature of puerperal fever, can never be appreciated. 
 
 At the present day, we know positively, as far as any knowl- 
 edge is obtainable by human beings, that puerperal fever is 
 caused by a living ferment, and that in the vast majority of 
 cases some one who touches the patient, usually the doctor or 
 nurse, gives her puerperal fever. It is at once apparent that 
 certain strenuous precautions are imperative upon those who 
 attend such patients. Clean hands, clean instruments and ap- 
 pliances, clean bedding about the patient, scrupulous cleanliness 
 regarding herself, and, as an additional safeguard, the use of 
 certain chemicals to cleanse the hands, instruments, and appli- 
 ances which touch her, are what every woman has a right to 
 demand in the present state of our knowledge. This recent 
 knowledge should be of the greatest comfort and advantage to 
 the woman who is about to become a mother. She has the 
 
 6 
 
62 MOTHER AND CHILD. 
 
 satisfaction of knowing that the most dreaded complication of 
 maternity has been reduced to a minimum, and that where such 
 intelligent care is given, her chances for safety and a good re- 
 covery and the safety of her child are many limes greater than 
 in the last century. The fearful epidemics which at times de- 
 stroyed large numbers of women are unknown in the practice of 
 intelligent men. There still remain a number of physicians and 
 nurses who have not informed themselves regarding the causes 
 and prevention of puerperal fever, who do not know how to 
 recognize some forms of this disease when they arise, and who 
 cast doubts upon our knowledge regarding its origin and pre- 
 vention. Such objections, however, are no more to be consid- 
 ered in the discharge of duty towards patients or, friends than 
 are the theories of those who dispute the utility of vaccination 
 or the fact that typhoid fever is caused by impure drinking- 
 water. 
 
 The living germs which cause puerperal fever have their 
 most common production in the decomposition of the tissues 
 or fluids of some animal. Hence it is extremely dangerous 
 when the after-birth is not expelled, but remains in the womb, 
 where it is liable to decompose. After it has been expelled 
 it should be destroyed, if possible, by fire, or buried with lime. 
 The lochial discharge is also liable to decompose, and hence 
 the necessity for frequently changing the napkins used to re- 
 ceive it, and for employing such napkins as have been pre- 
 pared by antiseptics. Antiseptics are certain substances which 
 have the property of destroying these living germs. Such 
 are corrosive sublimate (bichloride of mercury) and carbolic 
 acid. One of these is usually employed as an antiseptic or fer- 
 ment-killer in caring for the patient during and after labor. The 
 hands of the physician and nurse, as well as all instruments and 
 appliances used, should be not only cleansed but also rendered 
 free from ferments by the action of one of these substances, 
 or heat. We know that equally powerful with chemical anti- 
 septics is the action of a high degree of heat; hence a piece of 
 cloth which has been thoroughly boiled cannot contain poison- 
 
FIRST FEW DAYS AFTER CONFINEMENT. 63 
 
 0U8 germs, and so it is comparatively easy to render clothing 
 and bedding safe for use ; but the hands cannot be boiled, and 
 there are certain appliances and instruments which are also 
 damaged by heat, and so it is necessary not only to employ 
 heat, but to make use of chemical antiseptics. The reason why 
 •we have urged that the napkins be burned and not used again 
 is because they may not be thoroughly cleansed in washing, 
 and when used a second time may retain decomposing material 
 which is easily absorbed by the patient, causing puerperal 
 fever, or blood-poisoning. We have taken the liberty of intro- 
 ducing what may seem to be a purely scientific discussion as 
 to the nature of puerperal fever, but we know from experience 
 that the average woman of intelligence is not willing to accept 
 a certain routine because her grandmother was cared for in 
 that way, but that she is fully aware of the advance made by 
 modern science in a general way, desires to profit by it, and is 
 ready and anxious to co-operate with any sensible physician 
 who will do her the justice which her intelligence deserves. 
 
 CHAPTEE XXL 
 
 FIRST PEW DATS AFTER CONFINEMENT. 
 
 The mother's first needs, after labor, will naturally be rest 
 and quiet. It very often happens that the excessive exer- 
 tion of labor and the perspiration which frequently accompa- 
 nies it render the patient especially susceptible to cold, and 
 hence the contact of the air after labor very often results in a 
 slight chill. This is partly owing, also, to the nervous exhaus- 
 tion and prostration from which the patient naturally suffers. 
 It is of no importance, and should be treated by placing an 
 extra blanket over the patient, or by giving a cup of hot tea, 
 or some other acceptable hot drink. It cannot be too strongly 
 insisted that the mother's greatest needs after confinement are 
 
64 MOTHER AND CHILD. 
 
 rest und quiet. The congratulations of friends, the idle^uri- 
 osity of those who are reiidy to intrude into a sick-room, should 
 be warded off from the patient, and having been assured by 
 the evidence of her own sight and touch that her child is living 
 and safe, she should be given some slight nouMshment or stim- 
 ulant, as a cup of broth or of tea, or a glass of milk, and then 
 allowed to go quietly to sleep. One of the great uses of the 
 trained nurse in the sick-room is the somewhat disagreeable 
 but necessary function of police, and in proportion as she is 
 allowed to control the patient, in that proportion can the physi- 
 cian's orders be intelligently canned out. In healthy women, 
 a refreshing slumber of from two to four hours will follow 
 delivery. This period gives the nurse ample opportunity to 
 wash and dress the baby, and affords the child also an occasion 
 for obtaining sleep. 
 
 The mother's diet is not subject to the fear which formerly 
 existed, that generous food produced puerperal fever or inflam- 
 mations of some sort. It is the kind of food and the intervals 
 at which it is given which occasion distress, and not the fact 
 that the food is nutritious or abundant. For the first three or 
 four days the most easily digi;sted food is indicated; milk, 
 broth, soups, milk-toast, soft-boiled eggs, koumiss, cocoa, and 
 stewed fruits should be eraploj'ed, the intervals of feeding 
 being governed somewhat by the mother's desires. Nourish- 
 ment, however, should be taken from four to six times in the 
 twenty-four hours during the first three or four days. After 
 this period, an abundant but easily-digested diet may be allowed, 
 embracing any articles which agree with the patient. The old 
 fear that acids and salads could not be taken is erroneous, as the 
 acid is digested in the body, and the practical test of any article 
 IS not whether it is an acid or not, but whether it agrees or dis- 
 agrees with the patient. Whatever agrees with her makes good 
 milk for her child. The patient should be fed abundantly, and 
 food may be taken in small quantities, if it be easily digested, 
 as often as four or six times a day, although the mother may 
 be up and about and able to resume her household duties. 
 
FIRST FEW DAYS AFTER CONFINEMENT. 65 
 
 After the third or fourth day, as we have already remarked, 
 the patient's diet may be governed by her appetite. Certain 
 sorts of food have been recommended as especially adapted to 
 produce a flow of healthy milk. Extract of malt can be taken 
 by many mothers with advantage. Young and tender sugar 
 beets, it is said, may be eaten ; beer and porter seem, in some 
 cases, to take a place which nothing else will fill. Milk as 
 a beverage, foods made of milk, and cocoa are often suffi- 
 cient; but the general principle that that which is best digested 
 and the most thoroughly enjoyed is the best food very rarely 
 leads us astray. So small a thing as the use of water as a 
 beverage is sometimes overlooked in caring for such patients. 
 At the third or fourth day the physician will usually prescribe 
 a thorough laxative. After this time, the bowels should be 
 moved by the simplest and mildest measures ; an injection of 
 castor oil and soapsuds beaten up together and warmed, or of 
 simple salt and water, the use of a gluten suppository, or a 
 glycerin suppository, will generally be sufficient. Compound 
 licorice powder, sold by druggists, will agree well with many 
 patients, and some preparation of cascara sagrada is often effi- 
 cient. It should be remembered that a dose of any laxative 
 medicine which failed to produce an effect during pregnancy 
 will often be sufficient to purge a patient violently after labor. 
 Thus we recall a case where a woman who had taken very 
 active cathartics during pregnancy urged her physician to give 
 her a " strong pill," as she expressed it, the fourth day after 
 labor. He could not yield to her request, but prescribed simple 
 doses of licorice powder, which acted far too energetically 
 for the patient's comfort. This difference is caused by the fact, 
 already mentioned, that the enlarged womb, before confine- 
 ment, presses upon the intestines, preventing their emptying. 
 When the womb is emptied, after the delivery of the child, 
 there is no obstruction then to movements of the bowels. 
 The womb grows smaller after the expulsion of the child by 
 process of contraction, which causes pain similar to that experi 
 enced during labor. These are called afier-pains, and after the 
 e 6* 
 
66 MOTHER AND CHILD. 
 
 birth of the second or third child are freriuentlj so severe 
 as to keep the patient awake at night. A warm cloth or 
 fomentation over the abdomen will often relieve them, and if 
 not, a physician's prescription must be obtained. 
 
 The diet of a mother after childbirth usually consists of 
 ordinary sick-diot. The object of keeping a woman on diet of 
 this kind is simply because she is in bed, her dgestive system 
 is rather weakened by the excessive strain, mental and other- 
 wise, which she has gone through, with fatigue, and liquid 
 nourishment can be given which is more readily digested and 
 quickly absorbed than solid food. 
 
 Doctors simply differ in their advice because patients differ 
 in regard to their digestion. Sometimes a woman is ordered a 
 mutton-chop, a bowl of thick gruel, or some milk-toast imme- 
 diately after a confinement ; others, again, are allowed to get 
 up before the ninth day. 
 
 The family physician knows the peculiarities of his case, 
 and is ca|)able of judging what is best for his patient. Strong, 
 healthy women can do many things that the frail and delicate 
 cannot attempt. 
 
 As the supply of milk contains so large a quantity of water 
 (almi)St ninety parts in a hundred), a great deal of the food 
 which the mother takes should be liquid to supply this demand. 
 If a mother loses her baby in childbirth, and it is necessary to 
 check the flow of milk, not only is it necessary to put bella- 
 donna plasters on the breasts, but also to diminish the amount 
 of fluid taken. 
 
 If she wishes to increase the flow of milk, she should drink 
 freely of milk, soups, water, and may also rub the breasts with 
 some castor oil. It is probable that in this way the use of 
 alcoholic stimulants, as beer and porter in large amounts, 
 became fashionable for the purpose of increasing the milk- 
 supply. 
 
 Though excellent at times for delicate, worn-out women, we 
 certainly would oppose their universal use. Alcohol rather 
 lessens the milk-flow. 
 
FIRST FEW DAYS AFTER CONFINEMENT. 67 
 
 The preparations of malt are far more valuable, as they in- 
 crease the appetite and aid digestion. 
 
 There being a determination of blood to the mammary 
 glands during the secretion of milk, many substances may be 
 carried along with it that should be thrown off in other ways ; 
 thus, medicines are often secreted by the milk, and affect the 
 child, that are intended to have a purgative action on the 
 mother; a dose of castor oil will act sometimes in this way. 
 Articles of diet also affect milk. 
 
 We are all familiar with the garlic taste given to milk and 
 retained in the butter, from cows turned out to grass in the 
 spring-time. And, indeed, cases have occurred of acute poi- 
 soning by milk from cows that have eaten largely of poisonous 
 herbs in the pasture-field. 
 
 Although a mixed diet, containing a free supply of vegetable 
 food, also of animal food, of the cereals, together with a proper 
 amount of fluid, is important for every nursing mother, there 
 are certain times when additions should be made to one of 
 these divisions of food to supply a demand ; thus, if a child is 
 emaciating, does not seem to increase in weight, the free use 
 of fats by the mother, as cod-liver oil, will soon be followed by 
 an improvement in the health of her babe. If there is a ten- 
 dency to rickets, the mother should eat more largely of prep- 
 arations containing lime, such as oatmeal, cracked wheat, or 
 even take lime itself. 
 
 A woman who is fat and well nourished may have the poor- 
 est kind of milk for lier baby ; all the nourishment goes to 
 herself, the milk probably being of a very thin, watery kind. 
 Indeed, in the choice of a wet-nurse, it is often found that 
 the lean but healthy woman giv^es the most and the best 
 milk. 
 
 Constipation resulting from torpidity of the liver, or over- 
 feeding, will frequently affect the milk and cause it to disagree 
 with the child. Not alone is milk altered in its nourishing 
 qualities, or in its digestibility, by materials not belonging to 
 it or entering into its composition, but we very frequently have 
 
68 MOTHER AND CHILD. 
 
 indigestion produced by milk which has probably been changed 
 in its characteristics by emotion, by strong nervous impressions 
 due to worriment, fright, or the fatigues of society ; certainly, 
 late dinner-parties-, both from the character of the food and 
 the late hour, would not be conducive to the production of 
 nourishing milk. 
 
 We have stated that regularity is the fundamental law to be 
 observed by the nursing mother. 
 
 DIET. 
 
 The diet of the nursing woman should always be carefully 
 regulated, for uj)on it greatly depends the amount and charac- 
 ter of her milk. It is impossible to lay down any laws in 
 regard to the kind of food she should have. 
 
 Every sensible person knows what agrees with her and what 
 does not; little indiscretions may be pardoned when she alone 
 has to suffer, but when indigestion means an infant with indi- 
 gestion also, greater care should be observed. It is not the 
 amount of food one takes, but the quantity one digests that 
 should regulate the diet. 
 
 Some people manage to live on much less than others be- 
 cause the waste is less. A too generous meat diet, rich milk, 
 cheese, and wines or beer will give the liver a heavy load to 
 carry, and so-called biliousness will result. 
 
 Therefore, a nursing woman should avoid this extreme. 
 A too liberal diet of farinaceous food, potatoes, hot breads, oat- 
 meal, etc., will produce flatulence and heart-burn. 
 
 The diet, therefore, should be a mixed one, suited to the indi- 
 vidual, to the climate, to the amount of exercise she takes, and 
 to her hereditary tendencies. A moderately rich milk, well- 
 steamed rice, rare and juicy meats, tender fowls and game with 
 fruits, light farinaceous and egg-puddings, well-made gruels, 
 eggs, oysters, and fresh vegetables form the best dietary. 
 
 But all fried dishes should be avoided. Her food should be 
 most plentiful, palatable, of the most nourishing quality, and 
 frequently taken. 
 
FIRST FEW DAYS AFTER CONFINEMENT. 69 
 
 Bread, butter, and milk should be used in large amounts. A 
 cup of hot coffee or chocolate in the morning, before rising ; 
 a substantial breakfast ; the heaviest meal in the middle of the 
 day J a light tea in the evening, with a bowl of gruel, such as 
 oatmeal, the last thing upon retiring; a glass of milk just 
 before or after each nursing, and possibly, if the patient feels 
 much exhausted, malt extract will be of service. 
 
 It 'is absolutely essential that the nursing woman should 
 keep her bowels regular. The skin, kidneys, and bowels throw 
 oflP poisonous matters, which, if not gotten rid of in the natural 
 way, will find themselves in the milk. 
 
 The organs of the body work as a co-operative association, 
 and have a remarkable way of aiding one another. Should 
 one organ become lazy or diseased, another will take its place. 
 In this way the milk-glands, regardless of the welfare of the 
 babe, will aid the kidneys, skin, or*bowels. 
 
 Much is written on the subject of water-drinking. Some are 
 very decided in opposition to water at meals, others to water 
 between meals, others to water at any time. Water is the 
 great solvent for all those substances which are projDerly called 
 the ashes of the economy. The main ingredient of all the 
 secretions and excretions of the body is water. The water 
 should be pure, fresh, and not iced, and a fair amount should 
 be taken with each meal. 
 
 Large amounts at meals will weaken the gastric juice and 
 undoubtedly cause dyspepsia. But difficulty will just as readily 
 attend the digestion of a hieal which has not sufficient liquid 
 with it to promote the secretion of the gastric juice. 
 
 A glass of water the last thing at night, or upon rising a 
 glass of warm milk or a cup of cafe, au laif, a glass of water with 
 a pinch of table salt before breakfast, will frequently overcome 
 the most obstinate constipation if persevered with. It is neces- 
 sary that the bowels should be daily moved ; this may be 
 accomplished by a free vegetable diet, the moderate use of 
 fruits, exercise in the open air, and an occasional enema, if re- 
 quired. 
 
70 MOTHER AND CHILD. 
 
 The use of purgatives should be confined to cascara cordial, 
 compound licorice powder, a teaspoonful at night, Husband's 
 magnesia, or effervescing citrate. 
 
 Great care should be taken by the mother that she does not 
 take cold. It is well to have always a light shawl to throw 
 over her while nursing her baby. 
 
 CHAPTEE XXII. 
 
 mother's recovery. 
 
 After lactation has become well established at the fourth or 
 fifth day, the mother usually enters upon one of the most com- 
 fortable periods of her physical existence. For the time being 
 she is, in a large measure, free from the anxieties and cares of 
 daily life ; the apprehension which she may have felt regarding 
 the termination of her labor has given place to the joy and 
 affection of maternity. If she is properly cared for, and is a 
 healthy woman, she is generally extremely comfortable. The 
 fatigue and soreness which follow labor have disappeared, her 
 appetite rapidly returns, and is generally better than for weeks 
 before her confinement. The companionship and care which 
 she gives to her infant are a source of endless delight, and the 
 affectionate soUcitude of friends and relatives makes her the 
 centre of all which is in the highest degree charming. It 
 should be remembered, however, that while this period is one 
 of repose, it is a time of the greatest activity in her physical 
 organism. The balance between various functions of the body, 
 which has been disturbed by the presence of the child in the 
 womb, has been restored ; the mother's blood, which was im- 
 poverished by the nourishment given to the child, begins to 
 make good its losses ; disturbances of the nervous system and 
 mental depression have passed away, and in many cases k new 
 era of physical development begins. The womb, which has 
 
MOTHER'S RECOVERY. 71 
 
 been enlarged many times its usual size to contain the child, 
 undergoes a process of becoming smaller, the successful com- 
 pletion of which is of the greatest importance to the woman. 
 The muscles of the abdomen, which have been stretched by 
 the womb and its contents, must regain their former firmness 
 and elasticity; this necessitates not only increased nutrition, 
 but also increased absorption of portions of the enlarged womb. 
 Hence it is that not only must the mother be fed, but those 
 functions of the body which tend to remove material already 
 used should be kept in full activity. The action of the skin 
 should be maintained by daily bathing and massage ; the 
 bowels, which generally have become distended through the 
 pressure of the enlarged womb, should be thoroughly and 
 regularly emptied. Sufficient fluid should be taken to assist 
 the kidnej-s in their work, while fresh air in abundance should 
 be given to the patient to replace the gases exhaled through 
 the lungs. 
 
 Sleep, the greatest promoter of nutrition, should be taken in 
 abundance and with regularity, while the development and 
 restoration of muscles over-distended or weak from lack of 
 use may be encouraged by systematic massage. The patit-'Ut 
 must not exercise or assume the upright position for at least 
 two weeks after the birth of her child, but passive exercise 
 may be given by skilful massage after the first week of her 
 lying-in period. This massage should begin with the arms 
 and legs, the muscles being gently kneaded and the joints 
 gently manipulated. The back may next be included, and 
 gentle rubbing without severe kneading given to the chest and 
 abdomen. This should be administered for fifteen minutes at 
 first, increasing gradually until, at the third or fourth week after 
 the birth of the child, the patient may enjoy three-quarters of 
 an hour or even an hour of such treatment. 
 
 Possibly no more important crisis occurs in the mother's life 
 than her getting up after confinement. There are various 
 well-settled traditions which govern the actions of the majority 
 of women ; one is that the mother's nurse should remain in 
 
72 MOTHER AyD CHILD. 
 
 all four weeks, hence the term " monthly nurse." Another 
 behef is that at the tenth daj, or after, the mother should sit 
 up. Both traditions are the result of experience and observa- 
 tion of a vast number of cases of confinement, but neither has 
 the slightest value as a guide in any given single ca-e. It would 
 be just as rational to say that because one mother is fond of a 
 certain article of diet, and does well on it while nursing her 
 child, that therefore every mother should eat exactly that 
 amount, and be expected to enjoy it, as it is to say that every 
 mother needs the same repose after confinement. It is a ques- 
 tion for the physician, and for him onl}-, to decide. It makes 
 no difference what the patient's mother or grandmother or 
 ancestors have done, nor what her dearest friend, confined a 
 few months before her, has done, nor what every woman re- 
 garding whose confinement she has ever heard of has done. 
 It is a question of careful study by the physician of the indi- 
 vidual case. "VVomen would bo slow indeed, when reaching a 
 certain age, to accept a costume exactly similar to that worn 
 by every other woman at that age, and yet in a matter on 
 which rests a mother's future health the endeavor is often 
 made to enforce a uniform tradition. A woman who had borne 
 a number of healthy children, and had retained her own 
 beauty, health, and happiness, was asked the secret of her 
 continued physical well-being. She replied. " For one thing, 
 my mother never allows me to do anything for three months 
 after the birth of a child. I get up when the doctor thinks 
 best, and have no responsibility for at least three months." A 
 woman after confinement was urged by her phj'sician to remain 
 recumbent two weeks ; being told by a friend, a woman of very 
 different constitution and strength, that she had gotten up 
 upon the tenth day, she hastily summoned her physician upon 
 that day, with the remark that she could not remain recum- 
 bent any longer. So great was her annoyance and restlessness 
 that it was necessar\- to place her at once in a serai-recumbent 
 posture upon a lounge, but the change in position marlced a 
 change in her progress towards recovery which, while it gave 
 
MOTHERS RECOVERY. 73 
 
 rise to no serious complications, yet made an evident difference 
 in her. subsequent strength. It occasionally happens that a 
 physician has the courage of his convictions, and positively 
 refuses to be resj)onsible for a patient who sits up before his 
 best judgment permits, but the subject is one upon which both 
 phj-sicians and patients can profit by education and mutual 
 study. It is quite true that the Indian squaw may drop out of 
 the line of march of her tribe and, attended by one or two 
 friends, crawl into a thicket and there be confined, and in two or 
 three days rejoin her tribe at their next camp. It is also true 
 that the healthy peasant woman of Europe, on the average, is 
 able to leave the maternity hospital in whicli she has been con- 
 fined on the tenth day thereafter, with a healihy baby in her 
 arms. It is frequently observed that farmers' wives in America 
 are often up upon the tenth day after confinement, but it is 
 equally true that the more delicate inhabitants of towns and 
 cities, especially women who have taken little exercise to de- 
 velop their muscles, in whom the absurdities of fashion have 
 dislocated the abdominal organs by tight lacing and weakened 
 the patient's powers of recovery, are no more fit to get up 
 the tenth day after confinement than they are fit to do the 
 physical work of the squaw, the peasant woman, or the farmer's 
 wife. Thej^ are the women who make the practice for physi- 
 cians whose specialty is the treatment of the diseases of 
 women, and they are the mothers who fail not only to recover 
 their own health, but to nourish their offspring. In this con- 
 nection it must be understood that, if the mother be healthy, 
 it is of the greatest importance that she nurse the child. One 
 of the best ways of reducing the womb to its usual size is 
 nursing the infant, and it is a happy sign for the American 
 people that at the present day it is considered not only not a 
 disgrace but also a source of gratification and pride if a mother 
 is able to nurse her child. The subject has been thought of 
 such importance as to be legislated upon by several European 
 countries, and the better physical development of American 
 women, resulting from the fact that exercise has become 
 D 7 
 
74 MOTHER AND CHILD. 
 
 fashionable among the well-to-do. iias resulted in furnishing 
 mothers whose offspring not only profit by their better de- 
 velopment, but can also be nursed by them up to a vigorous 
 childhood. 
 
 CHAPTEE XXIII. 
 
 DIET AND LACTATION. 
 
 It is often a matter of interest to know how healthy mother's 
 milk may be recognized. Of course, the surest proof of the 
 pudding is in the appearance and appetite of the one who eats, 
 and a well-nourished baby cannot be such without good 
 mother's milk. However, in appearance, poor mother's milk 
 is very thin, bluish, or occasionally streaked with yellow or 
 with red. A sore or cracked nipple may bleed when the child 
 nurses, or a sore upon the nipple may form matter which dis- 
 colors the milk. .If the infant does not thrive, the physician 
 can determine by suitable examination whether the mother's 
 milk is normal or not, and his attention should always be 
 called to any indigestion or lack of thriving on the part of the 
 child. The marks of a well-fed baby are its plumpness, rosy 
 color, good nature, eas}^ and lively movements, good appetite, 
 and sound sleep. When any one of these characteristics is 
 notably absent, there is something wrong which demands a 
 careful investigation. The decision on the part of the mother 
 that she cannot nurse her child should never be made without 
 the physician's approval. In general it may be said that when 
 the mother is affected by any serious disease, such as consump- 
 tion, puerperal fever, typhoid fever, and other serious troubles, 
 that then she should not nurse her infant, but the decision not 
 to nurse the child should not be made because she may have a 
 sore nipple, or the child may give her pain at first upon 
 nursing, and least of all because she dislikes the trouble and 
 exertion which the care of her infant causes. Sore nipples can 
 
DIET AND LACTATION. 75 
 
 almost always be cured by simple means which the doctor will 
 direct. A child frequently gives the mother some pain upon 
 beginning to nurse, seeming to bite the nipple, but this will 
 grow less with time, and finally disappear; and when the 
 mother reulizes that a refusal to nurse her child means de- 
 priving it of eight out of ten of its chances for life, she may 
 well hesitate before taking, or desiring to take, this step. 
 When a child gives evidence of hunger, as if the mother's nour- 
 ishment was insufficient, other food may be added at the physi- 
 , clan's direction. The mother and nurse, however, must be 
 sure first that the child is not thirsty, and the administration 
 of water will easily settle this point. In the absence of a physi- 
 cian, bc^iled milk and water, half and half, may be prepared, 
 warmed to a blood heat, and fed to the child by a teaspoon or 
 from a carefully-cleansed bottle to which is attached a simple 
 rubber nipple. If the mother be travelling, and good milk 
 cannot be obtained, condensed milk will often bridge over the 
 difficulty until she can arrive where proper milk can be had, 
 but the administration of anything but mother's milk to an 
 infant is a matter so serious as to demand a physician's atten- 
 tion. 
 
 The selection of a wet-nurse is also a matter for the physi- 
 cian only. It requires an experienced eye to detect in her 
 marks of disease which might prove most injurious to the 
 infant. The healthy wet-nurse is of course next best to the 
 mother, but no task is more difficult than the selection of 
 such a woman, IS'ot only should she be of about the same age 
 as the mother, her child of relatively the same age and devel- 
 opment, her history give no evidence of disease or vice, but the 
 physician himself must make a thorough examination to de- 
 termine her physical fitness for this important trust. 
 
 It occasionally happens that an excessive flow of milk 
 threatens the mother with inflammation of the breast through 
 engorgement. This can usually be relieved by withdrawing, 
 with a simple breast-pump, sufficient milk to relieve the dis- 
 tention. The free administration of saline laxatives, giving 
 
76 MOTHER AND CHILD. 
 
 the mother a diet which contains but little fluid, and limiting 
 her diet somewhat, will often aid in checking the excessive 
 flow. The breast-bandage already described is of the greatest 
 utility in such cases. A scanty supply of milk may be rein- 
 forced by the careful selection of milk-producing articles of 
 diet, as already described, by gentle rubbing, manipulation of 
 the breast, and by perseverance in urging the child to nurse. 
 Occasionally the infant will refuse the nipple ; if then it be 
 ascertained that the nipple is naturally formed, is not sore, 
 and that the child's mouth is not deformed, a little milk may 
 be drawn by a breast-pump and the nipple wet with the milk. 
 The child, when then applied, will often grasp the nipple and 
 nui'se eagerly. The most easy and rational way of determining 
 whether the child can nurse or not consists in putting the 
 finger in its mouth. It is very rare for a child to be so de- 
 formed that the lips cannot grasp the nipple and make suction. 
 Prematurely born and excessively weak children may fail from 
 lack of muscular strength, but malformation is not common. 
 Mothers frequently consult physicians for alleged tongue-tie 
 in their infants. This, like deformity preventing nursing, is 
 rare, and a little observation will generally convince the 
 mother that the tongue can move freely. If the child can 
 grasp the finger with the mouth, and the tongue can be felt 
 applied upon the under surface of the finger, no serious 
 tongue-tie exists. There are deformities in the upper jaw of 
 the child, producing what is known as " cleft palate," which 
 might cause difficulLy in the child's nursing, but such de- 
 formities could not be recognized without the assistance of the 
 physician. 
 
PART II. 
 
 CHILD. 
 
 BY 
 J. M. KEATING, M.D., LL.D. 
 
 7* 77 
 
CHAPTEE XXIY. 
 
 CARE OF NEW-BORN INFANT. 
 
 It is not necessary to dwell very long on tlie care of 
 the infant immediately after its birth ; that matter devolves 
 entirely upon the doctor and the nurse. But there are a 
 great many things that a mother should know about her 
 infant, and these we will endeavor to explain as simply as pos- 
 sible. 
 
 The child is commonly received from the hands of the physi- 
 cian in a soft, thick woollen blanket or cloth, which should be 
 warmed before use. The child, when well wrapped, may be laid 
 aside in a warm place until the mother's needs have been 
 attended to. If the nurse have an opportunity, it is well for 
 her to anoint the child's body thoroughly with some simple 
 ointment which will assist greatly in removing what is known 
 as the vernix caseosa, a cheese-like substance which covers the 
 skin. A misapprehension commonly exists that the new-born 
 infant needs a plentifid supply of fresh air at once. Eespira- 
 tion begins a very few moments after birth, but the child will 
 obtain sufficient air if it be entirely but loosely wrapped in a 
 coarsely-woven woollen blanket. The head may be covered 
 without fear that the child will suffocate, for its lungs are but 
 partially expanded, and its respiratory power is often not fully 
 developed until some time after birth. 
 
 It is important that the child be protected from draughts of 
 cold air, and that its eyes be spared the irritation of strong 
 light ; hence the folly of keeping the child's head exposed so 
 that it may breathe, and of carrying it to a door or window to 
 look at it immediately after birth. 
 
 Before giving the bath, its clothing should be selected and 
 placed in front of the fire to become thoroughly warmed. In 
 
 79 
 
80 
 
 MOTHER AND CHILD. 
 
 large bedrooms a folding screen is of great service, and may be 
 placed about the nurse and the basin or tub in which the child 
 is bathed. It will thus protect the child from draughts and 
 allow free ventilation for the mother. The temperature of the 
 water should not be less than 100° F., and the soap used white 
 Castile or spermaceti (Fig. 11). It should be remembered that 
 two separate toilets of the child's body are to be made : that of 
 the head and that of the trunk and extremities. Many toilet 
 sets contain two washbowls and pitchers, large and small, and 
 the smaller set is especially convenient to use in cleansing the 
 child's face and head. It is important to do this separately, 
 because poisonous material may be conveyed from the child's 
 navel to the eyes or mouth. Accordingly, the head and face 
 
 Fig. 11. 
 
 A convenient folding bath. The tub of heavy rubber cloth. 
 
 should first be bathed, the head being well lathered with soap 
 and the eyes flushed out with a solution of boracic acid (ten 
 grains to the ounce) ; this is easily done by using a medicine- 
 dropper ; a bit of old handkerchief which has been carefully 
 boiled may be dipped in the boracic solution, placed upon the 
 tip of the little finger, and the child's mouth be thoroughly 
 cleansed. The child may then bo grasped with the palm of 
 the left hand resting upon its back between the shoulders, the 
 
CARE OF NEW-BORN INFANT. 81 
 
 fingers grasping the trunk, while the thighs are taken in the 
 right hand. It should be lowered gently into the water up to 
 the neck, and thoroughly but quickly bathed with a soft, new 
 sponge or wash-cloth. Many nurses prefer a bathing-apron, 
 consisting of a large, full apron of white flannel. The apron 
 is so large that, as the nurse sits beside the baby's tub, a portion 
 of the apron lays over her left arm, and may be used as a towel 
 when the child is received upon her lap. After the bath the 
 child should be powdered or anointed with simple ointment, 
 dressed, and laid in its bed to sleep. It is weU to give to the 
 child, after the first bath, a teaspoonful of water which has 
 been boiled and cooled, as it is not infrequently thirsty. An 
 inquiry by anxious mothers and friends is often made as to 
 how long the child can survive without nursing : it is even 
 thought that within an hour after birth the child must obtain 
 nourishment from the mother. It is well to put the child to 
 the breast first when the mother wakes from her first nap. 
 There is no danger in waiting for several hours until this rest 
 has been obtained. The teas so frequently given new-born 
 children by nurses are worse than useless, and should be posi- 
 tively forbidden. If the child cries and frets, and no other 
 cause can be found for its restlessness, it should be laid upon 
 its stomach across the nurse's knee, and water as hot as can 
 be taken may be given to the child in teaspoonfuls, and, in 
 addition, a little peppermint and hot water. Cases are occa- 
 sionally met with where nothing but a hot alcoholic stimulant 
 seems efficient in controlling the spasmodic contractions of the 
 intestines which cause what is known as " colic." Should 
 the nipples be sore, nipple-shields should be employed. Of 
 these the simplest are the best, as is true of all appliances 
 and all articles to aid in the care of the child. The nipple 
 should be bathed, after nursing, in a solution of boracic acid 
 (ten grains to the ounce), to which has been added a little 
 glycerin. 
 
 The child's mouth should also be cleansed, after each nursing, 
 with a bit of soft, old linen dipped in the boracic solution 
 / 
 
82 MOTHER AND CHILD. 
 
 employed for the nipple, carried thoroughly but gently over 
 the mouth, gums, and tongue by the little finger. The first 
 meal which the child obtains is a partially-formed milk, which 
 acts as a laxative. Soon after birth the child commonly has a 
 bowQl movement which is of a peculiar dark, tarry color, and 
 is called meconium. It sometimes resembles burnt molasses. 
 The child should have several evacuations of this substance 
 during the first day of its life, and colostrum, or material first 
 obtained from the breast, is especially adapted to secure this 
 result. Should this fail, a simple laxative may be necessary, 
 such as a teaspoonful of syrup, or a little castor oil ; but none 
 should'be given without the doctor's order. 
 
 The child, at birth, is covered with a waxy material, differing 
 more or less in amount in different cases. It is said that in 
 children who have very delicate skins the amount of this ma- 
 terial is often greater than otherwise. 
 
 As it occupies every portion of the body, and can be removed 
 by greasing the surface, the new-born child should be thor- 
 oughly anointed with either washed lard or vaseline, and then, 
 with a soft sponge, tepid water, and a little Castile soup, given 
 a superficial cleansing to remove as much as j^ossible of the 
 material. Unfortunately, many nurses believe that "it is neces- 
 sary that the babe should be made thoroughly clean at its first 
 washing, and the poor little thing is rubbed and scrubbed 
 in a most merciless manner. 
 
 If the birth has been a hard one, or the little one is feeble, 
 it would be far better to postpone the thorough washing till 
 the next day. The eyes, mouth, ears, and nostrils — in fact, all 
 of the m.ucous surfaces — should be carefully washed with clean 
 warm water applied by means of a clean sponge or piece of 
 old linen. 
 
 This should be done after the cord has been severed. In- 
 deed, it is now customary among many obstetricians to wash 
 carefully the child's eyes the moment its head is born. 
 
 Usually the child's mouth, at birth, is full of a thick, viscid 
 mucus, and its first cry will cause it to inspire this. As soon 
 
CARE OF NEW-BORN INFANT. 83 
 
 as possible it should be turned over on its stomach, the head 
 somewhat lowered, and the mouth thoroughly cleansed with 
 a soft, wet rag. 
 
 The cord, which is the attachment between the child and 
 the after-birth, contains the blood-vessels embedded in a gelat- 
 inous material more or less thick. As soon as the child is 
 born and takes its first breath, the circulation in the blood- 
 vessels of the cord gradually ceases. 
 
 It is not at all necessary that the cord of the child should 
 oe cut immediately after birth, nor should it be done until 
 breathing has been fully established. The cord is usually 
 grasped by the hands, and the jelly-like material within it 
 squeezed with the fingers towards the mother ; in this way com- 
 pression of the blood-vessels takes place. 
 
 A ligature is placed tightly around it, about three inches from 
 the child's surface, and another one about three inches from 
 that towards the maternal j)arts ; it is then cut with scissors 
 between the two. After the child has received its fii'st wash- 
 ing, the navel-string should be enveloped in a mass of sub- 
 limated absorbent cotton, folded up in a piece of linen, laid to 
 one side, and then the child's binder placed about it. 
 
 The object of this binder is simply to give warmth and sup- 
 port the cord. Undoubtedly, if the navel-string were allowed 
 to hang, be caught in the clothing, or be pulled about as the 
 child receives its daily washing, a rupture might take place. 
 
 Undue stress has been laid upon the value of a binder to 
 prevent rupture, and not half sufiicient importance given 
 to the binder as a protector in our changeable, treachei^ous 
 climate. But it should be remembered that a misapplied binder 
 is worse than none at all. It will, if applied tightly, produce 
 rupture, undoubtedly, and will interfere with the intestines. 
 We recall a case we once had : the babe screamed for hours, 
 and the mother and nurse were almost distracted, but failed 
 to find the cause. Upon being called, we found a tight 
 belly-band which was acting like a vice around a flatulent 
 belly. 
 
84 
 
 MOTHER AND CHILD. 
 
 Many physicians do not approve of a binder for either mother 
 or child, and we must confess that if they are to be misapplied, 
 we, also, would like to see them discarded altogether. There 
 
 should always be ample room 
 ■^^^- ^^- for the hand to be run between 
 
 the binder and the skin, and 
 the material used should always 
 be soft and very elastic (Fig. 
 12). 
 
 "While the child is being 
 washed and dressed it is well 
 to secure deep and full respira- 
 tions. It is said by old nurses 
 that a crying child at bu'th has 
 stronger lungs afterwards. 
 
 If, also, it is turned over on 
 its stomach, with head lower 
 than the rest of its body dur- 
 ing the process of washing, the 
 mucus will not be drawn 
 in during inspiration, and a 
 healthy inflation of the lungs 
 wiU take place. As soon as possible the mother and child 
 should get some sleep. After several hours' sleep the child 
 can be again washed, if necessary, or sponged off; and this 
 time it should be much more thoroughly done. 
 
 The circulation will be more thoroughly established, and the 
 skin w^ill assume the delicate, soft, red appearance of health. 
 Extended exjierience has convinced us that for the first few 
 days a little vaseline or cocoa-butter is better to use on the 
 child after its bath than the dry powders heretofore in vogue. 
 It needs but very slight greasing of the surface to make the 
 skin soft and pliable and to prevent eruptions ; and when it 
 becomes necessary to use a powder for dusting to prevent 
 chafing, the non-scented talcum is decidedly the best ; indeed, 
 the only kind to use. 
 
 Child wearing knit binder. 
 
CHILD'S NAVEL. 85 
 
 The cliild's clothing should have two important qualifica- 
 tions : it should be warm and absolutely loose over all parts of 
 the body. 
 
 After the child has had its first nap, attention should be paid 
 to its secretions. Jf the bowels have been moved, use vaseline 
 instead of water for its washing ; if it has not passed its water, 
 call the doctor's attention to it at his next visit : this is an im- 
 portant matter. 
 
 CHAPTEE XXY. 
 
 child's navel — APPLICATION TO THE BEEAST — WET-NURSES. 
 
 In the care of the child, and closely associated with what 
 we have described under the head of antiseptic precautions for 
 the mother, is the care of the child's umbilicus. As a rule, 
 when the umbilical cord is cut, a stump or remnant from two to 
 three inches long is left, requiring attention for from five to ten 
 days. The dropping off of this cord usually occurs, by process 
 of drying, between the fourth and sixth day. The umbilicus 
 is left oftentimes in a state of soreness which requires atten- 
 tion. This sore may be contaminated by septic poison just as 
 any wound upon the mother may be found infected, and hence 
 it should be dressed with some antiseptic dressing. The better 
 way is to buy at the druggist's some antiseptic gauze, satu- 
 rated with bichloride of mercury or boracic acid. Cotton im- 
 pregnated with these substances is often preferable. At each 
 dressing of the child, the stump of the umbilical cord should 
 be carefully enveloped in such gauze or cotton, laid upon the 
 child's left side, and over it should be placed a knit abdominal 
 band or flannel binder. This has ah*eady been described, and 
 need not be repeated here. At the time of bathing, the cotton 
 should be cautiously removed and replaced. Care should be 
 taken not to make traction upon the cord, and in a few daj'S 
 it will have loosened and come away. 
 
86 MOTHER AND CHILD. 
 
 After the exj)ulsion of the meconium, — the burat-molasses- 
 like substance, to which reference has been made, — the healthy 
 child has usually two to four stools in the twenty-four hours. 
 They should be bright yellow in color, in consistence varying 
 from thinly-boiled to semi-solid corn-meal mush. The functions 
 of the kidneys are also early established in the child, and the 
 diaper will require changing a number of times during the first 
 and second days. The urine is often almost free from color, and 
 hence the delusion which exists in the minds of mam' mothers 
 and nurses, that this urine does not contain the usukl substances 
 in solution, and that the diaper wet with it does not require 
 washing, but simply drying before being used again. Nothing 
 can excuse the uncleanliness and filth of such a practice, and 
 the child's diaper from its first hours of life should not be worn 
 a second time unless it has been thoroughly washed and dried. 
 It is possible that some cheap absorbent paper may be found 
 which can be used for this purpose, and can be burned when 
 soiled. If the child does not pass urine freely, simple means 
 may be taken to secure its expulsion : placing the child in a 
 warm bath ; laying uj)on the abdomen a flannel wrung out 
 in hot water and sprinkled with a few drops of spirits of 
 turpentine ; holding the child with its naked back exposed to 
 the heat of an open fire or stove, so that decided warmth shall 
 be felt. All of these expedients are harmless and in mild 
 cases often efficient. A half-teaspoonful of sweet spirits of 
 nitre in a little warm water will often bring about the desired 
 result. 
 
 It will be noted that the navel-string will come away in four 
 or five days without any offensive odor whatever. The 
 above method of dressing the cord is a convenient one, as it 
 does not require to be touched after its first an'angement. 
 
 The navel should be kept absolutely dry, not the least grease 
 being used near it ; in this way there will be no odor and the 
 remains of the cord will diy up and fall off. Should any odor 
 be perceptible, the pai't can be dusted with boric acid or with 
 a powder containing one-half boric acid and one-half talc. 
 
CHILD'S NAVEL. 87 
 
 As a rule, there is very little trouble from the navel, though 
 possibly at times, if the child should become constipated, or 
 have a severe cough, great straining may take place, when 
 bulging or rupture ensues. This can be readily obviated by 
 placing a small pad beneath the binder, not exerting great 
 pressure ; indeed, a binder which is too tight is more apt to 
 cause a rupture than none at all. 
 
 Should there be any discharge from the navel, the nurse 
 should make a careful examination of it when the child is being 
 washed, and if a small ulceration is found, as is sometimes the 
 case, it can be dusted with boric acid, and if the little red pro- 
 jection still remains, and there should be no doctor to call upon, 
 it can be touched with bluestone and then dressed with ben- 
 zoated oxide of zinc ointment. 
 
 It makes very little difference on which side the child lies 
 after its birth. It is scarcely necessary to dwell to any 
 great length upon the appearance of a healthy child at its 
 birth. 
 
 The soft, peach-like character of its skin, the constant ten- 
 dency to sleep, which is uninterrupted and quiet, associated 
 with an air of repose, are well-known evidences of health. It 
 is not necessary to dwell at length on the fact that the child at 
 this age is a noted creature of habit ; indeed, as we come to 
 consider infants as they grow, and to study the many causes 
 for that most distress'ng state of affairs, sleeplessness of infants, 
 we can trace it back, I can almost say in one-half of the cases, 
 to the unfortunate indiscretion in humoring the child when it 
 is not more than a few weeks old. 
 
 The young mother feels that the cry of her child must 
 naturally come from hunger ; but as nature has failed to supply 
 constant material for the fountain, she is often indiscreetly 
 advised to substitute milk and water or a little catnip tea. 
 Our own experience teaches us that this is wrong, and that 
 the following procedure is the one to be recommended. 
 
 After the mother has rested thoroughly the child should be 
 placed to her breast. Some children will immediately go 
 
88 MOTHER AND CHILD. 
 
 to work, knowing exactly what they have to do ; others again 
 may refuse absolutely to nurse. 
 
 Those that seem to know all about it will find it hard at first 
 to obtain any nourishment. After manj' attempts, and suc- 
 ceeding only in extracting what is known as colostrum, a lax- 
 ative secretion which precedes the nailk-flow, they will from 
 sheer exhaustion give up the attempt and fall asleep. 
 
 Infants that refuse the breast cry and fret. To these it 
 may be well to give a linen rag moistened in water to suck, or 
 a little water with a spoon, and then at a regular definite in- 
 terval, say an hour, place them once more to the breast until 
 they become used to it. 
 
 There is no danger, under any circumstances, of a child 
 starving to death; for several hours, at least, it can' exist 
 without food, and needs only a little water; and then, if it is 
 placed during the next twenty-four hours, in daytime, every 
 hour to the breast, and after that regularly every two hours, 
 by the time the flow of milk is thoroughly established the 
 child will have its little programme laid down for it, from which 
 it must not deviate under any circumstances. If it becomes 
 absolutely necessary to feed the child, condensed milk, one tea- 
 spoonful to twelve or fifteen of boiled water, is to be preferred. 
 
 Mothers and nurses should recognize the fact that the habits 
 which a child acquires in its first few days of existence are very 
 hard to break. If it be spoon-fed, it will be difficult to make 
 it take the nipple ; if it be bottle-fed with rubber nipple, it will 
 be difiicult to get it to nurse its mother. 
 
 Then, again, the taste of cow's milk, however carefully it be 
 pi-epared so as to resemble breast milk, will often cause it to 
 refuse to nurse. Often the nipples are so tender or the suction 
 will so affect the nursing woman as to restrain the milk-flow, 
 and the child will nurse in vain, while the mother will suffer 
 such torture that nursing will be abandoned and the child 
 be hand-fed. 
 
 A glass nipple-shield will frequently obviate the difficulties, 
 or, by gentle pressure and coaxing, sufficient milk can be 
 
WET-NURSES. 89 
 
 taken from the mother to spoon-feed the babe until nursing 
 can be gradually accomplished. We have been so much im 
 pressed with the importance of a healthy mother nursing her 
 child that we believe in temporizing as much as possible to 
 secure this end. 
 
 • For about two or three weeks the child should be nursed 
 every two hours daj' and night, and during the periods of 
 intermission both the mother and child should sleep as much 
 as possible. It is understood that the child should nurse at 
 each breast alternately. This is an important matter, because 
 a child would soon get accustomed to one breast and refuse the 
 other, and this leads to incalculable suffering. After the child 
 is nursed the nipple should be washed with a little plain water 
 or soda, or borax and water, and greased with some vaseline. 
 
 The flow of milk generally begins on the third day. This 
 flow may come on suddenly. 
 
 There seems to be a rush of milk to the breasts. Indeed, 
 this is usually the way the milk comes at each nursing. 
 
 Frequently the woman will have no evidence of milk what- 
 ever, when, at the hour at which her child usually nurses, or 
 even at emotion or thought of her child alone, the flow of milk 
 will take place. This is especially the case with those who 
 have had children before. 
 
 These women sometimes make the very best wet-nurses. 
 
 WET-NURSES. 
 
 It sometimes, as we all know, becomes necessary to decide on 
 very short notice the question of having a wet-nurse. We 
 will not go deeply into this matter, because the circumstances 
 of each case so group themselves as to bi'ing the answer with- 
 out consulting a book. The age of the child, the financial 
 condition of the family, the residence, are all to be taken into 
 consideration. 
 
 The wet-nurse should, preferably, have had other children ; 
 her child should be about the age of the one she is to nurse ; 
 she should be a perfectly healthy woman ; her child should 
 
 8* 
 
90 MOTHER AND CHILD. 
 
 also be seen, be thoroughly examined, and should give all the 
 evidences of perfect health. First of all, the family record 
 should be investigated. 
 
 Did her father, mother, sisters, or brothers die of consump- 
 tion, cancer, scrofula? 
 
 If she has had other children, were they strong and healthy ? 
 Did they thrive upon her milk ? 
 
 If they died, of what did they die ? The physical condition 
 of a wet-nurse is as important, of course, as her family record. 
 
 She should have no constitutional disease of any kind ; her 
 lungs should be healthy; her skin should be clean, free from 
 any eruption, or the remains of one ; her teeth should be good, 
 which is an evidence of good digestion ; her eyes bright, her 
 muscles firm and well formed ; she should have no loss of hair, 
 sore throat, or chronic nasal catarrh, and her breasts should be 
 well formed. Then comes the question of temper, and indeed, 
 as regards this, it is as hard to get satisfactory testimony as 
 it is for the physical condition. 
 
 She should be pleasant in disposition, not stupid; energetic, 
 willing, devoid of high temper, and possessed of those traits 
 which will soon endear the child to her. Such a nurse would 
 probably give about two quarts of milk in twenty-four hours. 
 
 Of course, much of this examination is made by the family 
 physician, who is the one to decide whether the nurse is suit- 
 able or not ; but there are times in cases of emergency, when 
 the mother, or monthly nurse, has to decide. On that account 
 we have dwelt at length on this subject. 
 
 The nurse's child should be plump, well formed, free from 
 any eruption. Its odor should be sweet and fresh, not sour ; 
 should it vomit, the material should be simply the overloading 
 of the stomach and not sour milk. A healthy baby will often 
 take more than its stomach will hold, especially if the mother's 
 milk is plentiful and flows freely. 
 
 Having, then, decided upon the health of the wet-nurse and 
 on the chances that her milk will be plentiful, she should be 
 .questioned carefully about her supply of milk. The question 
 
WET-NURSES. 91 
 
 as to the employment of a wet-nurse is one with so many 
 phases that in a work of this sort it cannot be answered by 
 "yes" or "no." 
 
 Dr. A. Jaeobi, writing of the diet of wet-nurses, expresses 
 himself as follows : 
 
 " Powerful salts are to be avoided under all circumstances, 
 as well the salines as the more powerful drastics, likewise an 
 injudicious use of table salt, ethereal oils, and strong condi- 
 ments. Furthermore, everything is to be avoided, whether 
 of substances taken into the stomach or improper habits, which 
 have a tendency to derange or to weaken digestion and assimila- 
 tion. Generally the wet-nurse looks upon her position as one 
 would regard ' a land which flows with milk and honey,' and 
 where 'roasted pigeons fly into the mouth,' — Canaan and 
 America at once, — and where there is no end of things to eat 
 until the appetite is satisfied or spoiled. Somewhat more of 
 albuminous food is indicated than under ordinary circum- 
 stances. Too much of this, or a diet composed exclusively 
 of it, would destroy health and the milk-secreting power as 
 well. Much fluid food and an abundance of water will increase 
 the volume of the milk. Water and barley gruel act upon the 
 milk as well by virtue of the water which they contain as by 
 their nutritious qualities, and the same is true of tea in mod- 
 erate quantities. Potatoes, in large quantity, and other carbo- 
 hydrates are to be avoided as a principal means of nourish- 
 ment. Fat in moderate amount is desirable. In general it 
 may be laid down as a fundamental principle that a wet-nurse 
 will have the largest quantity and the best kind of milk when 
 using the same nutriment to which she was accustomed before 
 pregnancy, provided it kept her in good physical condition, 
 with the addition of a certain quantity of albuminoids and 
 plenty of fluid food. What the nursing woman spends in 
 the shape of milk must be returned to her. Where we are 
 dealing with small, atrophied breasts, and it is necessary, to 
 stimulate the secreting function, considerable time is required 
 before a free and satisfactory flow of milk can be obtained. If 
 
92 MOTHER AND CHILD. 
 
 we are looking simply to keeping up an abundant supply, carbo. 
 hydrates may prove satisfactory. The most common question, 
 however, is in regard to the improvement of the substance of 
 the mammary glands themselves. It must not be forgotten 
 that tissue-changes and good health do not depend alone upon 
 what is eaten. A wet-nurse must not be thrown too suddenly 
 upon conditions which are quite strange to her. She must 
 live, as nearly as possible, in the manner to which she has been 
 accustomed, A nurse who is removed from the hay-field or the 
 kitchen-table to the boudoir of a lady, and who is held in re- 
 straint from fear lest she might eat a raw apple, or drink a 
 glass of beer, or meet her lover, or who is deprived of her cus- 
 tomary physical exercise, will not remain healthy nor give a 
 proper quality of milk. In accordance with these fundamental 
 directions, the various articles must be criticised which have 
 been recommended as proper means of nourishment and diet 
 during the period of lactation. The list of such articles contains 
 beer (?), buttermilk, milk, chocolate, thick soups, husked grains, 
 oysters, crabs, sea-eel soup, etc. If all these dietetic means do 
 not accomplish their end, one has to look around for therapeu- 
 tic measures for the stimulation of the milk-secreting function, 
 with more or less of reason and more or less of confidence." 
 
 If the question be asked. Can a babe be brought up without 
 the wet-nurse, depending upon the bottle alone ? we will say 
 "yes;" but so careful must be this bringing up, so vigilant 
 the nurse or care-taker, so conscientious, so scrupulous in 
 attention to details, that one almost feels like saying that if 
 a wet-nurse can be obtained who fulfils all the above require- 
 ments, — who is healthy, docile, and of an aff'ectionate dispo- 
 sition, intelligent, and one especially who has lost her babe and 
 takes the new one to her heart in its place, — secure her by all 
 means. In times of illness, there are occasions when a wet- 
 nurse seems to be, for a time at least, a necessity. 
 
 One objection which is frequently raised by mothers is that 
 they do not liice to see their babe nursed by other women. 
 This may be valid when the balance is equally divided between 
 
WET-NURSES. 93 
 
 the wet-nurse and the bottle, but where the babe is deli- 
 cate, where a strong hereditary taint is present, ttnd the 
 chances for the child's future health would be made greater 
 by the nourishment it would receive from a strong, healthy 
 woman, this objection should have no weight whatever. Tho 
 mother who really cares for the future of her offspring will 
 cast aside such feelings and gladly see her child get a start in 
 life that will enable it to compete with others in the struggle 
 for existence. Indeed, the condition of her own baby will be 
 evidence in itself. There are other matters to be taken into 
 consideration. 
 
 The nurse's child will have to be taken by some one who will 
 give it care, so that her mind may be entirely relieved on that 
 score, as anxiety and fretting may cause her to lose all her 
 milk in a short time. It must be remembered that she comes 
 from a class who, as a rule, are accustomed to m.uch out-door 
 life, very plain diet, and regular habits, and that a sudden change 
 to a life of luxury, variety in cooking, and over-stimulating 
 food is apt to bring about a condition of biliousness, laziness, 
 and irritability of temper which is difficult indeed to regulate. 
 
 We have frequently known the very best of wet-nurses, who 
 have given satisfaction for a month or so, suddenly, without 
 any apparent cause, lose all their milk, and in such cases the 
 whole trouble of selection, together with the risk of getting a 
 milk which disagrees with the child, has to be gone over. 
 Indeed, if under such circumstances the woman proves herself 
 to be reliable and affectionate, it is often far better to put the 
 child upon the bottle and keep her as ordinary nurse. 
 
 When the question comes up for decision- between a wet- 
 nurse and bottle-feeding, we should bear in mind that the child 
 who is to be subject to city influences should be wet-nursed, 
 especially during the hot summer months. We believe that 
 bottle-feeding, which, as we shall see further on, requires the 
 greatest amount of care and watchfulness, is successful in 
 many cases, but the more we see of it the more we are satis- 
 fied that every child, if possible, should receive breast-milk 
 
94 MOTHER AND CHILD. 
 
 until it is four months old; at least this is imperative for a 
 city child. 
 
 Of course, when a child is delicate, or where there is an in- 
 herited taint in the family, such as consumption, or the family 
 is known as a delicate one, wet-nursing becomes all the more 
 important. 
 
 The choice of the wet-nurse, when possible, should always 
 be left to the family physician ; indeed, a doctor's examination 
 of her milk and her baby should alwaj's be obtained. 
 
 The system recently established at the nurses' directories in 
 our large cities, of having certified wet-nurses, is a very valu- 
 able step forward, and should be encouraged by the public. 
 
 CHAPTEE XXYL 
 
 CARE OF THE BRAIN AND NERVOUS SYSTEM. 
 
 So far as the child's mind is concerned, the fond delusion 
 which mothers commonly cherish, that children perceive and 
 recognize as soon as born, or soon after birth, must be disre- 
 garded. It is probably not before the third or fourth month 
 of infancy that the human being perceives. By this we mean 
 that while rays of light may fall upon the child's eyes, and 
 waves of sound may strike its ears, and sensations of cold or 
 warmth or roughness or smoothness be excited in its skin, and 
 while sound may be heard as a confused noise, yet the child 
 has no idea as to the meaning, source, or character of these sen- 
 sations. It seeks its mother as any other young animal seeks 
 its natural source of food ; but perception, will, like or dislike, 
 other than the animal desires for food, warmth, quiet, and 
 muscular movements are undoubtedly absent. The child, 
 then, should be treated as a precious but very prosaic little 
 .animal, and while imagination and affection may detect elo- 
 
CARE OF THE BRAIN AND NERVOUS SYSTEM. 95 
 
 quence in its cries for food, and rejoice in caresses which are 
 largely involuntary, and sympathize with lamentations which 
 contain no prophecy except a warning that the stomach is 
 empty, all of these manifestations should be taken in the most 
 matter-of-fact way. If a vase is to be made by a potter, the 
 mass of clay is first prepared, and then the rude shape is turned 
 upon the wheel. It is only by repeated applications of the 
 hand and the potter's tools that a design becomes apparent 
 and the shape takes meaning. The infant resembles at birth 
 an organism whose general form is complete, whose design may 
 easily be inferred, but which utterly lacks details and connected 
 manifestations. It requires the many little touches given by 
 the different sights, sounds, and impressions which the child 
 receives to mould it into an intelligent being, and this process 
 cannot be accomplished to any extent before the period which 
 we have mentioned. This disquisition on mental philosophy is 
 not introduced to rob the mother of delight in her offspring, 
 but to allay her anxieties and enable her to lay aside worries 
 which otherwise would injure herself and her child. If babies 
 were exhibited more as kittens are,— as objects to be looked at, 
 admired, but let alone except by the mother and nurse, — the 
 babies would be more comfortable and their mothers likewise. 
 If it be true that the child does not perceive until three or four 
 months old, it is also true, however, that habits can be formed 
 from the day of birth. It is therefore of the greatest impor- 
 tance that quiet, regularity, and strict discipline should be the 
 atmosphere of the child's first months of life; tiie object being 
 to form a solid physical background for the development of iis 
 nervous S3'stem, this process should not be interrupted, and the 
 greatest regularity, the kindest but most efiicient care should 
 be given not only that it be regularly fed, but that it be fully 
 protected from useless disturbance. Any one who has watched 
 in a public conveyance a fretting, restless baby trying to sleep, 
 while an ignorant mother or the confusion about it prevented 
 its slumber, will recognize a species of physical unhappiness 
 which is very near frenzy. If the child must be taken in 
 
96 MOTHER AND CHILD. 
 
 public conveyances, it should be done in the most careful and 
 judicious way. The introduction of sterilized milk has made 
 it possible to take an infant upon a journey, maintaining the 
 regularity of its hours of feeding with the utmost nicety. 
 Possibly the time will come when the luxurious trains, which 
 now offer the conveniences of a good hotel, will contain cars 
 adapted for the transportation of women and infants, where 
 sterilized milk can be easily warmed, where a mother and 
 her infant and nurse can occupy their own apartment, and the 
 miseries of infant travel be almost removed. It is a familiar 
 fact that a child no older than six months can travel with very 
 little annoyance to itself and its attendants, if the prerequisites — 
 warmth, quiet, food, and sleep — be scrupulously maintained. 
 The very fact that the infant ordinarily notices its surround- 
 ings very little, makes its transportation comparatively easy. 
 There is no reason whj' these simple prerequisites should not 
 be placed within the reach of the poor. In several countries 
 of Euroj^e nobility has interested itself in establishing depots 
 where sterilized milk can be obtained at the lowest possible 
 cost by peasant families. Similar movements are on foot in 
 this country, and we trust that the time will soon arrive when 
 sterilized milk, and any other food which science can prove to 
 be essential for infants, may be obtainable at or near our great 
 railway stations. Of course, a nursing child needs only its 
 mother's food, but the mother should receive the same consid- 
 eration as is shown the child, and thus her nourishment will 
 remain uninjured by fatigue or deprivation. 
 
TEE NURSING OF INFANTS. 97 
 
 CHAPTEE XXYII. 
 
 THE NURSING OF INFANTS. 
 
 We have elsewhere written^ as follows, when on the subject 
 of nursing : 
 
 How much food does a babe require in twentj-four hours ? 
 Much depends on the infant: if the bowels be normal and 
 there is no evidence of indigestion, the breath sweet, and the 
 child seems desirous for more after it has finished its bottle, 
 there is no reason why it should not be satisfied. 
 
 From birth until it is a month old a babe should be nursed 
 every two hours ; it will take one ounce or a little less at each 
 feeding. There is one matter of great importance, and that is, 
 the child should be made to nurse from both breasts from its 
 birth, alternating at each nursing. 
 
 It is strange that an infant nearly always shows a prefer- 
 ence for one breast, and there may be a struggle to conquer 
 this ; nevertheless, the battle must be fought, or the neglected 
 breast will give much trouble. 
 
 Dr. Jacobi says, " The child ought to drink from the breast 
 or the bottle until it has had enough. It takes twenty to 
 twenty-five minutes to empty one or both breasts. After 
 having nursed, the infant should be quiet, should play with its 
 arms, should breathe somewhat more regularly than usual, or 
 go to sleep. If it be not allowed to have absolute rest, if it be 
 rocked, allowed to lie on its belly, or be carried around, lying 
 face downward upon the hand of the person carrying it, vom- 
 iting will be provoked. The facts which have been introduced 
 show that nature requires play-room; even the most careful 
 measurements may be incorrect." 
 
 A child a month old should be nursed about ten times in 
 
 1 Annals of Hygiene, July 1, 1886. 
 Kg 9 
 
98 MOTHER AND CHILD. 
 
 twenty-four hours, — every two hours during the day and three 
 hours during the night; at each nursing it should take from 
 two to three ounces of milk. At the age of three months it 
 will probably nurse only about eight times, taking some six 
 ounces at each feeding; at the end of six months it will take 
 about eight ounces. 
 
 We believe that the above represents about the amount of 
 breast-milk that a very robust child would receive, though Dr. 
 Rotch makes the estimate a little less. 
 
 The child gets the same food as does an adult, — that is to 
 say, the milk which forms its diet is composed of all the arti- 
 cles of food that enter into the diet required by a human being. 
 These may be divided into five classes : water, caseine (curds) 
 or albuminoids, salts, which go to the formation of bones and 
 secretions, /afe and sugar, which are burned up to make ani- 
 mal heat, and are also valuable in nutrition. Eighty-seven 
 parts of a child's food is water, but then we know that seventy 
 per cent, of the human body- weight is water. 
 
 .Mother's milk is a bland, watery substance, sweetish to the 
 taste, and has the property of forming curds in flakes; whereas 
 the milk of the cow precipitates in heavy masses, as a rule, and 
 is on that account difficult of digestion. 
 
 A healthy infant, if properly instructed in the earlier hours 
 of its life, will awaken with the regularity of clock-work and 
 seek its meal every second hour. It should be placed at the 
 breasts alternately, and after it has received its nourishment 
 it will probably fall asleep, showing no evidence of indigestion 
 or flatulence, so frequent in bottle-fed children. Babies are 
 very apt to get into the bad habit of falling asleep after 
 taking two or three mouthfuls. Should this habit be en- 
 couraged, it will be very difficult to break. The child should 
 be promptly awakened and made to continue the meal until it 
 has taken a sufficient amount. 
 
 At the third month a child should nurse about every three 
 hours, or possibly, it it is a large child, craves food, and takes 
 a great deal at once, every two hours during the day and at 
 
THE NURSING OF INFANTS. 99 
 
 longer intervals at night. If the mother has a very free flow 
 of milk, — more, indeed, than she can possibly retain, — it is 
 well for her to wear the ordinary disk or cracker-shaped nip- 
 ple-glass during the daytime, with a towel pinned over it, 
 which will absorb the surplus milk, and will prevent her 
 being constantly wet and catching cold. As can be readily 
 understood, the breasts of a nursing woman demand con- 
 stant attention. The nipples being of various shapes, there 
 is often a singular want of compatibility between them and 
 the infant. Olten a nipple will be so small that the child 
 cannot grasp it readily, and in its great impatience it will fail 
 to effect any suction whatever; then, again, the nipple will be 
 too large a mouthful, and a free flow of milk will almost choke 
 the child. These conditions can be regulated by the mother 
 grasping the nipple between two fingers (index and second) 
 of the unoccupied hand, and either making gentle pressure 
 to increase the flow or restraining the current by slightly 
 squeezing the nipple at its base. Some nipples are sunken 
 in, and it is impossible to keep them sufficiently raised to 
 allow the babe to grasp them or to prevent chafing and crack- 
 ing at their base. It is wrong to attempt to harden them by 
 astringents ; they should be kept clean, free from any acidity, 
 dry, soft, and pliable. They should be sponged off with a 
 weak solution of boric acid in water after each nursing, and 
 then thoroughly dried and the. base anointed with a non-irri- 
 tating salve,— something that will not be disagreeable in taste 
 or odor to the child. White vaseline or cocoa butter is as 
 useful as anything; the latter can be rubbed up wiih a little 
 glycerin to make it softer, if necessary. There is an excel- 
 lent old-fashioned salve, known as " Pomade Divine," de- 
 scribed in many old English books. It is made of wax 
 suet, herbs, etc., and no better ointment of a soothing, heal- 
 ing character can be found. Many people keep it to put on 
 bruises. 
 
 Some mothers suffer the most intense agony, at first, when 
 their babes nurse ; they become nervous, and the very thought 
 
100 MOTHER AND CHILD. 
 
 of it puts them into such a nervous state as either to entirely 
 stop the milk-flow or certainly to make the milk disagree. 
 When this is the case a glass shield with rubber nipple will be 
 of service, for a few days at least, until they become accus- 
 tomed to the suction. Breast-puntips should never be employed 
 unless ordered by the doctor, and then only under the super- 
 vision or direction of a trained nurse. 
 
 What should be done if the breasts cake or become tense? 
 If the flow comes very quickly this is apt to occur when the 
 demand of the child is not equal to the supply. To prevent 
 this, and to relieve it when it takes place, there is nothing 
 better than gentle but firm stroking of the breasts from their 
 margins towards the nipple. Hot lard is the best thing to 
 use for this. Some nurses have a special knack of relieving 
 engorged breasts in this way. The breasts should be sup- 
 ported by a suspensory bandage : a soft towel, folded bias, 
 passed beneath the breast and arm and tied behind the neck, 
 or a silk handkerchief, is the best thing to use for this. 
 Nursing women should be most careful not to get chilled; 
 although possibly breast abscesses are more apt to follow Bore 
 nipples and bruises, they may result from cold, and are indeed 
 most serious things. Sleep and exercise, ease of mind, — a 
 contented disposition, —are of great importance to a nursing 
 mother; fresh air and good food stimulate the appetite and 
 make good milk. A daily sponging of the body, or a bath, 
 makes the skin do its share of work and keeps the other organs 
 in good working order also ; in a sleeping room, fresh air with- 
 out draught is essential. If these things are necessary for the 
 mother, they are equally, if not more, so for the wet-nurse, 
 and the mother must see that they are attended to. 
 
 Colic is so frequent in nursing as well as bottle-fed babes 
 that it is not out of place to consider it here, though when 
 writing on bottle-feeding we will dwell more at length upon it. 
 
 What a mother wants to know is how to distinguish the 
 various causes of colic, so that she may properly apply 
 those domestic remedies that will relieve it. Frequently 
 
THE NURSING OF INFANTS. 101 
 
 a babe will be seized with severe pain at the first attempt 
 to nurse ; it will suddenly scream, draw its legs up, and re- 
 fuse the breast. If this were due to flatulency, the belly 
 would be round and tense. It is the result of what is 
 called reflex action or stimulation transmitted from one set 
 of nerves to another; the intestinal canal is set in motion and 
 its nervous centres are stimulated by the act of sucking, just 
 as the sight of food makes an animal's mouth water. There 
 ought to be a rule that, whenever a babe screams suddenly, 
 with evidence of acute pain, all its clothing shtmld be re- 
 moved to search for erring pins or too great pressure. Ear- 
 ache is a frequent cause of acute pain in babes, and is often 
 overlooked, but it is most common in infants of over three 
 months, and it would be well for the mother to send for her 
 doctor should the child not be relieved by the measures in- 
 tended to check intestinal colic ; he may be able to locate the 
 pain elsewhere and suggest appropriate measures. 
 
 The presence of food in the stomach and intestines will 
 often induce colic, until the digestive processes are fairly 
 established. That is one reason why it is desirable to allow 
 the child to nurse at regular intervals only, and to apply it 
 early to the breast, while the mother's milk is scanty. The 
 early secretion from the mother's breast has a somewhat 
 laxative efi'ect, and probably is intended to act as such in 
 order to purge the babe's intestinal canal of the accumulations 
 that have taken place during its foetal life. If the babe has 
 colic following the first attempt at nursing, it is often advisa- 
 ble to give it a teaspoonful of olive oil in a teaspoonful of 
 warm liquid "soda mint" before nursing, and to draw from 
 the mother the first secretions. Another cause of colic is 
 overloading of the stomach and intestines. Some babes evince 
 a greediness which is remarkable, or the flow of milk may 
 be totally beyond their storage capacity, and from bulk alone 
 promote pain. Again, fermentation may take place very 
 rapidly. Some babes regurgitate the milk veiy readily, and 
 thus the bowels do not suffer from distention by the gases 
 
 9* 
 
102 MOTHER AND CHILD. 
 
 of decomposiiion. Moihers often complain of this and fail 
 to see that it is nature's safety-valve ; indeed, it is only the 
 excess of food that is got rid of in this way. A babe can 
 digest only a certain amount and no more; the amount that 
 can be digested diifers with every infant. It is not the amount 
 of food a babe takes into the stomach, but the amount it digests, 
 that does it good: this must never be forgotten. One often 
 sees a babe crying from colic, and the nurse or mother at- 
 tempting in vain to soothe it by dancing it up and down or by 
 singing a lullaby ! Imagine the torture to the poor little one 
 from such a proceeding ! Unless a vent for the wind be found 
 the crying will continue, and the wonder is that convulsions 
 do not oftener occur. When a child, then, has colic, do not 
 nurse it; unclothe it, give it a warm drink by the spoonful, — 
 catnip tea, Hquid soda mint (some advise gin and water, but, 
 as a rule, we are opposed to any stimulants in such cases unless 
 ordered by the doctor). Eub the abdomen very gently from 
 right to left with some warm ohve oil, or, what is still better, 
 let the child lie face downward on the lap and gently rub its 
 back with some warm liniment, or even the bare hand. If it 
 still continues to cry. give an enema of a teaspoonful of tincture 
 of assaf'cetida in two ounces of water, introduced very gently; 
 and if the pain still continues after the enema has acted, put 
 the feet in hot water, tested first by the mother's arm that it 
 may not burn. Should this fail, send for the doctor. 
 
 The strictest attention should be paid to the clothing of a 
 babe ; not infrequently colic may be caused by cold, especially 
 cold feet. Sometimes a babe will seize the breast with avidity, 
 give a few attempts at sucking, apparently choke on the milk, 
 and cry. This may be caused by cold in its head, the mucus 
 stopping the nose so that it is impossible for it to breathe and 
 suck at the same time. The doctor's attention should always 
 be called to the babe's nose if it has sniflSes, or if it breathes 
 noisily or with difiiculty, that he may use appropriate meas- 
 uaes to clear out the nasal passages. The nurse should take 
 care, when washing the child, and especially in cold weather, 
 
THE NURSING OF INFANTS. 103 
 
 that it be not in a draught. I have often seen a fuithful nurse 
 bathing a babe in a stifling hot nurserj', near the fire probably, - 
 and the constant opening and shutting of an adjacent door 
 supplying a direct draught to the child. In my experience, 
 nasal catarrhs are very common with infants. 
 
 In choosing a wet-nurse it is, perhaps, better to select one 
 who does not menstruate. JSTot that ordinarily normal men- 
 struation will affect a nursing babe after it is three or four 
 months old; but excessive menstruation will act as a drain 
 upon a woman and certainly affect her milk. Matrimonial in- 
 tercourse need not, either, interfere with nursing, provided it is 
 indulged in with caution and in moderation ; but great watchful- 
 ness must be exercised over wet-nurses in this matter, coming 
 as they frequently do from a class not over-particular in morals, 
 unless one is fortunate enough to secure a married woman. 
 Wet-nurses are liable to excesses, and these will have a very 
 baneful effect upon a delicate child ; indeed, this and intem- 
 perance is a risk always run. The child being healthy, it may 
 be well to gradually enlarge its bill of fare as it grows older, 
 in order to accustom it to a change in diet, or to prepare for 
 any change that may become necess^ary. It has been said 
 that a child digests bottle-food when it also takes breast-milk, 
 and therefore that weaning should be a gradual process, — so 
 gradual, indeed, as to take several months for its accomplish- 
 ment. When it is deemed desirable to substitute it for breast- 
 milk, the bottle should be given in the daytime, after the 
 morning bath ; or better still, if the nurse has the child, to 
 give it the breast in daytime, so that the mother may get her 
 night's rest. By this time the child takes, as we have noted, 
 more food at each nursing and nurses less frequently, and now 
 it may have the bottle at about ten or eleven o'clock at night, 
 when the mother retires ; in this way she can nurse the child 
 at the early morning hour, and thus avoid the exposure of 
 getting up and preparing a bottle of food at that hour, if she 
 takes charge of the child herself. 
 
104 MOTHER AND CHILD. 
 
 CHAPTEE XXYIII. 
 
 BOTTJLE-FEEDING. 
 
 If wc have impressed sufficiently upon the reader the iropor- 
 tance of care in the selection of a wet-nurse, we did not do so 
 with the object of undervaluing the subject of bottle-feeding 
 by contrast, although there is no question but that the valu- 
 able suggestions, the outgrowth of careful study, that have 
 been published by such writers as Leeds, Smith, Meigs, Jacobi, 
 Eotch, and others in this country have impressed upon the 
 community the fact that the raising of children by means of 
 the bottle is by no means as difficult a matter as it was thought 
 even ten years ago. They have all premised their teachings 
 by impressing the fact that care is the primary step to suc- 
 cess. If it is a difficult matter to keep a wet-nurse in order, 
 it is no less difficult to give the requisite attention to each 
 bottle. One bottle of tainted milk may he fatal to an infant, and 
 though a mother or nurse may day after day watch with the 
 most zealous care the preparation of the baby's food, the 
 souring of the milk, its admixture with contaminated water, 
 the change of pasture of the cow, may bring on an attack of 
 diarrhoea or vomiting which would be uncontrollable. We wish, 
 therefore, to impress upon all those who have anything to do 
 with the bottle-feeding of chiLiren that a child, not exposed 
 to the dangers of a large city in the summer-time, can be 
 brought up on the bottle from the day of its birth and be free 
 from disease, become strong and healthy, provided the same 
 attention is given to it as would be given by a mother to her new- 
 born nursing babe. At the same time, we believe that every 
 mother should be impressed with the fact that no form of 
 bottle-feeding, however perfect it may be- and however 
 closely it may resemble breast-milk, can take the place of 
 breast-milk for a child under three months of age. Breast- 
 
BOTTLE-FEEDING. 105 
 
 milk is the ideal infant's food, and if we dwell at length upon 
 bottle-feeding, we do not for a moment wish it understood that 
 we undervalue the milk of the mother or, next to it, that of a 
 reliable wet-nurse. 
 
 The first requisite for carrying out bottle-feeding with thor- 
 oughness is that somebody should take charge of the child who 
 has a special interest in it. If we are talking to a young mother 
 whose milk has given out, or whom the family physician has 
 advised to bottle-feed her child, then she is the one to undertake 
 . the work, and either to prepare each bottle or to su23erintend 
 its preparation for a time at least. Possibly she has had a wet- 
 nurse whose milk has gone, and it has been decided to use a 
 bottle instead of procuring another. Then let that nurse 
 undertake the duties. She has a special interest in the child 
 who has drawn its nourishment from her breast. If not, then 
 get some middle-aged woman, not too old or cranky, or over- 
 burdened by previous experience, but never a small chit of a 
 girl who would require a nurse to look after her. Strange to 
 say, these latter are often engaged as child-nurses, and no won- 
 der the doctors are kept busy. Choose a middle-aged woman, 
 or a strong, healthy young woman of intelligence, — one who is 
 bright, cheerful, satisfied. Make your pecuniary arrangements 
 with her perfectly satisfactory, so that she has nothing what- 
 ever on her mind. After you have tested her abilit}-, give her 
 your entire confidence ; let her see that she is trusted. It is 
 well that the child and nurse should have a room to themselves 
 near to the mother's bedroom, and this room should have in it 
 two things of great importance : one, a small sick-room refrig- 
 erator ; the other, a gas-lamp or something by which the milk 
 or water can be readily heated. It is necessary to have a half- 
 dozen nursing-bottles holding about eight ounces each. A 
 child a month old will take not quite one-quarter of this at each 
 nursing. At the age of six months it should take at one feed- 
 ing about six ounces. As there is more danger of decomposi- 
 tion from cow's milk, it is wiser to give an infant less bottle- 
 than it would get breast-milk at the same age ; but as the 
 
106 MOTHER AND CHILD. 
 
 capacity of a babe's stomach is in proportion to the weight of 
 the child, a feeble babe needs less food, but the intervals of its 
 nursing may be made somewhat shorter ; an extra bottle may 
 be given at night. Overfeeding is a great cause of diarrhcea. 
 Most mothers overfeed their bottle-fed babies : it is a temptation 
 hard to resist ; but the lesson is frequently a bitter one. It is 
 far better to underfeed for a time, and let the doctor regulate 
 the increasing diet, which he can gauge by the child's weight. 
 A gain in weight and a healthy condition of the passages is 
 the test of the amount of food a babe should receive. The 
 average healthy babe may gain by proper food from a half to 
 one ounce a day in weight for the first four or five months, and 
 half that amount daily for the rest of the year. The question 
 as to whether a woman becoming pregnant should continue to 
 nurse her child is one to be left to the family physician to 
 answer. 
 
 The fresher the milk the more readily it will be digested ; 
 indeed, we feel satisfied that the warm milk, just from the cow, 
 is far more digestible than that which has been kept with every 
 precaution for a few hours. There must be some change which 
 milk undergoes, as it is noted by all observers that the milk 
 when warm from the cow is but slightly acid, or neutral, by 
 litmus paper, but after it has stood for a while it always shows 
 a very decided acid change. Mother's milk is always slightly 
 alkaline. 
 
 The greater part of the secret of success in bottle-feeding is 
 to have pure, fresh milk ; and we would say beforehand that if 
 there is the least doubt of the character of the milk served, 
 there should be no hesitation about putting the child at once 
 upon condensed milk until this matter is thoroughly investi- 
 gated ; though it must be remembered that the condensed milk 
 must he either sterilized or treated with boiling water, as will be de- 
 scribed later, just the same as would be cow's milk. Although 
 one may be most careful in the selection of a milkman, in the 
 city, yet the jolting that the milk gets in transit, the risk that 
 is run from diseased cows, dirty cans, contaminated water in 
 
BOTTLE-FEEDING. 107 
 
 milk-houses, is by no means small, and especially during the 
 heated season, when the child's intestinal tract is weakened. 
 These causes of bad milk are followed by disease ; possibly 
 this accounts for the fact that milk from the same dairy that 
 has agreed perfectly during the spring months will sometimes 
 disagree with the child in summer. 
 
 So much attention has been paid to this matter recently that 
 the public has become interested in the establishment of dairies 
 where every precaution is taken to secure the very best of 
 milk by legislative interference. The pasture and winter- feed- 
 ing should be regulated ; the health of the cattle, the methods 
 of preserving the milk, and its transportation looked after; 
 the milk-inspectors should be on the alert to prevent the intro- 
 duction of such substances as boracic acid or salicylic acid to 
 preserve the milk. 
 
 Great care should be taken in the selection of milk, and in 
 its preservation, even after it has reached the house, until 
 used. The milk should always be tested with litmus ; if it is 
 alkaline, it has been made so by the addition of some preserva- 
 tive. Cow's milk always presents to litmus paper more or less 
 acid reaction, turning the litmus red. If there is the slightest 
 suspicion that the milk has been watered, is not very fresh, or 
 that it has been subjected to much jolting, our opinion is that 
 it should be boiled at once and then put in a refrigerator, 
 and warmed for each bottle. The boiling will destroy its fer- 
 ments, and in that way diminish the chances for intestinal dis- 
 turbances ; but boiling will not make milk sweet that has been 
 turned or make fresh that which is stale. 
 
 The propriety of obtaining milk from a single cow is one that 
 has been frequently insisted upon, and if one is satisfied that 
 such milk is obtained and is found to have agreed with the 
 child, it may have many advantages ; but we think that the ordi- 
 nary mixed milk from a dairy of common cattle will be less 
 liable to daily changes ; it will maintain, as it were, an average. 
 Not only should the milk be pure and sweet, but it should be free 
 from all matters that carry disease with them. Our medical 
 
108 MOTHER AND CHILD. 
 
 literature contains very many authentic cases of scarlet fever, 
 typhoid fever, and diphtheria which were undoubtedly carried 
 from the dairy by means of the milk, the farmer's family suffering 
 at the time from the disease in question. If, for instance, the 
 water of the milk-house should be contaminated by an out- 
 house well, and the washing of the pans convey these materials 
 to the milk, the result, of course, would be apparent ; indeed, 
 milk is undoubtedly frequently diluted, and the water will 
 carry the germs with it. ATilk also has the propensity of ab- 
 sorbing odors and gases that probably contain the germs of 
 disease. Milk also may contain the germs of disease affecting 
 the cow herself: so we see that there is a great risk to be run, 
 and be we ever so careful and watchful we can only avoid the 
 most apparent evils, and will have to trust to Providence to 
 save us from the others. 
 
 If each householder was more particular about his milk, 
 gave it the strictest watching, and if the laws in regard to that 
 outrageous and most criminal proceeding, the adulteration or di- 
 lution of milk, were rigidly enforced, dairymen would soon 
 feel the importance of obtaining and sustaining a reputation 
 for honesty. It is a very difficult matter to reach the legisla- 
 tors of the land, those who make its laws ; but possibly, by 
 placing these matters in a clear light before their wives, they 
 will be made to see the ci-iminality of adulteration of food 
 when it becomes a matter of their own individual interest. We 
 lay great stress upon this subject, because absolutely pure, fresh 
 milk — that used immediately after milking — does not have to be 
 sterilized or boiled, as it is free from germs of disease or fer- 
 mentation. Sterilizing and boiling the milk implies that a 
 doubt is cast upon its purity. A babe will not thrive as well 
 upon boiled or overheated sterilized milk as it will upon the 
 fresh article ; but unless a person has access to a cow and can 
 milk it for each bottle (which is the thing to do. when possible), 
 no danger of diarrhoea and indigestion should be incurred : the 
 milk must be rendered sterile. Or if this be not convenient, 
 the cow can be milked twice a day, with the following precau- 
 
BOTTLE-FEEDING. 109 
 
 tions : The bag and teats must be thoroughly washed, and the 
 cow then milked directly into a ivell-scoured jug or large bottle ; 
 this should be corked at once and placed on ice, and a sufficient 
 portion poured from it to make up each bottle. 
 
 I dwell at some length upon the importance of considering 
 step by step the preparation of a child's bottle, and this is done 
 because it becomes a monotonous work, and unless the mother 
 sees to it personally, the nurse, however devoted, may some 
 time or other become a little careless, and the result may be 
 the souring of the milk, formation of curd, and inflammation 
 of the bowels, and its consequences. 
 
 Dr. Parker recommends a pure gum nipple, with two holes 
 as far apart as possible, as the best for the nursing-bottle, 
 and in this connection makes the following remarks : " When 
 there is only one hole, the infant, in nursing, compresses the 
 nipple and sends the milk in a stream in such a manner as 
 often to nearly strangle itself. Milk coming through one hole 
 is not as comfortable as when it comes through two, and the 
 effort of nursing becomes disagreeable and wearisome to the 
 little feeder. The best way to nurse an infant is by holding it 
 in the arms, and give it the bottle in the same position and 
 at the same height as if it were really being nursed by its 
 mother. When it has finished nursing, the bottle should be 
 removed, emptied, and cleansed. ISTever should the bottle be 
 left in the infant's care to use at will." 
 
 We all acknowledge ' that cow's milk has the following ad- 
 vantages : it serves as the basis for the preparation of a milk 
 resembling that of the mother; it contains all the ingredi- 
 ents that are necessary for nutrition ; it is easy to obtain. Its 
 disadvantages are : that the relative proportion existing be- 
 tween its different constituents is not that found in mothers 
 milk; it contains a form of casein which forms hard curds; 
 this casein exists in larger amounts (at least twice as much) 
 than in human mi lie, ]t is acid. 
 
 1 Dr. Keating's paper, read before the Convention of State Boards of 
 Health in May, 1886. 
 
 10 
 
110 MOTHER AND CHILD. 
 
 A certain time must elapse during \vliich the milk undergoes, 
 possibly, some alteration from exposure to the air, and is liable 
 to be tainted with the germs which produce decomposition ; 
 this, indeed, is the greatest objection to its use in our large cities. 
 
 It is scarcely necessary to impress upon mothers the im- 
 portance of always using clean nursing- bottles. Unless the 
 following rules are strictly adhered to, there is no use of 
 reading this book further. 
 
 1. Have a number of nursing-bottles, so that a perfectly clean 
 one is always in use. 
 
 2. Keep the extra ones, after thorough washing in boiling suds 
 and water, in your sterilizer or in a pan of boiled water, with a 
 teaspoonful of borax and soda in each. 
 
 3. Use only plain black rubber nipples, have a number on hand, 
 and treat the unused as you treat the bottles. 
 
 4. Never use nipples with tubes. 
 
 CHAPTEE XXIX. 
 
 STERILIZING AND STERILIZERS. 
 
 By Sterilizing milk, water, or, in fact, any material, we mean 
 destroying within it those germs which render it more or less 
 noxious, and making it for a time thereafter an infertile soil for 
 the growth of germs. This may be done (1) by boiling. (2) by 
 more or less prolonged steaming, (3) by keeping the millc at 
 about 155° F. for six minutes, (4) by the use of chemical 
 agents. The latter would be as harmful to the babe as they 
 would be to the germs. Every bottle given to a babe should go 
 through one of these sterilizing processes. Moreover, all the 
 ingredients of the bottle should be sterilized, and the food 
 must be either prepared as needed or made up in bulk, and 
 that drawn from as needed, provided that bulk is most jeal- 
 ously guarded. The whole matter, indeed, would be simplified, 
 
STERILIZING AND STERILIZERS. HI 
 
 provided we could be certain that milk raised to a temperature 
 of 212° F., was as nourishing as that which is raw, and pro- 
 vided also that those ingredients which we are obliged to add 
 to cow's milk were not altered by so high a temperature. "We 
 will deal with these methods in detail. 
 
 1. What are the advantages of boiling the milk ? As a 
 sterilizer, boiling is certain ; there can be no question about it. 
 The germs of typhoid fever die at a temperature of 132.8° F., 
 but it takes a temperature of 212° F., a short time sustained, 
 to completely destroy those of tubercular disease. 
 
 Boiled milk will keep sweet, when exposed to the air, at least 
 twenty-four hours. Boiling is most readily accomplished ; it 
 needs only such kitchen apparatus as every household, however 
 poor, has already. Boiled milk, in summer, will control diar- 
 rhoea; in fact, one of the objections is that it is constipating; but 
 on the whole, taking everything into consideration, in emer- 
 gencies, or when there is the least doubt about the character 
 of the milk or the dairy it comes from, the advantages of 
 boiling a child's milk in the preparation of its food are greater 
 than the disadvantages. What are the disadvantages ? The 
 principal disadvantage, we are told, is that boiled milk is not 
 as nutritious as raw milk ; but as the most eminent authori- 
 ties have taken opposite sides in this matter, we can take 
 whichever side is most convenient and most judicious at the 
 time, and watch carefully those indications which point to gain 
 or not in the child's weight and nutrition, and act accordingly. 
 Dr. Eotch tells us that the investigations concerning the 
 relative digestibility of raw milk and boiled milk are so con- 
 trary in their results that he will not dwell upon them in his 
 article. The principal disadvantages, in our opinion, are the 
 tendency to constipation and the fact that the usefulness of 
 lime-water and millc-sugar is in a measure destroyed by the 
 high temperature. 
 
 2. What are the advantages of steam sterilizing? The 
 gradual increase of temperature to the boiling-point by means 
 of steam does not have the effect upon the milk of changing 
 
112 MOTHER AND CHILD. 
 
 its taste, or of rendering it so constipating. The milk thus 
 prepared is claimed to be as thoroughly sterilized as when 
 boiled in the ordinary way. It is claimed for this process that 
 it has no outward effect upon the milk, leaving it apjDar- 
 ently the same as if it had not been sterilized, but that 
 the process is a most thorough one, and when the proper 
 apparatus is used, is the simplest possible way of preparing 
 child's milk. "We have sti'ongly advocated this method ever 
 since its suggestion by Dr. Soxhlet and the strong argu- 
 ments used in its behalf by Dr. Caille, of iSTew York, and we 
 believe that the number of lives that have been saved by this 
 measure is incalculable ; moreover, we felt certain that the 
 purchase of a sterilizer, and the enthusiasm attached to a new 
 thing, would stimulate mothers and others interested in infants 
 to more care in the details of feeding and in the preparation 
 of the milk. Many who would scorn the proposition of using 
 boiled milk would jump for joy at the thought of a sterilizer 
 instead of a faiina boiler. This process applied to dispensary 
 practice, as is the case already in some of the large cities, 
 will save hundreds of babes who would otherwise succumb to 
 tainted milk. 
 
 Undoubtedly the best form of steam sterilizer is the Arnold, 
 manufactured by "Wilmot, Castle & Co., Eochester, ISTew York 
 (Figs. 13 and 14). 
 
 In order to make this matter thoroughly understood we will 
 quote at length from Dr. Walter Mendelson's article in "Baby- 
 hood " upon the subject of the Arnold sterilizer. 
 
 " Precautions. — The milk (or mixture of millc, water, cream, 
 and sugar suitable to age of the child) should be prepared as 
 early in the m.orning as possible, before the heat of the day 
 has caused the bacteria to multiply. Enough should be made 
 up for the whole twenty-four hours, by multiplying the amount 
 to be used in each bottle by the number of bottles needed. In 
 making the mixture use a pitcher previously cleaned with hot 
 water and soda and by plenty of rubbing. Simple rinsing is 
 DOt enough; so let the pitcher be sufficiently large to easily 
 
STERILIZING AND STERILIZERS. 
 
 113 
 
 admit the whole hand. Scrupulous cleanliness must be insisted 
 on at every step. It is the indispensable element of success, 
 for bacteria flourish in dirt. 
 
 Fig. 13. 
 
 " Bottles. — The bottles should be the plain, old-fashioned kind, 
 without shoulders, and with a flat bottom, so that they may be 
 stood upright. There is much complaint of the bottles cracking. 
 
 h 10* 
 
114 
 
 MOTHER AND CHILD. 
 
 To avoid this, heat the sterilizer rather slowly at first, and 
 when the bottles are taken out do not put them upon a cold 
 marble wash-stand, or in the draught of a window-sill, but place 
 them, rather, upon a wooden table to cool gradually. Bottles 
 will last longer if annealed, which may be done by placing them 
 in a large pan of cold water and gradually heating this to the 
 boiling-point, and as gradually allowing it to cool again. They 
 should be of such a size that when filled -wdth the quantity 
 needed, there will be at least two inches of space between the 
 
 Fig. 14. 
 
 surface of the milk and the lower end of the stopper, so as to 
 prevent the latter being wet with milk. 
 
 " Too much attention cannot be bestowed upon the care and 
 cleaning of the bottles and nipples. ISTew bottles should be 
 thoroughly scoured with a hot solution of washing soda and a 
 bottle-brush. If, by chance, milk has soured in a bottle, it 
 should be well boiled in soda, then thoroughly rinsed, and set 
 aside for several hours, filled with hot water to which a tea- 
 spoonful of borax has been added. When the child has finished 
 
STERILIZING AND STERILIZERS. 115 
 
 nursing, the bottle should not be allowed to stand about with 
 the remaining millv in it, but should at once be emptied, rinsed 
 with hot water, and left filled with borax water till the time 
 for final cleaning. 
 
 " It is often quite difficult to thoroughly clean a bottle, es- 
 pecially of the greasy rim that forms at the level of the milk. 
 After trying many things, I have found that ' pearline' gives 
 the best results. Use it with hot water and a bottle-brush. 
 Fine specks, consisting probably of some crystalline compound 
 of the milk sugar, are often found adhering with great tenacity 
 to the inside of the bottle. Those that still remain after using 
 the brush may safely be left. After cleaning and thoroughly 
 rinsing in fresh water, tbe empty bottles should be jJut on some 
 shelf, out of the way of being splashed or soiled in any way. 
 It is not necessary to keep them filled with water. In filling 
 the bottles, always use a funnel — by j)reference a glass one — 
 with a stem an inch and a half or two inches long. In this 
 way you prevent the inside of the neck, the top, and the out- 
 side of the bottle from being wet with milk, which might, 
 later, prove a path along which germs from without might. 
 travel downward into the milk. Should the bottle, after all, 
 have become wet with milk, let a few drops of water run down 
 the inside of the neck and over the top, to wash away that 
 which may have lodged there. ISTever use the same bottle for 
 more than one feeding. This is a cardinal rule, and I have 
 known all the good effects of sterilizing to be done away with, 
 and a child become very ill, from its having been disobeyed. 
 
 " Stoppers. — The best stopper consists of a plug made of ordi- 
 nary cotton batting (not necessarily absorbent cotton), folded 
 into a pretty firm wad, and pushed down for half an inch or 
 more into the neck of the bottle. Make sure' that there is no 
 milk about the mouth of the bottle when the plug is put in, 
 and that the stopper is not wet with milk from shaking the 
 bottle before being put into the sterihzer. The advantages of 
 cotton stoppers are : that they are clean, — being always used 
 new; that they are cheap; and that they save labor by re- 
 
116 MOTHER AND CHILD. 
 
 quiring no washing, as rubber ones do. "When the bottle is in 
 the sterilizer they allow the heated vapors to escape, and when 
 it is cooled again the outside air re-enters filtered of all germs 
 by the cotton it has had to pass through. Eubber stoppers, 
 with a hole for a glass plug, are not readily cleaned. Those 
 with a notch in the side, as in Seibert's apparatus, are better. 
 Only when bottles have to be kept a long time, as for sea- 
 voyages, are rubber stoppers to be preferred to cotton ones. 
 The cotton stopper must not be ren^oved until the bottle is 
 wanted for nursing, and it should then be withdrawn with a 
 twisting motion that will carry all the fibres with it. 
 
 ^'■Nipples. — The plain conical, pure gum nipple, that has no 
 constrictions in it, and can be easily turned inside out for 
 cleaning, is the best. iJ^ipples should be scrubbed clean like 
 the bottles, and when not in use, kept in a glass of water, to 
 which a teaspoonful of borax has been added." 
 
 What are the disadvantages of the steam sterilizer ? They 
 are precisely the same as attend boiling. Lately, Professor 
 Albert E. Leeds, of the Stevens Institute, Hoboken, in a paj^er 
 in the American Journal of the Medical Sciences for June, 1891, 
 has demonstrated the fact that, for all practical purposes in 
 the feeding of infants, a temperature higher than 155° F. so 
 changes the milk as to render some of its ingredients innutri- 
 tious ; that the sugar is changed to a certain degree, and that 
 the casein and fats are largely altered; that, in fact, milk 
 raised to a temperature of 212° F. is not a nutritious form of 
 food. Dr. E. P. Davis, of Philadelphia, as a joint writer of the 
 same paper, taking his experience from hospitals and dispensary 
 practice, confirms these statements, and claims that the steam 
 sterilizing of milk forms a non-nutritious substance, which, 
 though an admirable substitute for the tainted milk of the 
 alleys in hot summer weather, is not to be recommended as a 
 regular article of diet. 
 
 Steam sterilizing also has the disadvantage that the lime- 
 water cannot be put into the milk till it is cool ; nevertheless, as 
 this whole matter is still under consideration, and as the weight 
 
STERILIZING AND STERILIZERS. 
 
 Ill 
 
 of experience seems still to be in favor of the sterilizer, our 
 great test of its value is the condition of the child. If the 
 infant thrives upon its bottles of steam-sterilized milk, that is 
 all that is needed. 
 
 3. The marvels of modern surgery grew out of the germi- 
 cidal action of antiseptics ; but when the excitement calmed 
 dovvn, cooler minds discovered that it was asepsis — cleanliness 
 — that did the work. Just so I believe that in the majority of 
 cases the milk can be rendered aseptic by care and good sense 
 without prolonged steam sterilization. 
 
 Fig. 15. 
 
 Professor Leeds has recently demonstrated that a tempera- 
 ture of 155° F., prolonged for six minutes, is amply sufficient, 
 and that the whole mixture can be made without the danger 
 of destroying the lime-water and other ingredients by over- 
 heating. You can use for this purpose a sterilizer such as 
 represented in Fig. 15, made b}^ Blair Sons, Philadelphia. 
 
 All the small bottles can be filled with the prepared mix- 
 ture, — that is, milk, cream, lime-water, sugar of milk, — or a large 
 stock bottle may be used, from which a bottle can be filled at 
 
118 MOTHER AND CHILD. 
 
 each nursing; 'for a cork, either a plug of cotton batting or a 
 o'um cover can be used ; the bottles should be surrounded entirely 
 by water, — a thermometer hanging in the water somewhere, 
 where it can be readily seen ; there is no necessity for a cover 
 in this case. You now place the sterilizer on your nursery 
 lamp, the oil stove, or the kitchen range, if necessary ; but an 
 oil stove or lamp is much better, as the flume can be regulated 
 so that the temperature of 155° F. can be maintained for about 
 six minutes. Immediately after the heating is over each bottle 
 should be placed in a nursery refrigerator and warmed up as 
 needed, the nipple taking the place of the cotton plug or 
 rubber cover. 
 
 "What are the advantages of this process ? As will be readily 
 seen, the principal advantages of this method are, that we 
 have a stei'ilized milk about whose nutritive qualities there 
 can be no question, and that the entire ingredients of a child's 
 bottle can be sterilized. 
 
 What are the disadvantages ? The disadvantages are, that if 
 the milk should happen to be tuberculous, — and some lay great 
 stress on the necessity for precaution in that regard, — the tem- 
 perature is not high enough to kill its bacilli or spores, as it 
 needs a somewhat prolonged temperature of 212° P. for that 
 purpose. Again, it is by no means as simple as boiling or steam 
 sterilizing, and requires more care and intelligence. It is prob- 
 able also that the milk will not remain sterile for any length 
 of time. It is a method which should only be used when 
 the milk is intended to be given to the child within twenty-four 
 hours. 
 
HOW TO PREPARE THE BOTTLE. 119 
 
 CHAPTEE XXX. 
 
 HOW TO PREPARE THE BOTTLE FOR A HEALTHY BABE PROM 
 BIRTH TO TWO OR THREE MONTHS OF AGE. 
 
 One would imagine that nothing could be easier than to 
 prej^are a formula by which an exact imitation of mother's 
 milk could be attained. We know the ingredients, and the 
 question seems to be one of chemistry alone, — simply the pro- 
 portions in which to mix them. And yet the matter is by 
 no means settled to the satisfaction of the profession gen- 
 erally. A few years ago it was practically guessed at, and the 
 baby's bottle was never the same. To-day we are working it 
 out on a scientific basis in the laboratory, and are now wait- 
 ing for our chemists to settle amicably upon one formula, 
 — not that we would always strictly adhere to it; change is 
 a good thing for the digestion ; a little less cream to-day and 
 a little more water if the child be fretful or constij)ated ; the 
 omission of the lime-water if the child is very constipated, and 
 the addition of cane-sugar instead of milk sugar, may now 
 and then be of advantage. 
 
 We will endeavor to make the matter as clear as possible, 
 and to give the formula for, and an account of, each method of 
 preparation, so that a mother may so thoroughly understand 
 the subject that she can change from one preparation to 
 another if she finds it necessary, should there be no physician 
 to consult. 
 
 We now enter upon one of the most difiicult subjects of 
 our book; the reason of this being that it is a subject to 
 which much attention is being paid at the present day, and 
 the brightest talent of the profession is at work by careful 
 study, in the nursery and in the laboratory, to get a perfect 
 substitute for mother's milk. This has not yet been arrived 
 at, though we can now produce a milk mixture which will 
 
120 MOTHER AND CHILD. 
 
 agree with the average healthy babe under the ordinary cir- 
 cumstances of life. But when it comes to an unfortunate 
 little one who has not been born with the traditional " silyer 
 sjDOon in its mouth," and who has to withstand the vitiated, 
 devitalized air of a crowded, iilthy city in summer-time, there 
 can be but one opinion, and that is, it should have a wet-nurse, 
 we will give a variety of directions in regard to the prepara- 
 tion of the bottle, because the digestion of infants is a complex 
 matter and every babe is a law unto itself, and what agrees 
 with one may not agree with another. Indeed, what 
 agrees with a babe one week may not the next, and the doctor 
 may find it necessary to frequently change the kind of food 
 to suit the child's conditions. We have known splendidly- 
 formed, healthy children result from a prolonged use of con- 
 densed milk, though we would never advise its use alone for any 
 length of time ; again, we have known babes whose own mother's 
 milk acted upon them like poison, and who never could nurse. 
 
 Some most excellent ways of preparing a bottle have been 
 recommended, but the methods are tedious and require great 
 skill and patience and often certain apparatus that mothers 
 cannot get, and therefore a simpler method, which may not 
 be quite as good but almost so, has to be adopted. For 
 instance, the word sterilize has a very formidable sound and 
 seems wonderfully scientific, smacks of the laboratory, etc. 
 It really means a destruction of the germs of fermentation 
 and disease, and a temperature of 155° F. will do this, and 
 if the air is excluded the milk will remain pure. But if the 
 milk must be sterile, so must the water that is put into it, the 
 cream, the sugar, the lime-water; the bottle must be clean 
 also, and the nipple, and they must be kept so. jSTow, it is a 
 difficult and very tedious matter to keep each of these articles 
 sterile separately, and on that account the bottle of milk, 
 when prepared for the babe, is sterilized in bulk, as we shall see 
 later. 
 
 It must be remembered that cold will not sterilize : it checks 
 -germ-growth and development ; but once warm up the 
 
HOW TO PREPARE THE BOTTLE. 121 
 
 material and the germs return to life. Freezing will not kill 
 the typhoid-fever germ : it will be preserved in ice, and when 
 that ice melts it will regain its activity. So if you put milk 
 on the ice you only put such germs as are in it to sleep, and 
 when the bottle is warmed or the heat of the child's stomach 
 and intestines warms the milk, the germs of diarrhoea become 
 very active. Cold milk keeps sweet because the germs of 
 fermentation and putrefaction are made torpid ; that is why 
 milk is 2Dut on the ice when fresh. Milk can be made sterile 
 in the morning, and corked air-tight, and the great Pasteur 
 has taught us that a plug of cotton batting as a cork is im- 
 pervious to germs; indeed, it is the exclusion of germs, not 
 air, that we want, and this milk (or prepared food) need not, if 
 so kept, be steiilized again as each bottle for feeding is drawn 
 off. But the cotton batting must have been previously laid 
 for a few moments in the hot oven to sterilize it. 
 
 There is very little trouble about rendering a babe's bottle of 
 milk sterile ; every house has a stove or range, every kitchen 
 has a wash-boiler, ordinary bottles are easily obtained, and a 
 thermometer is not an expensive article ; these, with a few 
 rubber thumb-stalls that will fit over the bottles, or some cot- 
 ton batting, will complete all the requirements for the most 
 perfect sterilization. Of this we will speak later; sufiice it to 
 say that no babe should be allowed to take a bottle of milk 
 that is not sterilized. 
 
 The following method of preparation of the bottle has been 
 suggested by Dr. A. V. Meigs, and though it is somewhat 
 more complicated, makes a food much like mother's milk, 
 according to Dr. Meigs's analyses: 
 
 Order from a druggist a number of packages of sugar of milk, 
 each containing seventeen and three-fourths drachms ; dissolve 
 one of these packages in a pint of water each day. Take 
 three tablespoonfuls of this sugar-water, two tablespoonfuls 
 of ordinary cream, one tablespoonful of milk, two tablespoon- 
 fuls of lime-water. Put in nursing-bottle, to be taken warm. 
 , Dr. T. M. Eotch has modified this according to the careful 
 F 11 
 
122 MOTHER AND CHILD. 
 
 Biudies of himself and Dr. Harrington, and gives us the follow- 
 ing method. He concludes that there is too much lime-water 
 in the above mixture ; that one-quarter of the amount would 
 give sufficient alkaline reaction and make it more closely re- 
 semble mother's milk, the proportions necessary being one- 
 half ounce (a tablespoonful) to the half-pint of the mixture, 
 or, in other words, one-sixteenth part of the whole. 
 
 He has a measure made of tin or wood that will exactly 
 hold three and three-eighths drachms of sugar of milk, and he 
 advises the mother to buy the sugar of milk by the pound. It 
 is well to prepare each morning, or morning and evening if 
 fresh milk comes twice a day, sufficient food to last. 
 
 Cream (twenty per cent, fat), one ounce and. a half; 
 Milk, one ounce ; 
 Water, five ounces ; 
 Milk-sugar, one measure. Mix. 
 
 A glass graduate should be used for this purpose. This 
 mixture should be introduced into a clean bottle by means of 
 a funnel, so that the neck of the bottle be kept dry. The 
 bottle is stoppered tightly with a cotton plug. After steaming 
 for twenty minutes, remove the bottle and allow it to cool 
 slightly, and then add half an ounce of lime-water. Place 
 on ice. 
 
 As lime-water figures so largely in the bottle-feeding of 
 babes, we will here quote the method of its preparation from 
 the United States Pharmacopoeia (sixth edition). 
 
 LIQUOR CALCIS. 
 
 It contains about .15 per cent, of hydrate of calcium, 
 " Slake the lime by the gradual additions of six parts of 
 water, then add thirty parts of water, and stir occasionally 
 during half an hour. Allow the mixture to settle, decant the 
 liquid, and throw it away. Then add to the residue three hun- 
 dred parts of distilled water, stir well, wait a short time for 
 
HOW TO PREPARE THE BOTTLE, 123 
 
 the coarser particles to subside, and pour the liquid holding 
 the undissolved lime in suspension into a glass-stoppered 
 bottle. Pour off the clear liquid when wanted for use. 
 When heated to boiling it becomes cloudy, and is then probably 
 valueless." 
 
 Remarks. — To make this matter clear and more practical we 
 will suggest the following, based upon the above : Take a 
 piece of clean unslaked lime about the size of a hen's Qgg, 
 put it into a clean preserving jar, and add six tablespoonfuls 
 or, if you have a graduated glass (this and a funnel you 
 should by all means have), three ounces of water. This will 
 effervesce slightly, and generally heat in so doing. In a few 
 moments add thirty tablespoonfuls or fifteen ounces of water, and 
 stir with a glass rod occasionally for half an hour. ISTow lei 
 this mixture settle ; in the course of an hour or two decant 
 the liquid and add to the lime in the bottom about one gallon 
 of water that has been previously boiled and cooled. When 
 this has settled so far as the larger particles of lime are con- 
 cerned, pour it into a clean, glass-stoppered, gallon bottle, and 
 keep in a moderately cool j^lace while using. 
 
 Mothers often want to know the apothecary's measurements : 
 
 One drachm equals about sixty grains, — about sixty minims, 
 about one hundred and twenty drops of alcohol (a little less 
 of water), — and is represented by a teaspoon. 
 
 One-half ounce equals four drachms, — two hundred and forty 
 grains, two hundred and forty minims, four hundred and eighty 
 drops, — and is represented by the tablespoon. 
 
 Thirty-two tablespoonfuls liquid measure make about a pint, 
 and though a pint is equivalent to a pound, a level tablespoon- 
 ful of a light powder will be equal to only the half of a level 
 tablespoonful of a liquid. 
 
 This shows the great uncertainty attached to the use of 
 SPOONS in measuring, and we hope the readers of this book will 
 only use glass graduates in future. 
 
 The milk from an ordinary dairy should be obtained as fresh 
 as possible : mix together half a pint of this milk and half a 
 
]24 MOTHER AND CHILD. 
 
 pint of pure water, and to this should be added about two 
 hundred grains or two heaping teaspoonfuls of milk-sugar 
 with four grains of bicarbonate of soda, after which two table- 
 spoonfuls of cream should be stirred in, and it is ready for use, 
 to be given by bottle or drinking-eup, at about the body tem- 
 perature. 
 
 We have here a mixture which, according to Leeds, closely 
 resembles mother's milk. This should, of course, be rendered 
 sterile. 
 
 We have always, in practice, adhered to the rule that the 
 nearer we could approach to nature's standard the more fortu- 
 nate we would be in our results in baby-feeding. Thus, the 
 fresher the milk the belter; that directly from the cow the 
 best of all; the less we altered it by cooking and extras the 
 more easily assimilated it would be. The feeding of a healthy 
 babe and that of a delicate one are matters totally different, 
 and we are now considering the feeding of the healthy one. 
 Moreover, we have always attempted the simplest measure 
 first, and then gradually felt our way by changing the prepa- 
 ration of the food until we succeeded in finding that which 
 suited the individual case. On this account we have given a 
 variety of suggestions, so that a doctor or a mother may never 
 be at a loss what to " try next," for it is a question of trial, and 
 be who has the most resources at his command makes the 
 greatest success of it. 
 
 Our first attempt at bottle-feeding, when we have to aban- 
 don mother and wet-nurse, is to use fresh milk and scald it; 
 order, for instance, a half-pint of medium (unskimmed) milk, and 
 this is better obtained direct from the cow or dairy ; to this add 
 two teaspoonfuls, heaping, of milk-sugar and two tahlespoonfuls 
 of lime-water, and then pour upon it a half-pint of boiling water. 
 This is then tightly coi-ked and kept on the ice, and a portion 
 withdrawn for each bottle and the bottle immersed in hot water 
 until the milk reaches about blood-heat (98° to 100° R). If 
 it be possible to obtain the cow's milk ofiener than twice a day, 
 so much the better : it will make fresher food ; but it should be 
 
HOW TO PREPARE THE BOTTLE. 125 
 
 obtained twice, morning and evening, at least. A slight pinch 
 of salt is a useful addition to this mixture. Dr. A. Jacobi 
 dwells at length on the great importance of salt in the diet of 
 the nursing mother, or in the bottle of a hand- fed infant. 
 "The quantity of salt in woman's milk is influenced greatly 
 by the direct addition of the same to the food. These facts 
 are of great importance in the preparation of an artificial diet, 
 whether of vegetables or of animal milk, designed for the 
 human infant. The addition of salt is not only of great 
 physiological importance, in the interest of tissue changes in 
 general, but without such addition artificial diet is deprived, 
 from the beginning, of the chemical mixture which renders it 
 quite similar in this respect to the natural. An extremely im- 
 portant fact is also this, that the addition of chloride of sodium 
 [salt] delays and renders difficult the firm curdling of the 
 milk by i-ennet. Thus, it ought to be added to cow's milk as 
 a general rule, and to woman's milk when the large curds 
 brought up by vomiting, or excavated by rectum, exhibit an 
 undue amount of coagulation.'' Watch the passages; if they 
 are curdled, and the child has colic, the food does not agree, 
 and must be changed, as, if persisted in, it will set up a ca- 
 tarrh and cause trouble. In this case we would try the fol- 
 lowing : 
 
 For new-born children, or those a month or two old, we may 
 diminish the amount of casein and increase the amount of 
 sugar by the following means : Take one ounce of ordinary 
 milk and three ounces of water; add one ounce of ordinary 
 cream and about a level teaspoonful and a half (eighty grains) 
 of milk-sugar. Indeed, it is better to run the risk of making 
 a mixture with too little casein than with too much, gradu- 
 ally increasing the strength of the milk by diminishing the 
 water. 
 
 Or we may dilute the milk as follows : 
 
 If to a mixture composed of one ounce of ordinary milk and 
 three ounces of water we add one ounce of ordinary cream 
 (about fourteen and a half per cent, of butter) and about eighty 
 
 11* 
 
126 MOTHER AND CHILD. 
 
 grains of sugar of milk (a level teaspoonful and a half),^ we 
 will get a result which closely resembles woman's milk, though 
 containing less casein and more sugar than most authorities 
 give as the result of their investigation. Still, for very young 
 infants this is an advantage. As the babe grows older the 
 amount of casein can be increased as follows : 
 
 Take two ounces of ordinary fresh milk, add two ounces of 
 water. Now add two tablespoonfuls of ordinary cream of 
 good quality and a heaping teaspoonful (about one hundred 
 grains) of milk-sugar. Cream itself contains about three per 
 cent, of casein. But we have insisted that there must be a 
 certain amount of lime added to the mixture, and for this 
 purpose lime-water can be used, a tablespoonful to the bottle 
 replacing one of water. As we have before suggested, if there 
 is the least doubt about the keeping of milk it should be im- 
 mediately brought to a boil and then placed in the refrigerator, 
 a certain amount being withdrawn and heated over for each 
 bottle. Under no circumstances should a bottle of made food 
 be heated again. — that is to say, what remains over after the 
 child is nursed should be thrown away. It can readily be 
 understood why this is the case when we consider that as the 
 child draws milk from the bottle the air which replaces the 
 milk is that exhaled by the child, and acts most quickly as a 
 putrefacient. 
 
 The milk should be given to the child at about the tempera- 
 ture of the body or a little warmer, — that is to say, about as hot 
 as can be borne in the mouth, — a temperature of 100° F. Each 
 bottle should be tasted, to see that there is nothing wrong 
 with it and also to see that it draws well through the nipple. 
 A black rubber nipple is certainly the best to use, and there 
 should be a number of them, so that a clean one which has 
 
 1 A silver teaspoon, such as is in ordinary use, when filled with sugar of milk 
 and " levelled," will contain about fifty-seven grains ; a plated teaspoon con- 
 tains ahout five grains less,^practically one drachm. A " heaping" silver 
 teaspoon holds about one hundred and seventeen grains of sugar of milk, 
 " — practically two drachms. 
 
HOW TO PREPARE THE BOTTLE. 127 
 
 been well washed may be used each time. After a child has 
 taken its bottle, if it is drowsy, it should be laid gently on its 
 right side and allowed to sleep. The clothes should be thor- 
 oughly loosened, and under no circumstances should it be 
 allowed immediately after taking its food to be tossed or 
 romped with, which, unfortunately, is a very common practice 
 and always ends in indigestion. 
 
 To some children lime-water seems to be objectionable, and 
 on that account it may be necessary to neutralize the milk 
 with another alkali ; and then, again, it would seem more con- 
 venient and accurate to have the lime or soda, or whatever is 
 used, and the sugar of milk, in a form that could be kept by 
 mothers and readily introduced into the milk. For this pur- 
 pose we suggested (Medical News, June 5, 1886) the following 
 powder made into tablets, each one containing — 
 
 Sugar of milk, 26 grains ; 
 Calcis lactophos., \ grain ; 
 Calcis carb., -^^ grain ; 
 Sodii bicarb., J grain ; 
 Potass, bicarb., J^ grain; 
 Sodii chloridi, ^ grain. 
 
 These can be made up in large quantities, put in wide- 
 mouthed bottles, and used as follows : 
 
 To prepare the bottle for a child about a month old or 
 younger, take one ounce of ordinary fresh milk, one ounce of 
 ordinary fresh cream, three ounces of boiling water, and add 
 three tablets and thoroughly dissolve. If curds appear in the 
 passages, diminish the milk and add water in its place. It is 
 not intended that this whole quantity should be fed to a babe ; 
 a child at this age should not take more than two ounces at 
 the most at each feeding. 
 
 For a child two or three months old, prepare the bottle as 
 follows : 
 
 Take two ounces of good, fresh, ordinary milk, one ounce of 
 fresh, ordinary cream, add to this two ounces of boiling water, 
 and dissolve into the mixture /owr tablets. 
 
128 MOTHER AND CHILD. 
 
 The material can be put up in cans in powder form with a 
 measure holding the quantity that would equal a tablet, and 
 this used in the preparation of the bottle. It needs no addi- 
 tional lime-water. 
 
 CHAPTEE XXXI. 
 
 HOW TO PREPARE THE BOTTLE FOR A DELICATE BABE FROM 
 BIRTH TO THREE MONTHS OF AGE. 
 
 In the last chapter we considered the various methods that 
 might be adopted to prepare the food of a healthy new-born 
 babe ; but enfeeblement of the digestive apparatus, otherwise 
 dyspepsia, is so common in infants that we are often taxed to 
 our wit's end when we are obliged to boLtle-fecd them. 
 
 So far we have spoken entirely of cow's milk as a substitute 
 for that of the breast ; but, as has been heretofore noted, the 
 tendency in cow's milk is to the formation of curds that are 
 compact and indigestible, and, though this can be to a certain 
 extent obviated by diluting the milk as recommended, there 
 are times when, owing to the difficulty in obtaining the pure 
 cow's milk, which is primarily essential, or owing to the deli- 
 cate digestion of the child, cow's milk seems to be indigestible. 
 We are then obliged to have recourse to some process that will 
 render the milk more digestible, and for this purpose various 
 means have been adopted to make up a child's bottle. 
 
 The simplest means of all would probably be to use whey only 
 for the first few weeks of life, and, indeed, in many cases this 
 would suffice, as Professor Leeds tells us that the nutritious 
 albuminoids remain in the whey after the curd has been re- 
 moved by rennet. The milk is warmed and a tablespoonful 
 of liquid rennet is used to the pint of milk. The milk will 
 turn if undisturbed, and when the separation has entirely 
 taken place the whey can be strained off. We have frequently 
 found a mixture of two tablespoonfuls of whey, one table- 
 
HOW TO PREPARE THE BOTTLE. 129 
 
 spoonful of cream, and two tablespoonfuls of boiling water an 
 excellent thing fur a new-born babe, especially if curds have 
 been noticed in the passages after a more complete milk diet. 
 
 Eustace Smith, for years the pre-eminent authority in Eng- 
 land on these subjects, has used the following as bottle-food for 
 babes deprived of breast-milk: 
 
 One tablespoonful of fresh cream ; 
 Two tablespoonfuls of whey ; 
 Two tablespoonfuls of hot water. 
 
 The whey can easily be prepared in the morning and placed 
 in a clean, well-stoppered bottle on the ice and used during the 
 day. We have frequently advised the mother, if she is obliged 
 to care for her babe at night, to place the child in a crib be- 
 side her, and to take to bed with her sufficient bottles filled 
 with whatever preparation is used, well corked and wrapped 
 in flannel. If the food has been sterilized at a temperature 
 of 155° F., and the bottles well corked, they will keep perfectly 
 well, and all she has to do is to slip a clean nipple over the 
 bottle in place of the stopper, and the warmth given by the 
 flannel will be sufficient to heat the food. She will thus avoid 
 the danger of catching cold and the annoyance of preparing 
 food so often. As will be seen hereafter, the curd or casein 
 of cow's milk is the great obstacle to its use generally, and 
 especially with delicate babes. On this account we have always 
 found it advisable not to persist in the- administration of 
 milk if curds are found in the passages, or in case of diarrhoea 
 with greenish and watery evacuations. We would advise that 
 the babe be at once placed on the following until a physician is 
 consulted : 
 
 Whey, two fablespoovfuls ; 
 
 Albumen water or acacia water, two tablespoonfuls ; 
 
 Sugar of milk, level teaspoonful. 
 
 The albumen water — a preparation we have the greatest con- 
 fidence in as a substitute for milk with sick children — is made 
 by dissolving the white of a fresh Qgg in a tumbler of water. 
 
130 MOTHER AND CHILD. 
 
 The acacia water, which is slightly astringent, is made by 
 dissolving a teaspoonful of powdered gum acacia in a tumbler 
 of boiling water. If the babe is weak, and it becomes neces- 
 sary to feed often and in small quantities, ten drops of wine 
 of pepsin can be added to each bottle. 
 
 After the child's digestion has become more tolerant, — in- 
 deed, in many cases of infants deprived of the breast without 
 having recourse to anything else, — peptogenic milk powder 
 (Fairchild) may be used and the curd predigested. There 
 are cases that seem to resist all forms of bottle-feeding, and 
 whose lives are saved alone by the wet-nurse ; again, there are 
 hundreds of babes with good digestion who will thrive on plain 
 cow's milk even undiluted with water. If a babe will digest 
 fresh cow's milk, it is the best food of all. 
 
 The following are the directions for using the peptogenic 
 milk powder : 
 
 DIRECTIONS FOR " HUMANIZED MILK." 
 
 No. 1. For the Daily Food of a Healthy Nursing Infant. — 
 Put into a clean agate-ware or porcelain-lined saucepan four 
 small measures,^ or one large measure, of the peptogenic powder, 
 a half -pint of cold water, a half -pint of cold, fresh milk, and. four 
 tablespoonfuls of cream. Place the saucepan on a hot range 
 or gas stove and heat, with constant stirring, until the mixture 
 boils. The heat should be so applied as to make the milk boil in 
 ten minutes. 
 
 Keep in a clean, well-corked bottle in a cold place. When 
 needed, shake the bottle and pour out the desired portion and 
 heat to the proper degree for feeding, — lukewarm. 
 
 No. 2. Specially-prepared Food for Infants with Feeble Diges- 
 tion or lohen suffering from Disordered Stomach and Bowels. — Put 
 into a clean bottle four small measures, or one large measure, 
 
 ^ Each can of peptogenic milk powder contains a large and a small 
 measure. Put the powder into the measure with the blade of a knife, 
 shaking it down firmly so as to well and evenly fill the measure. 
 
HOW TO PREPARE THE BOTTLE. 131 
 
 of the peptogenic powdor, a half-pint of cold wafer, a half -pint 
 of cold, fresh milk, and four tablespoonfuls of cream. Shake 
 well, place the bottle in a pail or tin kettle of water (at least 
 a gallon) as hot as can be borne by the whole hand (115° F.), 
 and keep the bottle there for exactly thirty minutes. Then 
 pour all into a saucepan and quickly heat to the boiling-point, 
 with constant stirring. 
 
 Keep and feed in the same way as directed in No. 1. 
 
 If it is absolutely necessary to use condensed milk, one 
 part of pure, unsweetened milk should be first mixed with 
 from two and a half to three parts of water, and it may then be 
 presumed to be equivalent to cow's milk. Then to eight 
 ounces of this mixture add eight ounces of water and the 
 cream and peptogenic milk powder in the usual manner. In 
 other words, we first require to dilute pure, unsweetened con- 
 densed milk with about seven parts of water, and to each 
 pint of this diluted milk should be added four tablespoonfuls 
 of cream and one large measure of the peptogenic powder, 
 and treated in the usual manner. 
 
 In this connection Dr. Leeds writes to us as follows : 
 
 " I know of no process that secures these advantages, except 
 that I have so constantly recommended and now am using 
 without seeing any difference, chemically, physiologically, or 
 practically, from mother's milk : four tablespoonfuls of milk, 
 four tablespoonfuls of water, one tablespoonful of cream, and 
 one measure of peptogenic powder, heated for five minutes 
 as directed. This (temperature is 155°) Pasteurizes ; converts 
 the cow's milk to a point at which it gives the reactions char- 
 acteristic of the albuminoids of cow's milk, gives the same 
 flocculi and has the same susceptibility to digestion, and insures 
 and secures the essential minei^al constituents. In short, this 
 process secures the advantages of Pasteurization and of a 
 proper degree of contact with the ferment at one and the 
 same time, and renders cow's milk both innocent and whole- 
 some for infants." 
 
132 MOTHER AND CHILD. 
 
 CHAPTEE XXXII. 
 
 CONDENSED MILK. 
 
 This brings us to the subject of condensed milk. A reliable 
 brand, such as Borden's or Canfield's, has the following advan 
 tages : When diluted with about ten parts of water, it repre- 
 sents mother's milk pretty closely, with the exception that 
 there is less cream, but to a pint of this mixture four table- 
 spoonfuls can readily be added. It is absolutely necessary that 
 cream should be added to a mixture of condensed milk, and 
 when made the whole mixture sterilized at 155° F. The evap- 
 oration of the milk in its preparation has destroyed its tendency 
 to fermentation to a great extent. This most certainly is a 
 great advantage. It will coagulate in flakes, and does not 
 require the addition of any sugar, as by analysis it is shown 
 that when the mixture is thus prepared the amount of sugar 
 it contains is about equal to that in mother's milk. It can be 
 universally obtained, and is useful on that score ; its disadvan- 
 tage in many instances is due to the cane-sugar, and some 
 object to it on the ground that it is supposed in many cases to 
 lead to rickets. Our own experience does not bear this out, 
 though certainly if we were to find that a child fed on condensed 
 milk showed undue acidity, either in its stools or in its breath, 
 due to the presence of lactic acid, we would at once change its 
 diet. 
 
 In summer weather the presence of cane-sugar, which is a 
 decided laxative, is objectionable, and herein exists the great 
 difficulty in the proper selection of a food for that season. 
 
 Dr. A. Jacobi does not believe that sugar of milk is better 
 than ordinary cane-sugar, and he writes as follows : 
 
 " The conversion of milk-sugar into lactic acid takes place 
 very rapidly. When this change occurs in cow's milk, it be- 
 comes sour at once. Cane-sugar is not so easily transformed. 
 
CONDENSED MILK. 133 
 
 Indeed, cane-sugar is utilized for the purpose of counteracting 
 the rapid conversion of milk-sugar, and the preservation of 
 articles of food in general. 
 
 " Condensed milk remains intact a long time, on account of 
 the addition of cane-sugar, in spite of the presence of milk- 
 sugar. Therefore, it is not at all an indifferent matter, whether 
 milk-sugar or cane-sugar is added to the artificial diet. Still, the 
 use of the milk-sugar has been urged upon other grounds. It 
 has been stated that milk-sugar is to be preferred because it 
 contains phosphatic salts, but verily these may be introduced 
 into the body in other and less dangerous ways. Besides, it 
 will be proven in another part of this book, that phosphates 
 are so plentiful in all kinds of foods that they are eliminated 
 as fast as they are introduced. It has also been said that 
 milk-sugar is contained in milk by virtue of a natural arrange- 
 ment, and if nature had intended to have cane-sugar in milk, 
 ihe same nature would have supplied cane-sugar. After all, it 
 is a fact, and often a disagi'eeable one, that milk-sugar is 
 quickly converted into lactic acid, so that an excess of acid 
 accumulates in the stomach and causes the protein substances 
 to coagulate and become indigestible; it dissolves the alkalies 
 and the calcium out of the phosj)hate combinations to no pur- 
 pose except to produce dyspepsia and diarrhoea ; it eliminates 
 phosphoric acid before the proper time, and gives rise again 
 to diarrhoea, and, according to Heitzmann and others, to 
 rhachitis. These facts furnish reason enough for carefully 
 avoiding (he use of milk-sugar, and for preferring cane-sugar as 
 an addition to cow's milk and artificial foods. 
 
 '• In accordance with what has been said, I assert that arti- 
 ficial nutriments for children ought to be mixed with cane- 
 sugar, not with milk-sugar, in view of the active pi^oduction of 
 acids in the young, their tendency to diarrhoea, and the danger 
 incurred by the premature discharge of salts." 
 
 Let us study for a moment the question of the '• fresh evapo- 
 rated milk," which offers for the future the best field for infant- 
 feeding in those cities where it is daily supplied, especially in 
 
 12 
 
134 MOTHER AND CHILD. 
 
 summer-time, and where the dairy milk, as served, is of doubt- 
 ful character. We may add to one jjart of it seven parts of 
 water previously boiled or filtered. 
 
 We find that it will be necessary to add to the half-pint of 
 the above mixture of evaporated milk two tablespoon fuls of 
 cream and two heaping teaspoonfuls of sugar of milk. This 
 will be equal to cows' milk, with about the same percentage of 
 casein as mother's milk. The absence of cane-sugar in this 
 preparation renders it valuable in summer in our large cities, 
 when diarrhoea is prevalent. Indeed, in such cases half an 
 ounce of this milk in a graduated glass with four ounces of 
 water, previously boiled and filtered, given at the temperature 
 of the body, about 99° F., without adding cream or >ugar, 
 would in many cases be a most suitable diet. If the bowels are 
 loose, lime-water could be used. Unquestionably, disorders of 
 the intestinal tract are produced by fermentation and also by 
 mechanical irritation of undigested curds, and this is often due, 
 not alone to the method of preparing the food, but also to the 
 deficient supply of the gastric juices. If a large supply of 
 gastric juice could be encouraged, both of these causes would 
 cease to exist, as the acid mixture is antiputrefactive as well 
 as digestive. We are often obliged to use some means to pre- 
 pare the milk and destroy its ferments, and to diminish its 
 casein, or so affect it as to allow precipitation in fine masses. 
 The former is readily accomplished by boiling, or by subjecting 
 the milk to heated steam ; the latter by several means now in 
 vogue. 
 
 T^h.Q first, by rendering the milk alkaline, which retards in a 
 measure the coagulating property of the gastric juice. 
 
 The second, hy diluting the milk with water, which diminishes 
 the percentage of casein. 
 
 The third, by thoroughly incorporating with it some material, 
 such as gelatin, or a small amount of starchy matter, such as 
 oatmeal-water, barley-water, rice-water, or arrow-root, that 
 will intimately incorporate itself in the casein as it falls, and 
 thus allow the gastric juice to completely attack it. 
 
CONDENSED MILK. 135 
 
 The fourth, by partially predigesting the casein — peptonizing 
 it, as it is called — before it enters the stomach. 
 
 We have, in addition to these, various other preparations, 
 which are sometimes added to the milk to render it more 
 nutritious; for example, soluble carbo-hydrates, the so-called 
 " Liebig foods," as dextrin, glucose, or substances rich in albu- 
 minous matters. This, in fact, covers the whole ground of the 
 various preparations used in the bottle-feeding of infants, and 
 3'ou will thus see that they all have some scientific basis to 
 work upon, and their choice depends on questions of expediency 
 and reliabilitj", which should be studied in connection with each 
 particular case. 
 
 Cow's milk can readily be rendered alkaline by the addition 
 of lime-water, soda, or potash, and the curd affected thereby. 
 We think the importance of alkalinity is somewhat overesti- 
 mated, — that is, the tendency seems to be to put too much soda 
 in the milk ; all that is required is to make it neutral, even for 
 peptonizing purposes. 
 
 When lime-water is added to the bottle, one tablespoonful 
 to a half-pint mixture will be in most cases suflScient. It is 
 always well to consult a physician before lime or soda is 
 added to the bottle of milk ; there may be reasons why a choice 
 should be made between the two. Indeed, too much alkali 
 may weaken the digestive organs and make the child flatulent 
 and dyspeptic. Yichy or Manitou water is a very good addition 
 to milk instead of lime-water; if the child should continue to 
 pass curds, it should be used in the same strength as hme-water. 
 Dilution with water is a very important matter, because by 
 weakening the milk with the object of diluting the curd we 
 also diminish the fat or cream, the sugar and salts. Now, as 
 all of these are essential to nutrition, it is obvious that by 
 diluting them we are obliged to give the child gz'eater bulk 
 than it would otherwise take, and to overcome this difficulty it 
 is necessary to add cream, sugar, and salts to the bottle in its 
 preparation. The question of the digestion of fat is a very im- 
 portant one. The fats and sugars serve pretty much the same 
 
136 MOTHER AND CHILD. 
 
 purpose in the system : ihey are the so-called carbo-hydrates, 
 and go to the formation of animal heat. But the fats serve 
 even a greater pur|)ose : they are found essential to nutrition ; 
 they give strength, and act in that way the same as the curd 
 or nitrogenous principle. Fat is in greatest demand at the time 
 when animal heat is the most required, — that is, during the 
 winter months ; the fats and soluble car-bo-hydrates, when sup- 
 plied in excess, are stored for future use ; their excess in hot 
 seasons is productive of intestinal disorders. In such cases a 
 change to soups, or albuminous water, made by dissolving the 
 white of egg in water, makes a nutritiou.s diet and is a valuable 
 change. The oils, when stored, give a condition of body which 
 is firm and elastic to the touch, and when this i-eserve is called 
 upon the emaciation is gradual. On the contrary, when the 
 storage takes place from excess of sugar fat, the fat is not 
 staying and its disappearance is sudden. This is well seen in 
 children fattened on condensed milk to which no cream has 
 been added. 
 
 Lessen, then, the amount of cream and sugar for the summer 
 season and increase the nitrogenous elements. 
 
 The question so often arises as to the exact value of condensed 
 milk and the cases in which it may be used, that we may well 
 be pardoned if we again dwell upon it for a few moments. The 
 heat which is used in making it has destroyed the germs of 
 putrefaction and thereby hel^Ded to preserve it. This is a very 
 great gain. Then, also, the statement that only fresh, sweet 
 milk can be condensed is undoubtedly true, as the odor which 
 arises from stale milk would at once expose its character. 
 But in all probability the heat which has driven off the water 
 has acted in the same manner as the heat in the steam sterili- 
 zation : it has deprived the milk of some of its nutritious quali- 
 ties, and as a regular article of diet, to be depended upon alone 
 for nutrition, it is. not to be recommended. The soft, floccu- 
 lent masses into which it is coagulated are of immense advan- 
 tage, especially in young infants ; it is the nearest approach to 
 mother's milk. The only question which is at all worthy of 
 
CONDENSED MILK. 137 
 
 consideralion is that of the sugar which it contains and the 
 deficiency of cream, when the mixture is diluted, compared 
 with that of mother's milk. For instance, a bottle made up 
 of an ounce of condensed milk (mothers and nurses should 
 use a large graduated measure in preparing babies' bottles) with 
 ten ounces of water is almost ideniical in its composition to 
 mother's milk, with the exception that it contains cane-sugar 
 instead of sugar of milk, and has less cream. For a very 
 young infant, one who has been suddenly dej)rived of breast- 
 milk, a mixture of this kind probably possesses greater ad- 
 vantages than any other milk food, and we feel satisfied that 
 it will agree better and can be more easily prepared than 
 any other bottle. The water should be previously boiled and 
 filtered, the can kept in a cold place, well covered, and each 
 bottle made up fresh. "We would even prefer this form of 
 condensed milk to the evajDorated fresh milk, which has no 
 sugar, for a very young infant, unless it is previously under- 
 stood that to the freshly-evaporated milk sugar of milk should 
 be added to each bottle. 
 
 In order to be on the safe side, even this mixture should be 
 sterilized at 155° F., as the milk is liable to contamination after 
 the can is opened. Let us, then, be distinctly understood as 
 recommending condensed milk, not as a regular article of diet, 
 but simply to be used to bridge over that most delicate period 
 in a child's existence when it is deprived, at an early age, of 
 breast-milk, and when there are doubts as regards the character 
 of the cow's milk from which its food is to be made. It will 
 carry the child safely over a change in the character of 'its 
 food, which is all-important ; it also has the advantages of being 
 always at hand, and when obtained fresh and from reliable 
 sources is usually of about the same quality. We have seen 
 children a year or more old brought up entirely on condensed 
 milk, with every appearance of health and strength, and they 
 are unusually fat children, as a rule, but at the same time we 
 would not advise it. There is no necessity for this, as most 
 certainly by the tim.e a child is five or six months old it can 
 
 12* 
 
138 MOTHER AND CHILD. 
 
 easily digest one of the preparations hereafter recommended, 
 containing cow's milk boiled with oatmeal or barley. 
 
 Of course, as a child grows older its digestion becomes 
 stronger: it becomes, in fact, accustomed to its food. A 
 change can be made by adding cream to each bottle in the 
 proportion before recommended, — that is, to a half-pint of the 
 condensed milk, as prepared above, an ounce of ordinary cream 
 may be added. If one lives in the country and milk can be 
 obtained warm, fresh from the cow, it should be used instead 
 of condensed milk ; but we would not recommend a city child 
 to be given, shortly after its birth, ordinary cow's milk and 
 water, such as is supplied by the ordinary milkman. 
 
 CHAPTEE XXXIII. 
 
 PREPARED BOTTLE. 
 
 The question of the curd commands the most serious atten- 
 tion. This curd is always in the way, although it is an im- 
 portant article of diet, being a muscle-forming element ; and 
 yet it is not the most important by any means to the young 
 infant, as nature has shown by supplying so little to the 
 human milk compai'ed with that of the cow. We must either 
 get rid of this curd entirely for children who are suffering 
 from disease or indigestion, or we have to so act upon it as 
 to ^rnake it either coagulate in flocculi, or to digest it in the 
 bottle, as has been done in the process called peptonizing. 
 
 The whey food, or a mixture of cream and hot water, gives us 
 a preparation without the curd at all, or, as in the latter, very 
 little of it, so that children with the weakest digestion can 
 probably live comfortably and thrive on such food ; but of 
 course when it comes to growth and development, requiring 
 active muscular exercise, a stronger food is needed, and casein, 
 or curd, becomes a necessity. We will quote here, 'for the in- 
 
PREPARED BOTTLE. 139 
 
 formation of those who are interested in the subject of di- 
 gestion, a portion of a paper read by one of us.^ 
 
 " Digestion is not merely a process of disintegration ; certain 
 secretions are requisite to bring about the chemical changes 
 required. What are these secretions? First, we have tbat 
 from the salivary glands which changes starch into sugar. 
 The saliva secreted by a child under six months is at a mini- 
 mum ; very little is required, simply enough to lubricate ; but 
 I may say that in a series of experiments I have recorded a 
 child of seven days who secreted saliva which possessed suffi- 
 cient diastase to convert the boiled starch used into grape- 
 sugar. This readily accounts for those infants who fatten 
 on corn-starch, much to the surprise of the family medical 
 attendant. 
 
 " As the child grows and teething begins, quite a large 
 amount of saliva is secreted, and undoubiedW the activity of 
 this secretion forms a prominent part in its digestive process ; 
 in other woi'ds, a child that slobbers, as a rule, has little diges- 
 tive disturbance. 
 
 *' The curd is precipitated and turned into peptones, or albu- 
 minose. All albuminous matter is so converted, and a burden 
 by no means light is placed upon the liver, — an organ more 
 prominent in infancy than in adult life. 
 
 " The precipitation of the casein presents some curious 
 features; indeed, this matter is of fundamental importance 
 in our studies. Woman's milk is alkaline, it is watery, its 
 curd is precipitated in soft flakes. Cow's milk is slightly 
 acid, its curd forms in firm, hard masses of cheesy consist- 
 ence. The curd in all cud-chewing animals, of which the 
 cow represents the class, is thrown down in masses so as 
 to be readily regurgitated by the calf for the purpose of tritu- 
 ration. In the non-cud-chewers the reverse is the rule. 
 There may be other peculiarities of the curd, — chemical differ- 
 ences, — but these have not as yet been determined." 
 
 ^ Keating, Annals of Hygiene. 
 
140 MOTHER AND CHILD. 
 
 Dr. E. P. Davis writes, " These results of investigation, com- 
 bined with the clinical study of infantile digestion and its 
 disorders, warrant the inference that in the digestion of the 
 infant hydrochloric and lactic acids do not normally exist j 
 that milk is clotted by a rennet ferment active in alkaline or 
 neutral media j that the stomach serves the purpose of a co- 
 agulating bottle which is empty in less than an hour after 
 feeding; that digestion and absori^iion proceed according to 
 the activity of the pancreatic and intestinal secretions, the 
 pancreas being esjDccially concerned in normal digestion, and 
 the lack of its functional activity being most apparent in 
 gastro-intestinal disease." 
 
 The secretion from the pancreas is the next and last of im- 
 portance. It is com^Dosed principally of two materials; in 
 fact, a third may be added, the curdling principle ; these will 
 act in an alkaline or faintly-acid solution : the first a material 
 analogous to the pepsin of gastric juice, which converts casein, 
 or other albuminous matters, into pe23tones, and substances 
 that have escaped the action of the gastric juice ; and a diastase 
 like that of the saliva, which converts starchy matters and 
 cane-sugar into dextrin or grape-sugar. 
 
 To the infant the gastric juice is the most important of its 
 secretions ; only such food as contains albuminous matter with 
 soluble carbo-hydrates, as glucose and oil in emulsion, should 
 be given ; such, indeed, is milk. 
 
 "We have, then, two matters to consider in the artificial 
 feeding of infants, and we shall limit ourselves to those within 
 the first year: one, the preparation of a food containing the 
 elements of mother's milk, in a combination as much like it 
 as possible ; and the other, no less important, the elaboration 
 of those secretions which digest it. An equal balance must 
 bo maintained between the two. 
 
 The coagulation of the casein of cow's milk into hard masses 
 can be prevented by certain means ; one of the most impor- 
 tant of them is diluting with water. It is for this purpose that 
 water is added to cow's milk ; but it has also been noted that 
 
PREPARED BOTTLE. Ill 
 
 if certain materials which are not digested in the stomach are 
 allowed to become thoroughly mixed with the milk, tbey will, 
 acting in that way, so honoy-comb the curd, as it were, as to 
 prevent its forming a solid lump of cheese. Lime-water may 
 do this, — if the bottle is shaken there will be seen a great deal 
 of lime which is not dissolved in it, — but farinaceous foods, such 
 as the cereals, the starches, if they enter the stomach as such, 
 are not digested there, but probably act in a measure towards 
 the curd as sand does in the stomach of a bird. The cereals, 
 when examined under the microscojDo, are found to be cov- 
 ered with a material that is destroyed by heat or digested 
 by the gastric juice ; the starch in either case becomes free, 
 and the saliva, if it comes in thorough contact with it, will 
 turn it into dextrin or grape-sugar; in that state it is carried 
 to the liver. The same takes place when the panereaiic 
 secretion attacks it, — that is, after the food has left the 
 stomach ; but as a child has botii the saliva and the pan- 
 creas secretion in but small amount, to feed it entirely on 
 starchy food is simply to give it starvation diet. It cannot 
 live on such material. Very fortunately for the baby, its corn- 
 starch has to be boiled, and this boiling process converts it 
 into grape-sugar, or at least so nearly so as to allow the con- 
 tact of the feeblest secretions to finish the work ; and fortu- 
 nately, also, nature often supplies the child with very active 
 salivary glands during its teething period : it slobbers con- 
 stantly, and the corn-starch food comes in contact with this 
 secretion, which renders it digestible ; but the poor infant who 
 is given half-boiled arrow-root, or flour, or corn-starch too 
 thick to flow readily through the bottle, and who cuts its 
 teeth hard, — that is to say, has dry gums, little secretion, — 
 will not be long before it shows an inflammation of the bowels 
 that will be the cause of its death. 
 
 The reader can now see why it is that some children get 
 along well on corn-starch food and thrive from a very early 
 age upon boiled bread and milk, cracker-dust food, or sub- 
 stances of that sort ; but, unfortunately, it is these very chil- 
 
112 MOTHER AND CHILD. 
 
 dren who form exceptions to the rule that cause the invariable 
 evil result by tempting mothers to give starchy food to two- 
 thirds of the childi-en when too young. A cereal ma}' be added 
 to the child's bottle after it is three or four months old, if it be 
 deemed advisable, beginning with a very small quantity. 
 
 The simplest and one of the best ways of preparing the 
 bottle is the mixture suggested by Dr. J. F. Meigs and used 
 by him for so many years with success. A two-inch-square 
 gelatin calce is soaked for a short time in half a pint of cold 
 water, the water is then boiled for fifteen minutes until the 
 gelatin is thoroughly dissolved, a teaspoonful of arrow-root, 
 rubbed into a paste, is stirred into the boiling water, and 
 then the milk added in the proportion of one-third milk and 
 two-thirds water for the new-born, two-thirds milk and one- 
 third water at six months, varying in proportion at the ages 
 between. These are allowed to boil together for a few min- 
 utes, and then for the young infant two tablespoonfuls of 
 cream are added to the pint of food, and to this about six and 
 a half drachms (or teaspoonfuls) of sugar of milk, or three tea- 
 spoonfuls of white sugar. 
 
 Dr. J. Lewis Smith recommends for the preparation of in- 
 fants' food the following plan : Take from five to ten pounds 
 of well-selected wheat flour, put this into a bag, tie firmly, 
 and keep covered with water for several days, possibly a 
 week; this should occasionally be made to boil. In the prep- 
 aration of the bottle f )r a child under three months, the water 
 used for diluting the milk should have boiled with it some 
 of this flour, grated in the pi'oportion of two heaping tea- 
 poonfuls to a pint ; after the sixth month four teaspoonfuls. 
 
 Another excellent preparation is made as follows: The 
 milk is diluted with its bulk of water, which should be pre- 
 viously thoroughly boiled with either gi-ound barley, oatmeal, 
 or baked flour, in the proportion of a dessertspoonful to the pint, 
 the milk poured in while the water is boiling, the whole boiled 
 together for from twenty minutes to a half-hour at least, and 
 then strained. This may be sweetened, an ounce of cream 
 
PREPARED BOTTLE. 143 
 
 added, and the whole forms an excellent food for a child after 
 its fourth month. 
 
 It being understood that a cereal such as barley, oatmeal, 
 or Graham flour is not to be given to a child as the basis 
 of its food, but only to slightly thicken the milk and give it 
 substance, and to prevent heavy curding, the choice of the 
 article is a matter for consideration in each individual case. 
 Mothers ought to know that the outer portion of a grain 
 of wheat, corn, or oats — in other words, the bran — acts as 
 a laxative, and it is on that account the crushed grain is 
 more valuable where there is a tendency to constipation. 
 Next to the outer surface we have that portion of the grain 
 in which resides most of the nitrogenous principle, the so- 
 called gluten : so that in the debranned flour we have a prep- 
 aration which is nourishing and fattening, but not laxative. 
 The internal portion of the kernel of all these cereals con- 
 tains the starch -granule, and this part we know gives the 
 tendency towards constijjation, and is least nutritious of all, 
 but is the heat-forming element; thus, in the lohole crushed 
 grain we have all the elements necessary for health and 
 nutrition. When it is desirable to use any of these cereals 
 it is far better to use the whole grain, crushed, unless there 
 should be looseness of the bowels or irritation of some sort, 
 in which ease the flour alone should be used. But mothers 
 should bear in mind what we have laid stress on before, 
 that whenever a starchy food is used the starch-granule should 
 he thoroughly broken up by heat, either by baking or by boiling. 
 This is an essential matter, and we cannot repeat it too often. 
 
 When a mother wishes to put her child on the bottle (sup- 
 posing it to be about the age of four months), aud wishes to 
 add something to the bottle, it is a difficult matter to know 
 with what to begin. Dr. J. F. Meigs advises gelatin and 
 arrow-root ; Dr. J. Lewis Smith, of New York, advocates the 
 flour-ball, — that is to say, flour tied in a linen rag and boiled 
 for hours, then taken out, grated, and used with the milk. 
 Our own preference is for barley : it is the least constipating 
 
144 MOTHER AND CHILD. 
 
 and usually agrees well, and after the child has become 
 accustomed to it and the digestion is in good condition, a 
 small amount of oatmeal may be adiled with each or every 
 alternate bottle, and a variety of diet in that way insti- 
 tuted. 
 
 Now, in preparing the barley for the bottle we may either 
 take the whole-grain pearl barley, and have it crushed in a 
 coffee-mill, or use Eobinson's barley, which comes in packages, 
 finely powdered. Of course the latter is easier manipulated 
 and requires less time to prepare. Of the powdered barley, 
 take a dessertspoonful, mix it into a smooth paste with a 
 little water, and gradually stir this into a pint of boiling milk. 
 If the child is under six months of age you can then add from 
 one-half to one-third of water, and, stirring constantly, allow 
 the mixture to boil fully twenty minutes. To this can be 
 added a heaping teaspoonful of white granulated sugar and a 
 pinch of salt. It should then be strained. Nqw, if this mixt 
 ure is put in the refrigerator at once when it is made, in the 
 morning, it can be used for each bottle by warming over and 
 straining. If there is much constipation, oatmeal or Graham 
 flour (cracked wheat) can be used in the same way. A variety 
 of oatmeal known as the Bethlehem oatmeal comes powdered 
 for this purpose. It is simply a carefully-selected meal well 
 ground; any good oatmeal will do as well. Of course, if the 
 coarser grain is used, the -boiling process will have to be very 
 much prolonged ; and in such cases, if simply the crushed 
 barley, the cracked wheat, or the ordinary oatmeal is made 
 use of, it will be necessary to boil it in water beforehand, say 
 a heaping dessertspoonful to a quart, and the whole allowed to 
 simmer until it is boiled down one-half Then this can be 
 added to the milk, stirring well, and either both boiled together 
 for a few minutes, or, if the child is constipated, simplj- scald 
 the milk by pouring the boiling water and meal into it, stir- 
 ring it meanwhile, and then strain. The sugar and salt can 
 be added. 
 
 In city practice we always recommend the boiling of the 
 
PREPARED BOTTLE. 145 
 
 milk for precaution's sake, and think the tendency to con- 
 stipation can be overcome by giving the child occasionally a 
 bottle of water, which it will readily take. It is important to 
 bear in mind that the food should never be made so thick that 
 it will not run through the nipple. The food should be made 
 in a farina-boiler, that the milk may not become scorched. 
 
 As we have said, the selection of food is to a certain extent 
 an experiment, and therefore the child should be watched to 
 see whether it exhibits any symptoms of indigestion. Eegur- 
 gitation of food, the souring of it in the stomach, flatulence, 
 hiccough, nausea, and, finally, either constipation with great 
 pain, passage of curd, undigested milk which has a disagreea- 
 ble odor, white passages, or diarrhoea, are of course all evi- 
 dences of indigestion, but these must not be confounded with 
 the symptoms that are brought about by tight bandaging, 
 jolting, dancing the child up and down after a meal, forcing 
 it to take more food than it can conveniently carry or 
 digest. 
 
 We have often seen cases in which the mother blamed the 
 indigestion on the diet when the food had agreed perfectly 
 well, but the indigestion had been brought about by the way 
 in which the child had been treated. If the child uses the 
 bottle, it should not lie flat on its back, but should assume the 
 same position that it occupies when nursing from its mother. 
 It is well always to avoid the use of purgatives or laxatives, 
 in bottle-fed children, as far as possible. Use in their stead the 
 more laxative cereals. 
 
 Eemember that water is nature's most efficient laxative, 
 that when salt is added to the food it has the same excellent 
 effect, and that regularity and the establishment of habit, both 
 in its feeding and in the timely movement of its bowels, is of 
 the greatest value to the child. Do not think the amount' of 
 material you put into a child's stomach is alone necessary for its 
 sustenance. Do not think that because a child is given a 
 quart or more of milk a day it is all that is necessary, and 
 that it must tlirive whether or not. This is a mistake which 
 Q k 13 
 
146 MOTHER AND CHILD. 
 
 mothers are constantly making. It is the amount that is digested 
 and absorbed that nourishes, the rest decomposes or irritates. 
 
 This brings us to the subject of predigesting the curd. 
 
 Professor Albert E. Leeds, of Hoboken, gives us the follow- 
 ing way of preparing milk for infants : 
 
 One gill of cow's milk, fresh, unskimmed ; 
 
 One gill of water ; 
 
 Two tablespoonfuls of rich cream. 
 
 To these can be added one powder which contains two hundred 
 grains of sugar of milk and four grains of bicarboiiate of soda with 
 a grain and a half of extract of pancreas. These powders, each 
 one containing the above formula, can be made up in any 
 drug store. The milk, with this powder added to it, should 
 be 2")ut into a nursing-bottle, which should be placed in hot 
 water — so hot that the hand cannot be held in it for more than 
 a minute at a time (115° F.) — and kept therefor about twenty 
 minutes, and then allowed to cool sufficiently for the child to 
 take. This powder is called peptogenic milk powder. 
 
 In a lecture before the Philadelphia Hospital ]S"urses' Train- 
 ing School, Mv. Fairchild spoke as follows : ^ 
 
 " When we speak of peptonizing food, we do not mean that 
 pepsin is employed in the digestion of the food. We simply 
 mean that the albuminous portion, the casein of milk, for in- 
 stance, is converted into peptone. The materials used for the 
 purpose are the ferments of the pancreatic juice in the form, 
 of a powder, — the extract of pancreas.^ This contains several 
 ferments, each of which acts on a different form of food. 
 The conditions under which these ferments act are very 
 simple. If, in attempting to digest milk, you add the ferment 
 to the milk when it is very cold, no action will be obtained. 
 Again, if it is added to very hot milk, no action will be obtained. 
 The conditions under which these ferments act are similar to 
 those found in the body. A good test for determining the 
 
 ^ Keported by Dr. "William H. Morrison, Holmesburg, Pennsylvania. 
 * Or the " essence of pancreas ," or the " liquor pancreaticus," 
 
PREPARED BOTTLE. 147 
 
 temperature of the food is to taste it. If it is hotter than can 
 be sipped with ease, it is too hot. If it is desired, a little ther- 
 mometer may be employed to obtain the proper temperature, 
 which is 100° F. 
 
 " I shall now show you how to make peptonized milk. I 
 take one of these ' peptonizing tubes,' which contains five grains 
 of pancreatic extract and fifteen grains of bicarbonate of soda, 
 and empty its contents into a quart bottle. To this I add a 
 gill — that is, four ounces or eight tablesjDoonfuls — of cold water, 
 and if it is for infant feeding, the water had better be previously 
 boiled. Enough may be boiled in the morning to last all day. 
 I next pour into the bottle a pint of milk, and shake the bottle 
 well. By adding the water and milk cold, we run no risks. 
 Having done this, the bottle is set into a bowl of warm water, 
 which should bo of such a heat that j^ou can hold your hand 
 in it for a minute ; the temperature of the milk is thus raised 
 to about 100°, The milk is allowed to remain in the water for 
 half an hour; it is then put upon the ice, and the digestion 
 will still continue for some time, — until the milk is thoroughly 
 chilled, after which no further digestive change can take 
 place. 
 
 " I have here a bottle of milk which has been digested in 
 this way. I have allowed the digestion to be carried a little 
 further than is usually necessary, in order that I might show 
 you the properties of peptonized milk. I first take ordinary 
 milk and add an acid to it. At once a mass of coagulated 
 casein falls to the bottom of the glass. I treat a sample of 
 peptonized milk in the same way, and there is no trace of casein. 
 As I have said, it is not usually necessary to digest all the 
 casein, and the directions which I have given are for average 
 cases. You have to observe the effect of the milk on the 
 patient's digestion. If it is assimilated readily, the proper pre- 
 digestion has been secured ; but if it is necessary to digest it 
 still further, the milk may be allowed to remain longer in the 
 hot water. If the milk has been digested too much, and is a 
 little bitter, it may be made agreeable by the addition of a little 
 
148 MOTHER AND CHILD. 
 
 sugar. You will soon lear» by experience how to adapt the 
 process to the requirements of each case. 
 
 "Instead of using plain water, we may take a quantity of 
 starch paste, add a little pancreatic extract to it, and stir it up. 
 When starch is boiled it simply swells up, but within a few min- 
 utes after the addition of the panjcreatic extract it becomes a 
 thin liquid from the digestion of the starch, — by the pancreatic 
 diastase ; this stax'ch is now in the way of being converted into 
 glucose or grape-sugar. This may be put into a bottle with 
 the soda and milk, and digested in the manner just shown, and 
 we sSall have peptonized milk gruel. Here the nutritious 
 elements of the starch are added to the milk. In using the 
 peptonizing powder a little water is always used to dissolve 
 it, otherwise it would be slightly curdled by the extract of 
 pancreas. 
 
 '• This peptonized milk can readily be made into lemonade. 
 It may strike 3'ou as rather odd to add lemon-juice to milk, but 
 as the milk has been completely peptonized, it will not curdle, 
 and the lemon is often desirable to make the milk pleasant. 
 Eum and suu-ar may be added if stimulants are required, making 
 a delicious punch. It may also be taken with carbonic-acid 
 water, and, if thought necessary, lime-water may be added, 
 although we have already added an alkali. 
 
 " You may make a peptonized milk jelly. If you wish to 
 make a jelly, it is necessary to allow the digestion to progress 
 for a longer time. A pint of peptonized milk is heated to the 
 boiling-point, — that is, you scald the milk. This is necessary 
 to destroy the ferment. Then take three-fourths of an ounce 
 of Coxe's gelatin, a tablespoonful of lemon-juice, and a couple 
 of tablespoonfuls of orange-juice. When the milk is scalded 
 some of the lemon- and orange-peel may be scalded with it, 
 which gives a fresh flavor of the peel. The gelatin is then 
 added, and wine, brandy, or St. Croix rum may also be added. 
 If you do not remember to scald the milk, you will not get a 
 jelly, for the extract of pancreas will not only digest the casein, 
 ■but it will also digest the gelatin. 
 
PREPARED BOTTLE. 149 
 
 " In digesting meat, take two tablespoon fuls of chicken or 
 beef finely minced and boil it with a gill of water. This makea 
 the meat soft and facilitates its digestion. The meat is then 
 rubbed into a fine pulp and put back into the water. You may 
 now add a gill of the starch mucilage and one of the pepto- 
 nizing powders. It is then set aside for two or three hours, 
 and at the end of that time scalded. The peptonized soup 
 may be seasoned to suit taste. The scalding is necessary to 
 stop the digestion, which otherwise would go on and lead to 
 but refractive changes. 
 
 " This plan may be used with ordinary soup. Take two or 
 three tablespoonfuls of the meat, barley, etc., strained from 
 soup, rub it to a pulp, and add fifteen or twenty grains of pan- 
 creatic extract and half a drachm of bicarbonate of soda ; add 
 to a pint of the soup, and proceed as just shown. There is no 
 doubt that you get artificial digestion of all the substances, 
 and at the same time you have no more trouble than in making 
 ordinary food. If this is strained, and gelatin added, you ob- 
 tain a nice clear jelly. The peptonized milk jelly is more 
 agreeable than those made with ordinary milk. 
 
 '• In preparing peptonized milk for babies, we follow a little 
 different plan. In using cow's milk we have to dilute it with 
 an equal quantity of water in order to obtain the proper 
 amount of casein. We have to add a small quantity of milk- 
 sugar to make up fur that lost by the dilution with water, 
 because mother's milk contains a little more sugar than cow's 
 milk. Then we have to add the alkaline salts which are found 
 in human milk. Dr. Keating s])oke of the acidity of cow's 
 milk, and this is a point which few people properly appreciate. 
 Testing this sample of milk with litmus-paper, it is found to be 
 distinctly acid, and, in fact, I have never tested cow's milk 
 without finding this acid reaction. Here we have a powder 
 (peptogenic milk powder) which presents the proper proportion 
 of milk-salts, milk-sugar, and the digestive ferment to change the 
 casein into the soluble form in which the albuminoids exist in 
 mother's milk. I take four ounces of milk, add the proper 
 
150 MOTHER AND CHILD. 
 
 amount of the peptogenic milk powder ; next we add /our ounces 
 of water and two tablespoonfuls of cream. This latter is an im- 
 portant element, for mother's milk contains more fat than cow's 
 milk. In this way we obtain the same proportions of the dif- 
 ferent elements as are found in human milk. All that is now 
 I'equired is to heat it to the proper temperature for five or six 
 minutes in order to properly modify the casein. The temper- 
 ature is to be determined as in the former ease by sipping or 
 by the use of the thermometer. In this process, having first 
 made a milk mixture which contains the right quantity of all 
 the elements of mother's milk, and with its peculiar alkaline 
 character, then we seek to effect just such a change of the 
 casein — the ' curd' — as will present it to the infant's stomach 
 in the condition fit for digestion, in such a condition that it will 
 behave in the stomach just as mother's milk does, and make 
 the same demand upon the natural digestive functions. If, 
 however, the baby is very ill, and not even capable of digesting 
 its natural food, this method allows you to digest it still further, 
 
 " There are two other ways in which the ' humanized' milk 
 may be prepared. Instead of taking the quantity of milk 
 which I have done, we may take a larger quantity and a pro- 
 portionately larger quantity of the other ingredients, mix them 
 and keep them on ice. There will be no action as long as the 
 low temperature is conlinued. The proper amount may be 
 •poured out and heated whenever it is required. 
 
 " The other way is to make the mixture as just described, 
 and stand it in warm water for fifteen minutes. This will give 
 the proper amount of digestion. Then scald it ; this kills the 
 ferment, and the milk can be kept with no more care than or- 
 dinary milk. You can then take the proper amount and warm 
 when it is needed, and you have no further trouble with it. 
 For asylums, where there are many children, this is probably 
 the best way. This gives us milk which is as exact an imita- 
 tion of the natural milk of the mother as we can expect to 
 obtain it in practice." 
 
 The extract of pancreas can be obtained at any drug store, 
 
PREPARED BOTTLE. 151 
 
 and peptonized milk is at present highly recommended by all 
 physicians in this country and Europe, when prepared according 
 to the directions just given, for infants who are suddenly de- 
 prived of mother's milk or for those that are sick. A certain 
 amount of care is required in the preparation of this food, 
 because if the peptonizing process goes on too long the milk 
 will become bitter and the child will refuse it ; if it does not 
 go on long enough, the curd, of course, will not be affected. 
 There is another quality which the extract of pancreas pos- 
 sesses that is as important as that of the digestion of casein, 
 which is, that a small quantity of it, when added to the broken 
 starch-granule, will aid in converting it into grape-sugar and 
 thereby render it digestible ; for instance, if a child's bottle be 
 made up of barley-water and milk or oatmeal, a few drops of 
 the extract of pancreas in solution will render certain its 
 digestibility. And for children who have a tendency to diar- 
 rhoea, or with whom starchy food fails to agree, this can be 
 made use of. 
 
 This brings us to another subject. Anything which will con- 
 vert the cereals into grape-sugar before the food is taken to the 
 child, will aid in nutrition. "Why ? Because these cereals not 
 only contain starch, which goes to supply fat and heat, but 
 they also contain albuminoids, as gluten and other nitrogenous 
 materials, which go to the - formation of muscular tissue, and 
 salts, which are bone-forming. If the whole grain can be so 
 prepared as to be perfectly digested, a great deal will have been 
 gained in the nutrition of the child, and for this object various 
 foods have been suggested. A substance which converts starch 
 into sugar is diastase, or malt. Each granule of the cereals 
 possesses a certain ferment which, if allowed to develop by 
 heat and moisture, will turn the starch into sugar. This is 
 made u§e of in the preparation of food for children, such as 
 Liebig's foods, where the starch has been turned into grape- 
 sugar by malting. As will be readily appreciated, there is no 
 necessity for the addition to the milk for very 3'oung babes, or 
 for those that are very deHcate. Mellin's food is prepared on 
 
152 MOTHER AND CHILD. 
 
 the "same principle. It is a fat-making and nourishing food, 
 which when taken into the stomach will increase the nutrition 
 of the body and store up a certain amount of fat. and is valuable 
 because it requires very little digestion. The child at birth, 
 however, requires simply milk of the character which nature 
 presents. It needs no more albumen and no more sugar. 
 What we want is to supply a milk as nearly as possible of the 
 quality furnished by nature. All that we need is a milk which 
 will be digested and readily absorbed. But we insist upon the 
 importance of feeding a babe from birth to at least three 
 months on some preparation of milk alone. 
 
 Any preparation of malt that will aid the digestion of starchy 
 food is useful, not only for adults who suffer from flatulence 
 and debility of the digestive organs, but it is also good for 
 infants, when given in moderation ; but we advise naothers to 
 avoid these preparations for their very young babies. This leads 
 us to the consideration of those foods, in addition to the child's 
 bottle, which either aid in the digestibility or are themselves 
 of value in supplying nourishment. According to Professor 
 Leeds, these classes of foods may be divided into the milk foods, 
 the farinaceous foods, and the Liebig foods. We give many 
 of the different preparations under these headings, in order 
 that the mother can intelligently make her choice, should one 
 not agree with her child. 
 
 We have said before, and may repeat it here, as it is a very 
 important matter, that the choice of a food for a child is a 
 matter of experiment, for what agrees with one may not agree 
 with another, even in the same family ; that the test of whether 
 or not a food agrees with a child is if the child thrives upon it, — 
 if it sleeps well, if its flesh becomes firm, if its digestion is good, 
 if its temper is amiable, and if it gains in weight, — because a 
 cross child, in nine cases out of ten, is either a d3'spej)tic or a 
 sickly.one. These tests are the only ones that are of value, not- 
 withstanding the advertisement that such and such foods are 
 the only ones that agree with the baby. As the child grows 
 older, a farinaceous food may be given in the way described 
 
PREPARED BOTTLE. 153 
 
 before. Should the passages become constipated and there be 
 much flatulence, should the child suffer from colic, become rest- 
 less at night, lose its appetite, then the change should be made 
 to one of the Liebig foods, and in this way iis digestion encour- 
 aged and nutrition established. An intelligent mother watch- 
 ing carefully her child can thus be guided in the choice of its 
 food; but it should be always borne in mind that as milk con- 
 tains all of the elements for nutrition in such proportion as is 
 required, those foods which are not milk foods should always 
 be made up with milk inthe preparation of the bottle; and if 
 fresh cow's milk cannot be obtained for this purpose, a milk 
 food well diluted should be used, such as ordinary condensed 
 milk, fresh evaporated milk, or one of the milk foods given in 
 the table : 
 
 MILK FOODS. 
 
 Carnriek's Soluble Food, 
 
 Anglo-Swiss, 
 
 Gerber's, 
 
 American Swiss, and others. 
 
 FARINACEOUS FOODS. 
 
 Blair's Wheat, 
 
 Hubbell's Wheat, 
 
 Imperial Granum, 
 
 Hard's Food, 
 
 Eidge's Food, 
 
 Eobinson's Patent Barley, 
 
 Bethlehem Oatmeal, and others. 
 
 LIEBIG FOODS. 
 
 Mellin's, 
 
 Malted Milk, 
 
 Lactated Food, 
 
 Hawley's, 
 
 Keasby & Mattison's, 
 
 Savory & Moore, and others. 
 
154 MOTHER AND CHILD. 
 
 Frequently a child may be so weak or exhausted from disease 
 or from inanition that food of the mildest character will not 
 remain on its stomach. It would be useless to keep on diluting 
 condensed milk, as it would render it valueless. In cases of 
 this sort, the while of an egg shaken up in a bottle of warm 
 water to which a couple of grains of lactopeptine or Fairchild's 
 liquor pancreaticus is added, sweetened and given by the 
 bottle if the child will nurse, and by spoon in small amounts if 
 the child will not, is very nourishing. Wine-whey can be given 
 in the same manner. Gum-arabic water will nourish for a sur- 
 prisingly long time, and allay irritability of the stomach and 
 bowels, and finally, the child can be gradually encouraged to 
 take small and i-epcated quantities of peptonized milk. No 
 babe, of whatever age, should be fed exclusively for any length 
 of time on bottle-food that has not fresh milk as one of its 
 ingredients. We insist upon this, as cases of scurvy have un- 
 doubtedly come from the prolonged use of stale preparations. 
 It should be remembered that all infants need water. For 
 the nursing babe a tablespoonful of boiled water should occa- 
 sionally be given ; for the bottle-fed babe an occasional bottle of 
 vater is a necessity and must not be forgotten. 
 
 CHAPTEE XXXIY. 
 
 WEANING. 
 
 The question is often asked. At what age should weaning 
 begin, provided that there is no immediate necessity, and how 
 should the process be managed ? It greatly depends on the 
 family arrangements for spending that season of the year 
 which in this part of the world is most to be dreaded, the 
 summer. Of course, if a child is to be taken to the sea-shore, 
 or some cool summer resort, where milk can be supplied fresh 
 and in abundance, the question of weaning in the summer-time 
 
WEANING. 155 
 
 has not half the importance attached to it that it has to those 
 who are obliged to spend the summer in, or near, one of our 
 large cities. Our own opinion is that if a child ha& been nursed 
 for four months, certainly for six months, the gradual addition 
 of a bottle to its dietary will be of advantage. A child 
 partly nursed and partly bottle-fed, after its fourth month, 
 thrives better than one bottle-fed alone ; in fact, breast-milk 
 helps to make the bottle-food more digestible. Not only is 
 this the case, but it is a great relief to the mother, gives her 
 more time to rest, occasions less drain upon her nutrition, and 
 is also of importance should the child be obliged to take the 
 bottle, either because the mother's milk gives out, she becomes 
 pregnant, or her health gives way ; but four months is j'oung 
 enough, provided the mother's milk is found to be of good 
 quality, nourishing, and the child thrive ujDon it. An occa- 
 sional bottle, in addition to nursing, will have a tendency to 
 concentrate the breast-milk, making it more nourishing, and 
 thus avoid the necessity of weaning altogether for a few 
 months more. 
 
 The addition of a bottle or two during the night will give 
 the mother a good night's rest, — a most important matter. 
 Apart from the great importance to the child, the nursing by 
 its mother will have usually a most desirable effect upon her 
 own health, unless she be consumptive. It is a law of nature 
 and therefore is beneficial. It will aid much in reducing the 
 womb to its normal size ; indeed, a mother who does not nurse 
 her babe is apt to have some womb trouble following her labor. 
 
 For a child that is born as late as January or February we 
 would not recommend the addition of any bottle-food until 
 the following October, provided the mother is able to nurse it. 
 For a child born in October or November, and especially when 
 the following summer can be spent out of town or at the sea- 
 shore, the weaning process could possibly be all over by May. 
 If a mother is strong and hearty, has no consumption in the 
 family, has plenty of milk, is not in the least pulled down by 
 nourishing her baby, and can nurse it a year, it is so much 
 
156 MOTHER AND CHILD. 
 
 the better. For the last six montlis lier child can take some 
 bottle-food in addition. A mother should not nurse her child 
 for more than a year; there is no necessity for it. The milk is 
 not suflSciently nourishing, and unless it is supplemented 
 by the bottle the chances are that the child will become 
 sickly. Indeed, a good, strong, healthy child that becomes 
 accustomed to the bottle-food will Avean itself before that 
 time is up, and this is exactly what we wish a child to do, — 
 to wean itself. K'ow, in the gradual process of weaning or 
 the addition of a bottle to its regular nursing, the babe of 
 five or six months may take its food according to ihe following 
 programme : K should nurse from its mother in the morning at 
 six or seven, and then after its bath take a bottle about half- 
 past ten or eleven o'clock; possibly nurse from its mother 
 about one or two o'clock ; again a bottle at five or six ; and 
 then the mother should nurse it on retiring at ten or eleven. 
 In this way it becomes gradually accustomed to the bottle at 
 the time of day when it is most apt to agree. This also gives 
 the mother an opportunity to take exercise and rest. Possibly 
 it may need a bottle about four o'clock in the morning. 
 
 The question is asked. What should be the first choice when 
 selecting the bottle-food of a child at this age, — four months? 
 
 Certainly the first choice should be the simplest preparation 
 and one which will tax the digestive organs least. The chapter 
 on bottle-feeding should be consulted in regard to this matter, and 
 that preparation of milk, cream, milk-sugar, and lime-water rec- 
 ommended by Dr. Eotch or the proportions advised by Professor 
 Leeds should be tried first, remembering that the mixture must 
 be sterilized, and that the sterilization at 155° F. is the one we 
 particularly advise. The next bottle-food that can be tried is 
 the formula of Dr. J. F. Meigs, of milk, cream, gelatin, arrow- 
 root, and lime-water, and finally, barley, oatmeal, rice, or flour 
 can be added as is advised in the chapter under consideration. 
 As the child grows older, the mid-day bottle can be varied. We 
 believe that by using a mixture of the cereals we often get a 
 more palatable and more nutritious preparation than by uriing 
 
WEANING. 157 
 
 them singly ; thus, oatmeal and barley, or G-raham flour, can 
 be used together, or oatmeal and rice. The child will show a 
 decided preference for some kind of bottle-food, but bear in 
 mind that it is a great mistake to stuff a child. The mother will 
 often be tempted to add a little more oatmeal, or Mellin's food, 
 etc., thinking that a little increase will make her baby stronger 
 and rosier. This may be true if the child lives in the country 
 or at the sea-shore, where it is out of doors all day long, in a 
 cool, bracing climate, especially if it is able to run about ; but 
 if mothers could see, as doctors do, the numbers of sluggish, 
 heavy children that our cities afford, with coated tongues and 
 foul breaths, and constipation, who are fairly packed with 
 " baby foods" and all the most concentrated articles of diet 
 that modern chemistry presents us with, they would under- 
 stand why it is that the ill-fed, ill-clothed children of the poor, 
 who live on a crust and digest it, are so much more, able to 
 resist disease than their own. It is on this account we believe 
 that, although oatmeal is a most valuable addition to the diet, 
 it should only be used in small amounts, should be thoroughly 
 boiled, the children when taking it kept out of doors as much 
 as possible, and should not be used in hot weather, nor with 
 children who have what is called a " bilious tendency." 
 
 If fresh cow's milk is not obtainable, condensed milk can 
 be used in this gradual weaning of children : one part to ten 
 parts of water, and fresh cream as before recommended. Some ■ 
 studies we made a few years ago convinced us that woman's 
 milk contains a diastase or ferment capable to a slight degree 
 of turning starch into grape-sugar, and that cow's milk does not 
 possess this. Possibly this accounts for the excellent results 
 that are frequently found in the association of breast- and 
 bottle-feeding. Let us here say again that when we use any 
 substance besides milk in its bottle, such as the cereals, we 
 should not forget that the child needs water, — pure, clean water 
 to drink. Very often a child that is partly bottle-fed and 
 partly nursed is restless at night, — will not sleep. Instead of 
 the mother's trying to put it to sleep by nursing it, if she 
 
 14 
 
158 MOTHER AND CHILD. 
 
 would simply give it some water in its bottle, or possibly a little 
 Mellin's food in the water, it would go to sleep and not run the 
 risk of indigestion from over-feeding. 
 
 Dr. A. Jacobi/ writing of the necessity at times for supple- 
 mental feeding, says, — 
 
 " Such practitioners and authors who convinced themselves 
 of the ill success often attending the use of milk, or watered 
 milk, commenced at an early period to mix it with meat-soups, 
 meat-tea, or egg. The administration of some beef-soup, well 
 made, a cupful every day (mutton-broth when there is a ten- 
 dency to diarrhoea), is advisable towards the end of the first 
 year. Long before this period, indeed, at any time during 
 infancy, is it indicated in cases of early rhachitis, rhachitical 
 constipation, undue adiposity, and retarded teething. 
 
 " Beef-tea, well made, in the bottle swimming in the water- 
 bath, is still believed by some to be the model food. That it is 
 not so rich in soluble albuminoids as was believed, ought to be 
 generally understood by this time. What, however, it does 
 contain in large quantities is salts. Thus, it is a dangerous 
 article in summer diarrhoea, and must never be administered 
 by itself. When given at all, it ought to be in combination 
 with farinacea, raw albumin (which, in this mixture, requires 
 very little salt, if any). 
 
 " Egg has been utilized as an admixture to milk, or as its 
 substitute in a great many ways. The yolk and the albumin 
 have been so employed. The white of an egg, with a little 
 salt and six ounces of water, well beaten and shaken, is a 
 good mixture, which can take the place of infant food but 
 temporarily, but is an invaluable makeshift in severe intestinal 
 catarrh, or a permanent nutriment in the same when added to 
 other food. 
 
 " In the course of the second half-year some changes may be 
 made in infants' diet. In the relation of the barley prepara- 
 tion to the milk a change should be made ; the milk may exceed 
 
 ^ Intestinal Diseases of Infancy and Childhood, p. 89, 
 
WEANING. , 159 
 
 its former quantity, and in the same proportion in which the 
 children are permitted and accustomed to drink pure water, 
 the food may become more condensed. Towards the end of 
 the first year the quantity of barley or oatmeal to be used in 
 the decoction may be increased. It is soon enough to begin 
 the use of pure milk in the third half-year, if at all. About 
 the eighth or the tenth month the chewing of a crust of bread 
 or of a piece of " zwieback" may be allowed. About this time, 
 too, the daily allowance of meat-soup may be increased to two 
 hundred and fifty grammes, and in addition one or two tea- 
 spoonfuls of broiled beef may be given. These articles, dis- 
 tributed through four or perhaps five meals, will be sufficient 
 for the greater part of the second year. The quantity may 
 be gradually increased, but a more radical change is useless. 
 If a child, which is healthy and is not spoiled, awakens at 
 night, it needs and desires nothing but a drink of water, or of 
 thin barley-water without milk. 
 
 " About the middle of the second year, when the child begins 
 to use a spoon, the breakfast may be made up of more solid 
 elements than heretofore, barley broth or oatmeal mush, thor- 
 oughly cooked, an egg, a glass of milk, a piece of stale bread 
 with or without butter. The child must be taught never to 
 drink milk in haste. It will be digested better when time is 
 taken. The daily quantity of meat, preferably beef, to which 
 gradually may be added lamb or chicken, may now be increased 
 to one hundred grammes, and this is to be at two or three 
 meals. The evening meal must be similar to that of the morn- 
 ing, and lighter than the mid-day meal. Neither at this age, 
 nor later, should nervines, stimulants, condiments, coarse vege- 
 tables or salads, coffee, tea, wine, beer, play any part in chil- 
 dren's diet. A piece of sugar, after a meal which is frugal but 
 rich in albuminoids, will prove an agreeable and useful addition. 
 Children from two to three years of age will get along well 
 on four meals daily. Those who are a little older may do with 
 three, provided they get once a day between meals a piece of 
 bread and a drink of milk, made agreeable and more digestible 
 
160 « MOTHER AND CHILD. 
 
 by the addition of a little salt. Before children are two years 
 of age no vegetables in any quantity should be given to them. 
 Small quantities may be given later on ; they will be accept- 
 able and be readily digested. As age advances, the diet should 
 approximate, more and more, that of grown people. Alto- 
 gether, there is no easier and no more grateful task than that 
 which consists in accustoming children to a simple diet, and to 
 shape their habits and their demands into harmony with those 
 of natui'e from the first year of life." 
 
 Eear in mind, that if in the summer-time, a child takes more 
 food than it can digest, this food is apt to decompose, act as an 
 irritant, and possibly give rise to an inflammation that will end 
 in summer complaint. Suppose, then, that a child has been 
 weaned fi'om the breast, and the object now is to gradually 
 take it off the bottle or give it some additional food besides 
 that which it takes in its bottle. We may presume that its 
 bottle has been agreeing with it, but that for the last few weeks 
 it has turned against it, as it were: it seems to crave more 
 solid food. Certainly by the time it is twelve months old it 
 could very well be given a small cupful of chicken-broth or 
 beef-soup. Possibly before this time it has been given, instead 
 of the usual bottle after waking from its mid-day nap, some 
 boiled bread and milk ; and now, instead of bread and milk, 
 some chicken-broth, with a little dry toast soaked in it, can 
 take the place of this meal, and the bread and milk be given 
 for supper about six o'clock. In this way the " bill of fare" 
 for three meals can be gradually mapped out, and the child 
 permitted to masticate part of its food ; this will aid the cut- 
 ting of the teeth as well as increase its digestion. When a 
 child takes bread and milk in this way it is always well to let it 
 have an occasional drink of plain milk, and we must never 
 forget that it also needs from time to time some fresh water. We 
 repeat this constantly, as we want to impress upon mothers that 
 much of the complaint about the constipation of bottle-fed 
 babes comes from the want of drinking-water. 
 
 Very often during the coutaq of weaning it is advisable to 
 
WEANING. 
 
 161 
 
 give a child soups or, preferably, broths and beef-juice. The 
 latter is frequently given in preference to soups, as it is readily 
 digested and is most 
 nutritious and blood- 
 making. 
 
 To make good beef- 
 juice a piece of lean 
 beef from the round, 
 preferably of fresh meat 
 and not that which has 
 been frozen, should be 
 used. Chop this fine 
 and remove every shred 
 of fat, heat slightly, and 
 use a meat-press. A 
 tablespoonful of juice 
 thus expressed is enough 
 for any infant at a time. 
 
 Of the ready-made ex- 
 tracts we have found 
 Valentine's most reliable 
 and 'a\^o Rudisch's sarco- 
 pepiones. 
 
 Dr. Jacobi, writing of delicate children who suffer from dys- 
 pepsia caused by intestinal catarrh, says, — 
 
 " Most cases, in older children, bear boiled milk, strained oat- 
 meal, barley gruel, stale wheat bread, and a few also raw beef. 
 Some take nothing but boiled milk, or buttermilk, or koumiss. 
 Many, particularly convalescents or adults, will tell you that 
 they do not digest milk. That may be true, but then they 
 gulped it down and it formed a large caseous cake in the 
 stomach that was not afterwards dissolved and digested. They 
 must boll their milk in the morning and heat it several times 
 during the day almost to the boiling-point. They must add a 
 small quantity of table salt to it ; also, in case the stomach is 
 very acid, some bicarbonate of sodium, or calcium, or magne- 
 l 14* 
 
 Meat -juice press. 
 
162 MOTHER AND CHILD. 
 
 slum. Thej must not di'ink their milk, but pour it upon a 
 plate and sip it with a spoon. Thus prepared, they will digest 
 it, particularly when it is not quite cold. In fact, many require 
 their meals warm or hot. 
 
 " For the purpose of easier digestion, milk may be peptonized 
 according to Fairchild's directions, or it may be rendered more 
 digestible by the process recommended by Dr. Eudiseh. This 
 consists in mixing one part of dilute muriatic acid with two 
 hundred and fifty parts of water and five hundred parts of 
 raw milk, and then boiling it. 
 
 CHAPTEE XXXY. 
 
 MENSTRUATION. 
 
 We will devote a few moments to the consideration of the 
 changes which take place in girls at puberty, partly from the 
 fact that at this time we are still within the period of the 
 second or permanent dentition. Indeed, it will be noticed 
 that at the very age when menstruation first shows itself, the 
 girl is susceptible to all those functional disturbances that "may 
 be brought about by the cutting of the four second molars, a set 
 of teeth that are developed anew, not replacing any of the 
 milk-teeth. SuflBcient attention has not been called to the dis- 
 turbances caused by the pressure of the twelfth-year molars. 
 These may show themselves in either dental neuralgia or, in 
 fact, any form of trifacial neuralgia, gastric disorders, or men- 
 tal peculiarities amounting to melancholia, or symptoms of 
 acute meningeal irritation. Iso wonder, then, that it is most 
 important that the young girl should be under the care of a 
 mother properly instructed to guide her and guard her during 
 this time. The natural impulse of her sex is towards sedentary 
 occupation, seclusion, long dresses, and possibly her first real 
 novel, — all of these in themselves pernicious : they weaken 
 
MENSTRUATION. 163 
 
 her muscles, lessen her appetite, tend to constipation, and ex- 
 cite her brain. 
 
 It is scarcely necessary to mention the boys at this age. 
 The out-door life that they lead, especially at the present time, 
 when there is so much for a boy to do, tends to keep them in 
 good physical condition, and renders them insusceptible to the 
 many reflex disturbances which might otherwise exist. We 
 quote from a paper upon this subject as follows : ^ 
 
 We all recognize the very great importance of all that tends 
 towards muscular development in growing girls. They should 
 be symmetrically developed, should have full chests, straight 
 backs, and strong limbs. We should also urge the importance 
 of clothing of light weight and loose fitting, the principal 
 strain being on the shoulders, not on the waist and hips, and 
 also the evil results of cramped, stooped positions in the school- 
 room, eye-strain, and bad ventilation. We all urge these mat- 
 ters daily, and we know how little attention is paid to them. 
 But there are certain forms of various disorders which occur 
 about the time of the second dentition that deserve more 
 than a jDassing notice. These are manifested either as chorea, 
 (St. Yitus's dance), nervous excitement, such as night ter- 
 rors, and various mental disturbances (misnamed hysteria), 
 gastro-intestinal disorders, and evidences of malnutrition. 
 The child will probably become languid, suffer with frontal 
 headache, become peculiar in her disposition and show fits of 
 temper, shun society of other children, lose her appetite, be- 
 come despondent, and possibly develop a local twitching of 
 some of the facial muscles. It is customary to say that this is 
 all reflex, is possibly a warning that the system is undergoing 
 some change preparatory to the menstrual functions, — that it 
 is, in fact, a true hysteria. This may or may not be the 
 case. Our own impression is that it is often due to the anae- 
 mia (impoverished blood) brought about by rapid growth and 
 
 ^ Published in the Medical and Surgical Eeporter by Dr. J. M. Keating 
 October 23, 1886. 
 
164 MOTHER AND CHILD. 
 
 development, with faulty assimilation and deficient oxygena- 
 tion. 
 
 The nervous system seems to run riot, but this very excite- 
 ment in itself is an evidence of the demand on the part of 
 nature for a blood-supply which is nutritious and well oxygen- 
 ated. All the exercise in the world, all the most nutritious 
 and sustaining of foods, will have no effect until the digestive 
 organs are made to perform their normal functions. If you 
 examine the tongue you will find it coated ; the breath is 
 foul, the bowels are sluggish, the appetite is perverted, the 
 child craves extraordinary articles of food, especially acids and 
 sweets. She has a disgust for her regular meals. There is 
 flatulence, cardiac palpitation, often asthma after exertion. 
 The urine is either scanty and high-colored or very copious 
 and light. If the menses have been established, they are scanty, 
 colorless, and irregular, or there is a leucorrhoea. In these 
 cases the recommendations of popular writers for gymnastics, 
 friction, milk diet, etc., are admirable after the digestive organs 
 have been cleared of their accumulation and the normal func- 
 tions whipped into activity. 
 
 As far as the general treatment is concerned, the patient 
 should be sponged every morning with tepid water; she 
 should stand in a tub, and have a pitcher of it poured down 
 her spine from the nape of her neck, and then be thoroughly 
 rubbed into a glow with a soft Turkish towel. The breakfast 
 should consist of warm milk or cocoa, a soft-boiled egg, a rare 
 steak or chop, either oatmeal, cracked wheat, grits, or Indian 
 meal alternating; bread and butter, not hot cakes. For dinner, 
 soup, rare meat, fresh vegetables, ripe or stewed fruits. For 
 supper, stewed fruits, broad and butter, warm milk or cocoa, 
 neither tea nor coffee. She should retire early, and not be 
 permitted to read at night. The supply of oxygen should 
 come from out-door exercise, not an over-indulgence in walks or 
 games that fatigue ; let the school-hours be limited to the early 
 part of the day, and avoid that abomination of preparing long 
 lessons in the afternoon or evening for next day's recitations. 
 
MENSTRUATION. 165 
 
 Moderate calisthenics, or massage, should be daily given. 
 In about a week's time the girl will be able to bear iron alone, 
 and the tincture of the chloride can be given in ten- or fifteen- 
 drop doses for some time, or a chalybeate water can be given 
 with arsenic. The digestive organs will now also tolerate 
 milk in large quantities, provided it is of medium richness, is 
 fresh, and given warm. 
 
 But this is not all. There are very many cases of a highh-- 
 nervous type which, despite the most careful treatment, will 
 not improve at home. The constant association with parents 
 of like temperament, however solicitous they may be in 
 carrying out instructions, is of itself a cause of nervous irri- 
 tation. It may be necessary to send such children from home, 
 either to some relative, living possibly in the country or some 
 distant city, or perhaps to some suburban or country boarding- 
 school, where a thorough change of air and scene and the 
 association with girls of a different temperament will work 
 wonders. 
 
 The age at which menstruation appears cannot, of course, 
 be definitely stated, so much depends upon climate, race, social 
 position, and family peculiarities. Ordinarily, about the age 
 of fourteen may be taken as the average in the temperate 
 climate. Of course, whatever tends to early development, 
 such as warm climate, in-door occupation, and especially 
 among those whose occupation is sedentary or where it is 
 attended with much mental excitement pertaining to literary 
 pursuits or the excitement from the whirl of society life at 
 too early an age, may bring about an early appearance; whereas 
 the contiary miay have a retarding effect. 
 
 The period at which this change to puberty takes place is 
 marked by a series of phenomena which show the revolution 
 undergone by the system. For some time previous the nervous 
 system has felt the change ; the temper becomes variable, at 
 times uncertain. A girl who before was probably gay and 
 boisterous in her deportment becomes timid and shy, easily em- 
 barrassed, the slightest cause making her blush, the knowledge 
 
166 MOTHER AND CHILD. 
 
 of which may add to her embarrassment. She may notice a 
 gradually increasing development of her figure, which annoys 
 her and makes her shun company. Her younger companions 
 no longer have the same charm ; involuntarily she prefers the 
 society and dress of those older than herself. The watchful 
 mother at once recognizes the cause which is bringing about 
 these changes, and it is her duty to gain the confidence of her 
 child and, without exciting her suspicions or disturbing her 
 already uncertain nervous system, lead her to understand that 
 she is no longer a child. In this way should the matter be ex- 
 plained to her by her mother. She is a woman, and it falls to 
 the lot of all women who are in good health to have a certain 
 monthly drain upon their system which is calculated to relievo 
 the other organs of the body ; and should it appear at any 
 time, which it is now likely to do, she should avoid all things 
 that might check it, and take certain precautions, as rest, etc., 
 to secure its regular return, which should be painless. As this 
 often in many cases comes unawares, certam precautions in 
 clothing have to be taken ; especially is this the case if the 
 child should happen to be awaj^ from home at this time. Then, 
 again, it is well for her to learn that the menstrual flow may at 
 times, especially in delicate girls, be attended by severe pain, 
 by nervous prostration, in fact, by a constitutional thunder- 
 storm. There may be severe headache (frequent in such cases), 
 colic, — this latter may be extremely severe ; there may be 
 giddiness, nausea, extreme nervousness, chills or creeps, exces- 
 sive backache, all of which may come on suddenly, following 
 some slight indiscretion in diet which tends to mislead the 
 j)erson as to its true cause. 
 
 "When a young girl once distinctly understands that the 
 object of her monthly flow is to keep her in good health, — and 
 this surely is the light in which it should be presented to her, — 
 she will readily understand that to secure the health which is 
 heaven's greatest blessing she must be strictly guarded as to 
 the care of herself. She should understand that- after one ap- 
 pearance the periodicity of this function is not at once estab- 
 
MENSTRUATION. 167 
 
 iislied ; there is frequently great irregularity in its return. It 
 may last but a few hours and then return in fifteen days; it 
 may be copious at first and then not return for two months or 
 more. Instead of appearing, as it should, at the time of its ex- 
 pectation, it may appear as a bleeding from the nose, or it may 
 be replaced by a diarrhoea or by a leucorrhoea. 
 
 There are certain signs wl)ich note the advance of a period, 
 and it is well for the mother to impress upon her daughter to 
 watch them carefully. Although the normal return of the 
 period is calculated by the lunar month, really the idea that the 
 moon exerts an influence upon this condition has no basis; this 
 is shown by the fact that the day of return differs in women. 
 Again, some have the normal return every thirty, others every 
 twenty-five or twenty-eight days. The duration of the period 
 also differs in most women ; in some it lasts three or four days, 
 in others eight or more. The quantity also differs ; the range 
 comprised within the area of health is widely spread. These 
 facts are important to bear in mind ; though should any devia- 
 tion exist from that which the mother believes to be the normal 
 condition, she should mention the fact to the family physician, 
 and let him be the judge of its importance. 
 
 During this period of life there is a tendency in certain 
 types of young girls to develop what is known as hysterical 
 phenomena. Now, it is well to know that what is understood 
 as hysteria by physicians is not merely those attacks which 
 people call hysterics. 
 
 Physicians frequently hear this reply, "But, doctor, my 
 daughter is not hysterical; she is of the most amiable disposi- 
 tion , I know her to be extremely brave and fearless." At the 
 same time she may be a marked subject of hysterical vomiting, 
 or some of the paralyses. It is a difficult matter to decide 
 whether these troubles — which are usually termed reflex by 
 doctors,- because they are sympathetic or reflected from other 
 organs through the chain they have in common, the delicate 
 nervous system — are due to disturbance in the generative sys- 
 tem or are simply the result of an associated weakness, of 
 
168 MOTHER AND CHILD. 
 
 which the disturbed menstruation, the pain, or the diminished 
 quantity of the flow is another evidence. 
 
 In many cases the "womb-troubles," which may simply be 
 irregularity of the function of menstruation, may be the cause, 
 and rest, hot foot-baths, laxatives, etc., bring about a cure ; or it 
 may be due to weakness on the part of the indiv-idual, poor 
 blood, deficient put-door employment, too much standing, as is 
 80 common with store-girls, and only yield to tonics, fresh air, 
 ample diet, and exercise. 
 
 "What is generally understood as hysteria by the nonpro- 
 fessional is an outburst from the nervous system upon the 
 slightest irritation, whether pleasurable or painful. To a certain 
 extent this is independent of -any disease or even disorder of 
 the generative system, and is solely, we regret to have to say, 
 due to bad " bringing up." Gentle, over-indulgent, tactless 
 parents are themselves the cause of such a state of affairs. 
 
 It is not for us to study the cause of these changes in indi- 
 viduals that produce this function, nor to describe the anatomy 
 and physiology of the organs that are engaged in it. It is 
 merely necessary to insist upon the fact that normal menstrua- 
 tion should be, painless, and that disturbances occurring at this 
 time, whether in the foi-m of local pain, headache, or lassitude, 
 bear the same relation to normal menstruation that discomfort, 
 nausea, and pain bear to healthy digestion. Just as dyspepsia 
 is dependent upon indiscretion in diet, or weakened digestion 
 from debility, so difficult or painful menstruation is the result 
 of indiscretion at the time when cure and watchfulness should 
 be the rule, or it is the penalty paid for neglect at some earlier 
 period. 
 
 Debility in early girlhood is one of the principal causes of 
 pain when the function is established. It is usually found in 
 rapidly-growing girls whose tastes have led them enthusias- 
 tically into literary pursuits, partly from a feeling on their part 
 that their muscular weakness will prevent their taking pleasure 
 in the rough out-door pleasures of their more robust companions, 
 and partly from the extreme excitability of their nervous 
 
MENSTRUATION. 169 
 
 system, which makes them at an earlj^ age noted for their 
 brilliancy, and which will also exaggerate their liability to pain. 
 Such children are easily recognized, and to them the watchful 
 mother should give her careful attention in anticipation of 
 what their development will bring forth. Their studies should 
 be gently directed towards those pursuits that lead them out 
 of doors; the muscular exercise involved in household duty 
 should be gradually given them ; habits of early rising and 
 early to bed should be insisted upon. There should be a 
 judicious division of their school-hours, the selection of well- 
 ventilated and bright school-rooms, daily gymnastic exercise, 
 swimming, riding, and walks, — not the aimless promenading 
 the streets, but walks that are calculated to give both pleasure 
 and profit. There is no better way of making healthy girls 
 than to make the various branches of science, according to 
 their taste, a part of their education ; there is not a girl, or 
 in fact any individual, who has not a latent taste which, 
 with a little care, can be developed. If fond of drawing 
 or painting, encourage it from the eai-liest moment; teach 
 her to draw from nature, and she will spend hours in the 
 open air. Botany, mineralogy, photography, will embrace the 
 repertoire of an educated woman as well as Latin and Greek, 
 and a woman's mind is capable of accommodating them all, if 
 necessary. 
 
 Unfortunately, the present fashion is totally at variance, 
 strange to say, with that of the ancient days of Greece and 
 Eome. Nowadays it seems that a person can learn nothing 
 except in an ill-ventilated school-room, in a barrel-hoop posi- 
 tion. The philosophers of ancient days studied as hard as 
 those of modern times, but they sought the solitude of the 
 woods, and made their studies a pleasure instead of a task. 
 It is not intense study that breaks so many down : it is the 
 confined air, the sitting in a bent posture, the loss of appetite, 
 the muscular weakness, and the poor blood that does the 
 harm. We wish we could impress firmly upon mothers the 
 importance of an erect carriage in young, growing girls. It is 
 H 15 
 
170 MOTHER AND CHILD. 
 
 not merely fhe case that stooping shoulders and curved sj)ines 
 make their daughters unattractive in appearance, but such 
 conditions are absolutely a predisposing cause of disease; 
 and we are satisfied from personal observation tbat such girls 
 are fit subjects for tuberculosis and are always more or 
 less afi'ected with painful periods. To correct this before the 
 age of puberty should be the aim of every mother. Make 
 your girls straight from habit with shoulders well thrown back, 
 and they will avoid many womb-troubles in the future. If 
 out-door exercise does not seem to correct this habit, there are 
 certain movements of the muscles, — light gymnastics, — which 
 your family physician can tell you of, that are beneficial. One 
 of the straightest and best-formed girls we ever saw — a picture 
 of health — owed it all to her mother, who, noticing a gradual 
 habit of stooping, required her to lie flat on her back on the 
 floor without a pillow for one hour each day, while she read 
 some entertaining book to her. Another matter, which is im- 
 portant in this connection, is the question of young girls wearing 
 corsets. Fortunately, so much attention has been paid lately 
 to the subject of dress in England that those whose oj)inion is 
 most valuable have freely expressed themselves. We fully en- 
 dorse the view of the London Lancet in an editorial, that cor- 
 sets should not be worn by young women ; their dress should 
 always be made so as to give free and independent movement 
 to every part of the body ; their garments should be light in 
 weight, and the burden should fall as much as possible on the 
 shoulders ; there should be no restriction of any part of the 
 body, and if a girl's figure needs a corset to make it shapely, 
 let her endeavor to accomplish the same end by the more 
 natural means of muscular development, which will at the 
 same time give health as well as beauty. A strong back is far 
 better than a corset. 
 
 Young girls should know that w^hen the time comes for 
 their period they should avoid everything that would either 
 postpone it or make it painful. If a horseback excursion has 
 been fixed for that time, some excuse must be made ; if a boat- 
 
MENSTRUATION. 171 
 
 ing-party involve exposure to the chilling air, by all means avoid 
 it. Swimming, climbing, tennis, should be interdicied at such 
 times. In avoiding extremes, one does not merely mean the 
 extreme of doing too much, but also that of doing too little. 
 The lounging about one's bedroom, or spending the''whole day 
 sitting reading a novel, will be as apt to give trouble as the 
 opposite extreme ; it will make the circulation sluggish, tend 
 to headache, make the liver torpid, give rise to indigestion, 
 and weaken the system. If one is accustomed to moderate 
 exercise, the daily avocations of life should not be interfered 
 with ; but heavy lifting, or over-fatigue in walking, or too long 
 standing, riding, dancing, or tennis, should be carefully avoided. 
 
 We cannot lay too much stress on the importance of a careful 
 regulation of the bowels, especially in its bearing upon the dis- 
 orders of women. Every one knows the necessity of estab- 
 lishing a- daily habit, from the fact that the wastes of the 
 body which are discharged through the intestine, if allowed 
 to remain, decompose, are reabsorbed, and produce a certain 
 poisoned condition of the system, made evident by furred 
 tongue, nausea, distaste for food, disagreeable taste in the mouth, 
 headaches, bad complexion, pimples and other disorders of the 
 skin, rendering the individual miserable to herself and. others. 
 Constipation also allows an accumulation to take place in the 
 bowel, which by distending it will press upon the organs that 
 lie in contact, and cause the extreme jDain so common at times, 
 especially in the left side. ISTothing should interfere with this 
 daily duty ; but no one should use powerful purgatives without 
 consulting a physician. 
 
 Of course, fresh, pure water is the best laxative we know 
 of, and a proper amount should be taken each day, usually 
 at meals. Then fruits, ripe, raw, or cooked, should not be for- 
 gotten, also fresh vegetables. The compound liquorice powder — 
 a teaspoonful or more at night in milk or water — is a mild and 
 excellent laxative. Occasionally upon rising in the morning a 
 wineglassful of Eubinat-Condal water, Friedrichshall, Tarrant's 
 aperient (teaspoonful), are excellent. Tlie elixir cascara sagrada, 
 
172 MOTHER AND CHILD. 
 
 compound rhubarb pills, and Lady Webster pills are efficacious, 
 but the latter should not be taken for any length of time nor im- 
 mediately before menstruation. Whatever medicinal laxative 
 is used, it should not be made a matter of daily routine ; once 
 or twice a week is sufficient, and alternating with an enema. 
 Gluten (Health Food Co.) suppositories or glycerin supposi- 
 tories are often useful. But whatever means is used, the child 
 should be impressed with the importance of regularity as to the 
 hour, and should never vary, never let anything else call her 
 away; and parents should see that she has a comfortable closet 
 to go to. Many a case of obstinate constipation has come from 
 the dread of a cold out-house in an exposed yard. 
 
 The varieties of disordered menstruation are known as 
 amenorrhoea, dysmenorrhoea, and menorrhagia ; the former mean- 
 ing absence of menstruation, the second difficult or painful 
 menstruation, and the third an unusual flow at that time. 
 Delayed menstruation — that is, where a young girl has reached, 
 say, the age of nineteen without the appearance of the flow — 
 is apt to give rise to much anxiety. If this is associated with 
 evidences of tardy sexual development, it is not of itself 
 alarming, and cases are on record where women have married 
 and given birth to children without ever having menstruated. 
 But it is always well, and especially if occasional signs are 
 present of an attempt at the establishment of menstrual flow, 
 not to allow this state of aifairs to run on long. The family 
 physician should be consulted, as the obstacle may be a me- 
 chanical one, or certain causes may exist which could be readily 
 removed, but which otherwise might lead to serious disease. 
 It is a recognized fact that the general mortality of women is 
 increased at this period of life, and as soon as the establish- 
 ment of the menstrual flow takes place the mortality shows a 
 reduction. In the cases just mentioned it will be readily un- 
 derstood that to attempt to bring on the period by hot baths, 
 or especially by the severe and forcible means of powerful drugs 
 obtained without the doctor's consent, would be harmful, even 
 fatal, and we regret to say that many such accidents haj^pen. 
 
MENSTRUATION. 173 
 
 Dr. Mathews Duncan thus writes of delayed menstruation : 
 " Like other processes of development, that of the generative 
 system admits of considerable variation in point of time, with- 
 out of necesfeity passing the limits of health. Indeed, just as 
 one child cuts its first tooth at seven months and another not 
 till a year old, so one gii'l will menstruate at fourteen to fifteen, 
 and another not till seventeen." Weakness or feebleness of 
 constitution, more or less the result of city life, may be in 
 itself another cause for this condition. We quote again from 
 the above author : 
 
 " A girl previously in good health approaches the time of 
 puberty; some of the changes characteristic of it take place: 
 the form assumes the contour of womanhood, and nothing but 
 the occurrence of menstruation is wanting to announce the 
 completion of the change. The menses, however, do not show 
 themselves, but the girl begins to suffer from frequent head- 
 aches; and the flushed face, frequent backache, pains in the 
 lower portion of the abdomen, constipation, a furred tongue, 
 and a full pulse, and all these signs of constitutional disorder 
 undergo a marked increase at stated periods of about a month. 
 At length menstruation occurs, though in all probability 
 scantily, and attended with much pain, and then for several 
 months together there is no sign of its return. The general 
 health was at first probably not seriously disturbed, but by 
 degrees the patient becomes habitually ailing, the appetite 
 falls off, the powers of digestion are weakened, the strength 
 becomes unequal to ordinary exertion, the pulse grows feeble 
 and frequent, and the face itself assumes a pallid, sallow tinge, 
 whence the term ' chlorosis,' ' green sickness,' has been selected ;" 
 and it might be added that such patients are not by any means 
 necessarily thinner than usual. The great mistake most 
 people make is to attribute this to disorder of the liver; they 
 call it biliousness, and are apt to do harm by overdosing for 
 this supposed condition. Again, they will imagine languor 
 represents weakness, and immediately have recourse to some 
 strong preparation of iron or the inevitable dose of quinine, 
 
 15* 
 
174 MOTHER AND CHILD. 
 
 and then seem surprised that no improvement follows. It is 
 the tonic influence of fresh air, healthful pursuits, exercit^e 
 short of fatigue, and a nourishing, wholesome diet, of which 
 milk should form the essential feature, that does most good, 
 aided by those drugs which the investigation of the careful 
 physician has warranted his suggesting to aid nature. 
 
 In the treatment of this form of difficult menstruation, 
 which is applicable as well to those cases where, from one 
 cause or another, the period has been missed by an ordinarily 
 healthy girl, either from exposure to cold or the resuli of some 
 shock to the system, or perhaps from the debility consequent 
 upon convalescence from fever, or some such cause, Dr. Dun- 
 can says. " The patient should be kept quiet, and if there is 
 any considerable suffering or much disturbance of the circula- 
 tion, it is desirable that she remain in bed, while the hot hip- 
 bath night and morning should be rendered still more stimu- 
 lating, in cases where the local pain is not considerable, by the 
 addition of some mustard." A gentle laxative should be admin- 
 istered, such as a dessertspoonful of the compound liquorice 
 powder, or a teaspoonful of magnesia or phosphate of soda, or, 
 better than alL probably, a dose of castor oil. Should there be 
 much pain, hot applications to the abdomen, either in the form 
 of a light meal poultice or a flannel bag of hops wrung out fre- 
 quently in hot water, in addition to a hot foot-bath. Under 
 no circumstances whatever should the powerful irritants sold 
 in the drug-shops for such purj^oses be used ; all drugs should be 
 left for the physician to order. The use of hot teas is recom- 
 mended, — ginger tea, tansy tea, etc., — and by such means en- 
 deavor to encourage and not force the habit of menstruation. 
 An excellent tea can be made from powdered ginger, senna, 
 and dulcamara ; it is laxative, and can be used every night 
 with no bad efi'ects. 
 
 The subject of pain during this time next claims our atten- 
 tion. At times it is so intense as to demand immediate relief; 
 and frequently persons, especially those who have not the 
 ■mother's care or her experience to guide them, will put off 
 
MENSTR UA TION. 175 
 
 month after month the consultation with their phj-sieian, 
 hoping that time will bring relief, and endeavor by various 
 means to struggle through the periods which to them bring re- 
 newed horrors, and which finally wear them out by the constant 
 effort to withstand the pain. And what means do they adopt 
 to obtain relief? We regret to say it, little reflection is given 
 as to the cause of the disturbance. The period once over, they 
 assume the same habits which have resulted in making a func- 
 tion normally painless fraught with pain ; the same giddy life 
 of society or the same over-indulgence in mental excitement 
 and all that tends to enervate both body and mind. The cause 
 of their trouble never for a moment attracts their serious atten- 
 tion ; the treatment that they ajjply for their relief consists 
 only in that which dulls their sensibilitj^ and deadens their 
 nervous system. Alcohol in some form, whether gin or brandy, 
 and opium, bromides, or chloral, are used in large amounts, 
 and made to play the part of the greatest curse of a house- 
 hold. 
 
 We do not mean to say that all those who suffer do so on 
 account of indiscretion, nor do we believe that the most rigorous 
 and careful living would at once relieve the tendencies to peri- 
 odical pain ; but we cannot dwell forcibly enough upon the fact 
 that those whose temperament is such that the slightest cause 
 will result in hours of torture, can be in time relieved by rest, 
 nutritious diet, and careftd living. 
 
 If there be one cause more frequent than others to which 
 the agony of the period is due, it is constipation. When the 
 question is asked, the}^ will positively assert that their bowek 
 are moved daily with regularity ; but probably a very small 
 portion of the matter contained is passed, and a large amount 
 remains accumulated, which presses against the tender, con- 
 gested ovary as a morsel of food or a filling presses on the 
 sensitive nerve of an inflamed tooth and causes the severest 
 form of neuralgia. We have not gone deeply into this subject, 
 but have been sufiiciently explicit to enable any one to under- 
 stand this matter so as to prevent it. It is on this account that 
 
176 MOTHER AND CHILD. 
 
 enemas are so effectual at times, and especially if a teaspoonful 
 or two of tincture of assafcetida is added to the warm water ; 
 but one of the gravest of mistakes is to attempt to treat such 
 cases by strong purgatives without the advice of a physician ; a 
 gentle laxative will encourage nature, a purgative may bi'ing 
 about a very serious inflammation. By the frightful abuse of 
 stimulants, though the habit is brought about without a thought 
 on the part of the sufferer, she is doing herself a most grievous 
 wrong ; month after month, each time increasing the dose, she 
 will have recourse to her bottle of gin, her mixture of morphia, 
 or her bottle of chloral, until finally she recognizes the unfort- 
 unate fact that she has become a victim to its use. It is far 
 better to begin by a firm determination to avoid them at the 
 onset. 
 
 You want to relieve a congestion and bring on the flow. To 
 do this, apply hot cloths or poultices to the abdomen, hot salt- 
 bags to the back, a hot hip-bath and foot-bath, rest in bed or 
 lounging around one's room in loose clothing ; or if the pain 
 is not too severe, a moderate walk, or an agreeable change 
 that will occupy the mind, and calm the nervous system by 
 pleasant thoughts. The next thing should be the administra- 
 tion of a laxative, and probably tlie best of all is an enema 
 which will secure the thorough removal of matter that may be 
 the cause of trouble. A thin gruel may be used, made of oat- 
 meal and strained. Of this about a pint should be used, or of 
 the ordinaiy Castile soap and water. If mothers 'who are 
 solicitous about the well-being of their daughters would gain 
 their confidence at these times, and minister to them during 
 their hours of pain, applying those remedies which their ex- 
 perience has proved valuable, thei'e would be far less suffering 
 and far less danger of the habitual use of drugs that can be 
 hidden in some convenient closet and taken ad libitum. Fre- 
 quently the pain is so severe that a physician is called in, who 
 gives a prescription — a strong anodyne in a pleasing mixture — 
 or suppositories of opium. The relief is magical ; the patient falls 
 into a quiet sleep, and, barring the nausea and headache of the 
 
MENSTRUATION. 177 
 
 following day, is surprised at the result. A copy of the pre- 
 scriptiou is obtained, and it serves ever after for herself and 
 friends. This is wrong, and every right-minded woman should 
 feel that to expose herself to a habit of this kind is to sacrifice 
 her life to a slavery which ends only in the grave. It is far better 
 to consult the family physician at once and tell him frankly 
 and without hesitation what the trouble is. It is an old story 
 to him ; he has listened to many lectures upon it, he has re- 
 cited your symptoms in class, he has heard the tale often told, 
 until it has assumed a very monotonous sound. You imagine 
 that the matter is too delicate a one to speak of without em- 
 barrassment, but you forget that the position your family physi- 
 cian holds towards you is one so intimate and confidential, so 
 sacred in its associations, that it has received the sanction of 
 heaven it^^elf, as you arc bidden to obey him. 
 
 The severest form of painful menstruation is that which 
 occurs in young women whose period has not appeared till a 
 much later age than usual. " The pain in such cases precedes 
 menstruation for a day or two, generally reaches its greatest 
 intensity in the course of the first thirty-six hours of the flow, 
 being sometimes so intense that the patient writhes in agony, 
 and then often by degrees subsides, though it does not cease 
 entirely till the period is over, though severest in the uterine 
 and pelvic regions (lower part of the abdomen). The pain is 
 not generally limited to these situations, but is experienced 
 also in the back and loins, and shoots down the inside of the 
 thigh. The pain, too, is aggravated at intervals, and becomes 
 paroxysmal like colic ; and the whole abdominal surface is so 
 tender as scarcely to bear the slightest touch. Intense head- 
 ache is very frequent, often confined to one side of the head ; 
 and in other cases the stomach is disordered and the patient 
 distressed by constant nausea and vomiting." The treatment 
 may be summed up as follows : absolute rest before the pe- 
 riod is expected, avoidance of any active enterprise, running 
 up- and down-stairs, horseback exercise, tennis, long walks, and 
 sudden changes of temperature ; to have the bowels moved 
 
178 MOTHER AND CHILD. 
 
 freely by compound liquorice powder or some sueti simple 
 laxative. ExjDosure to cold is very apt to bring this on, and it 
 is especially liable to occur in girls who sit out of doors after 
 dark in their thin summer clothing, and thus allow the damp, 
 cool air after nightfall to chill the surface before the expected 
 period. This is frequently noticed at the sea-shore or mountain 
 resorts. How many of the gayly-dressed beauties, in their 
 lightest clothing, will dance a waltz through and then rush 
 frantically for a walk on the porch, and will next day suffer 
 tortures in their rooms for their imprudence, while their friends 
 marvel at the number of sick headaches they seem to have ! 
 Sleep, rest, — absolute rest in bed, — hot foot-baths prolonged 
 and frequently repeated, a strong, hot, well-seasoned cup of 
 beef-tea, are the best means of procuring relief. If the pain 
 still continue, a hot lemonade with a dessertspoonful of sweet 
 spirits of nitre to the tumblerful. The applications to the surface 
 of the abdomen are usually valuable on account of their warmth ; 
 a mush poultice well sprinkled with laudanum is useful, or a bag 
 of hops, quilted, wrung out frequently in hot water and wet 
 with the spirits of chloroform. Frequently a hot salt bag to 
 the back will give relief, or the rubber bag filled with hot water. 
 " In some of the cases, the discharge, having continued for a few 
 hours, ceases and then comes on again, while, though scanty, it 
 is intermixed with small ' clots.' " 
 
 In these cases anodynes no longer furnish the ready relief 
 which follows their administration in the neuralgic form. 
 There are so many causes for this form of dysmenorrhoea that 
 the physician should at once be consulted, in order that the 
 proper treatment may be instituted before the next period. 
 Laxatives, such as the various purgative waters, give relief in 
 these cases; the granular effervescent Carlsbad salt, a table- 
 spoonful in water, may be taken, or a claret glass of Hunyadi 
 water, or Friedrichsball water with an equal part of hot water. 
 A free purgative action of the bowels should be the first thing 
 to accomplish. If the patient is away from a physician, she 
 should take a tahlespoonful of liquor ammonioe acetatis during 
 
EDUCATION AND SCHOOL-HYGIENE. 179 
 
 the painful time, when the flow is scanty, in some weak, hot 
 lemonade every two hours, until three or four doses have been 
 taken. Should the pain still remain severe, notwithstanding 
 these domestic remedies, the physician should be sent for and 
 the matter fully explained to him. 
 
 It is so obviously the mother's duty to be the confidante of her 
 child while nature is establishing these physiological processes, 
 that we have felt the necessity of adding this chapter to our 
 book. Most of the disorders of the nervous system which 
 attend this time of life are directly traceable to indiscretions 
 ^ which are the result of ignorance. The intellectual girl of 
 sedentary habit offends nature by retarding her physical de- 
 velopment. The thoughtless enthusiast lays the seed of future 
 disorders by an ignorance which the timely admonition of a 
 watchful mother would avoid. 
 
 CHAPTEE XXXYl. 
 
 EDUCATION AND SCHOOL-HYGIENE. 
 
 The question of education is a most important one, and it 
 will not be long after the child ceases to need the ever-careful 
 watchfulness of its nurse before that problem will present 
 itself. The Kindergarten system serves as an admirable initia- 
 tion to more elaborate methods, and serves to interest the 
 little one while it gradually educates its mind in the proper 
 methods of thought, and teaches it to observe, reason, and 
 express its thoughts. Education does not mean mere book- 
 learning; it enters, or should do so (alas! in how many house- 
 holds this part is totally disregarded !), into the training of a 
 I'hild from the date of its dawning reason. The mental disci- 
 pline from obedience, from example, from proper surroundings, 
 constitutes the first great educational step. Unfortunately, in 
 this country the ambition of parents or the political manage- 
 
180 MOTHER AND CHILD. 
 
 ment of public schools educates children of the working 
 classes above their sphere in life. Not for a moment do we meaa 
 that persons can know too much, but they can obtain a veneering 
 of dangerous knowledge by reason of iis superficiality, which 
 only renders them unfit to assume positions attainable by 
 knowledge, and makes them too proud to labor in meritorious 
 work beneath their dignity. "Knowledge is power," but '-'a 
 little knowledge is a dangerous thing." 
 
 Mental and physical development should go hand in hand ; 
 overbalance in favor of the first will lead to disease ; of the 
 latter, to brutality. A mother should remember that " the boy 
 is father of the man;" the child's early training and discipline will 
 be the key-note of its after-life. The lessons of the nursery, by 
 its mother's knee, are the beacon light of its conscience in after- 
 years ; the seed then sown bears fruit in manhood. " A sound 
 mind in a sound body." Dr. D. F. Lincoln thus writes^ in 
 regard to school-hygiene : 
 
 '• Measured by the standard of the German schools, our chil- 
 dren do not have much overwork to complain of. Ten hours 
 a day, study and recitation, is a common requirement in gym- 
 nasia (classical schools) for boys of ten to fourteen years of 
 age; with us the work done in 'high schools' from the age 
 of twelve to eighteen varies fi-om six to about seven and a 
 half hours for average pupils; in colleges it is about eight 
 hours, and at "West Point and Annapolis nine or ten at most. 
 These requirements for American schools are not excessive. 
 But it is beyond a doubt that we compel younger children to 
 attend too long. If a child enters a primary school at five, he 
 is kept three hours in the morning and two in the afternoon, 
 — or fully two hours too long for his good. He is kept in, 
 nominally at work, far beyond the period for which he has the 
 power to use his mind at the work. The researches of Edwin 
 Chad wick have furnished us with data governing this point, 
 
 1 Keating's Cyclopaedia of the Diseases of Children, vol. iv. We take 
 pleasure in quoting freely from this valuable article. 
 
EDUCATION AND SCHOOL-HYGIENE. 181 
 
 which have never been set aside. He states that a child from 
 five to seven years old is able to attend to one subject for 
 about fifteen minutes, which should be the length of a lesson ; 
 from seven to ten year^, about twenty minutes ; from ten to 
 twelve years, about twenty-five minutes; from twelve to six- 
 teen or eighteen years, about thirty minutes. The total power 
 of attention for one day is somewhat in proportion to this. It 
 is a disgrace to our communities that they insist on having the 
 little ones sent, more to be taken care of than taught, for the 
 same number of hours that make a banker's day. Everv 
 minute in school, after their power of attention is exhausted, 
 is given to forming the habit of inattention, which is clear 
 loss to education. That health must suffer, is certain. 
 
 "The city of St. Louis fixes the age for admission at seven ; 
 but there are numerous kindergartens which take younger 
 children. The kindergarten is one of the best charities of 
 modern times ; it teaches neglected children habits of neatness, 
 order, punctuality, civility; feeds, washes, and clothes them 
 when necessary; keeps them half a day in an atmosphere of 
 physical purity and health, and must be classed as the best 
 evidence of what schools may do for hygiene. On the other 
 hand, the kindergartens for children of wealthy parents are 
 not wholly free from the charge of over-stimulating their 
 pupils. There is a constant tendency among the new teachers 
 to urge and arouse children who are doing well enough already : 
 I quote the words of a very experienced senior teacher. Some 
 children, in fact, are too much aroused, and have to be re- 
 moved ; but the danger is understood ; and, on the whole, 
 these children also receive moral lessons that are of inestima- 
 ble value. 
 
 " The fault of the old-fashioned school was in neglecting the 
 pupil's understanding of the subject and his interest in it. 
 These points have now been so thoroughly studied that it 
 seems as if les'^ons had become far too interesting for some 
 children. A bright bo}', making no progress in a common 
 school, is transferred to a ' Quincy' school and becomes devoted 
 
 16 
 
182 MOTHER AND CHILD. 
 
 to study, but he has to be taken out every few months to rest 
 his brain. The teacher ouo;ht of right to be taken out for the 
 same purpose, but she holds out — by the aid of coffee. 
 
 " A very exaggerated notion is entertained by some parents 
 regarding the value of primary work : as if children at the 
 age of five could be said to be students in the proper sense of 
 the word. Schooling at that age means something ladically 
 different from what comes later. In the words of W. T. Harris, 
 * We do not look so much to the gain in intellectual possessions 
 as to the training of the will into correct habits, during the 
 years previous to the seventh.' ^ In protest against the popular 
 delusion about losing no time, there is an occasional expression 
 of individual will, like this : ' I kept my little girl out of 
 school till she was eight (or ten) years old, and now she is up 
 with the rest.' There is a certain number of bright excitable 
 children who are benefited by this postponement of school-life. 
 . . . But the effects of anxiety are worse than those of carrying 
 heavy loads. 
 
 " It is a universal complaint among teachers that girls ruin 
 their health by social dissij)ation. The complaint is justified 
 by the facts, and it applies to almost all ages in school. The 
 fault is in the age we live in, which exacts too much and too 
 early display, and expresses the height of its contempt by the 
 word ' slow.' 
 
 " The parents of school-boys and school-girls ought to con- 
 sider that ' society' has not yet begun for them, — that school 
 is entitled to their entire strength ; in return for which, the 
 school ought to see that the children grow into the possession 
 of firm health. Many boarding-schools deserve praise for 
 their success in this matter, and it often happens that children 
 of rich and indulgent parents are never quite well except 
 when at boarding-school, where regular hours are kept and 
 sweetmeats are not allowed to be received from home. A 
 return to old-fashioned, English notions' about the value of 
 
 1 St. Louis School Eeport, 1872-73, p. 18. 
 
EDUCATION AND SCHOOL-HYGIENE. 183 
 
 play seems to be making, also, in boys' schools. But it is the 
 girls that .g\v& most anxiety, because of their readiness to 
 undertake double tasks. .... 
 
 " DYSPEPSIA. 
 
 " This is an established national trait of Americans, and a 
 familiar symptom of overwork at school. The first point to 
 be noticed here is the fact that it is not (as seems to be popu- 
 larly supposed) a local trouble, to be cured by some doses of 
 medicine, but a symptom of general want of force in the 
 system, to be cured by fresh air, exercise, food, sleep, and good 
 regimen in general. 
 
 " The school is responsible for dyspepsia, in some cases, by 
 interfering with the pupils' opportunities for regular meals. 
 The old plan gave two hours of free time at noon, during 
 which children had a good dinner ; the new plan, already in- 
 troduced into high schools and beginning to creep into those 
 of lower grade, keeps the child from nine to two o'clock, with 
 no food except the wretched ' lunch' of cake and sweets, dis- 
 missing him in an exhausted state from the day's work, to 
 seek for more cake or pie in the cupboard, or else to await the 
 family sujDper or dinner with what patience he may command. 
 
 " The privilege of having a whole afternoon to one's self is so 
 highly esteemed that we shall not probably see a return to the 
 old plan. A modification, however, by which an hour's recess 
 is given midway in the session affords ample time for the con- 
 sumption of a proper lunch, as is the custom in one of the 
 Chicago fitting-schools. 
 
 " Children often lose appetite during the course of a school 
 year, nor is this always evidence of overpressure, but some- 
 times of mere confinement to the house and want of exercise. 
 Some, particularly girls, have no appetite for breakfast: they 
 must not be allowed to indulge this want of appetite. Very 
 many think it worse to be tardy than to lose a breakfast: 
 they pei"haps are lazy at times in the morning, or have been 
 up late at an entertainment; or they may live a great way 
 
184 MOTHER AND CHILD. 
 
 from school, and may leave home before the family are quite 
 ready for breakfast. Many teachers notice children occasion- 
 ally coming to school in a famished state from such causes; it 
 is a duty to send them home at once, with advice. 
 
 " Other children there are in whom this failui^e of appetite is 
 a warning to investigate the day's doings. It is fully as bad 
 when children acquire a habit of depending on a cup of tea or 
 coffee at breakfast. 
 
 " HEADACHE. 
 
 " The causes of headache are as various as those of dyspepsia. 
 
 " If there is distinct excess of mental work, this will often 
 produce increased irritability of the brain, and disturbances in 
 the circulation of that organ. There is not a very gi'eat 
 amount of this overwork in our own schools, perhaps. In 
 Germany, and in the countries that have formed their educa- 
 tional systems upon her models, excessive study is the rule, 
 and the result is coming to light in some of the more recent 
 statistical reports, as well as in a general popular protest 
 against the cruel exactions that are made. . . . 
 
 " The headaches suffered by hypermetropic [far-sighted] chil- 
 dren are cured at once by suitable (convex) glasses, and by no 
 other treatment. The public ought to become aware of this 
 rather common class of cases. The patients are literallj^ unable 
 to accommodate their eyes for reading without hurtful efforts. 
 
 " NERVOUS DERANGEMENT. 
 
 " The term nervous derangement covers a wide field. One of 
 the common forms among school-children is sleeplessness, or 
 restless sleep disturbed by dreams. Chorea [St. Yitus's dance] 
 is brought on in some predisposed children by school-work. 
 Either of these conditions should give instant warning. 
 
 "A fair statement of the general condition of city public- 
 school children has been given by Dr. C. F. Folsom:^ 'Pale 
 
 ^ Six Lectures on School-Hygiene, Ginn & Co., 1885. 
 
EDUCATION AND SCHOOL-HYGIENE. 185 
 
 faces, languid work, poor appetite, disturbed sleep, headache, 
 and what is vaguely called nervousness, are more common 
 among them than they should be among children of their ages. 
 I doubt whether there is an exaggerated prevalence of manifest 
 or well-marked diseases of the nervous system among them. 
 If due to the school-drill, my impression is that they come for 
 the most part later in life, after the children have left school, 
 and becatise of constitutions weakened during the school-years, 
 instead of strengthened, as they should be.' 
 
 " The impression which the appearance of city school-children 
 made on the writer, when a visitor, precisely corresponded 
 with the above statement. 
 
 " Some children are extremely sensitive to the influence of 
 their comrades. They are unfit to mingle in a crowd; they 
 lose the power of expressing themselves in reciting; their 
 manner betrays mental pain and constraint. The rigid air of 
 discipline in large schools keeps many in an unnatural state. 
 Young girls entering college sometimes suffer greatly from 
 being obliged to live in the midst of crowds, with so much less 
 of personal freedom than young men enjoy under like circum- 
 stances. 
 
 " CHOREA. 
 
 " St. Vitus's dance is mainly a disease of the lime of bodily 
 development : the greater jDart of the cases occur from the 
 sixth to the fifteenth year, which includes the second dentition 
 and pubei'ty. It belongs to the class of diseases which may 
 spread by psychical contagion among children. Among the first 
 symptoms is a change of temper from cheerfulness to fretful- 
 ness or apathy, and along with this the powers of attention 
 and memory fail in a way which the teacher may be the first 
 to notice. A child suffering from chorea, therefore, is unfitted 
 for associating with school-children or performing school-work ; 
 and the first step in the treatment must be to remove it from 
 school and stop all head-work at home. There is a certain 
 number of children who possess a predisposition to comjplaints 
 
 16* 
 
186 MOTHER AND CHILD. 
 
 of this sort, and are not fit members of ordinary schools, with 
 the strain on the faculties which seems a necessary attendant 
 upon our system of large classes and fixed tasks. Such chil- 
 dren may develop well, if educated quietly and with much 
 open-air freedom. 
 
 " EPILEPSY. 
 
 " Children liable to attacks of epileptic fits are not proper in- 
 mates of school-houses. They are often backward, or even 
 feeble-minded. They are usually peculiar in temper, — easily 
 excited and falling into ungovernable rages, given to lying, and 
 licentious. It is impossible to manage them by the ordinary 
 course of discipline ; they are not understood by the average 
 teacher, and do not belong in the common school, but in those 
 special establishments where their nature is understood. Be- 
 sides the moral danger to which their presence exposes the 
 scholars, the occurrence of an attack in the presence of young 
 people is a thing to be greatly dreaded. Fright is a recognized 
 cause of epilepsy in well persons ; and a person in a fit is a 
 spectacle quite ugly enough to frighten others into fits. Add 
 to this the facts that childhood is eminently susceptible to 
 nervous impi-essions, whether of fright or otherwise, and that 
 most cases of epilepsy originate in childhood. 
 
 " Of epilepsy as a possible consequence of overwork in school, 
 little may be said. The connection 'is not proved, but we 
 cannot wholly reject the possibility of it.' ^ 
 
 " NEURASTHENIA, OR BREAK-DOWN. 
 
 "A complete failure of strength, bodily and mental, is some- 
 times the reward of excessive zeal in study. A partial break- 
 dovvn, implying a year's semi-illness, with a recovery to one- 
 'half the former working-powers, is rather common. High 
 schools, normal schools, and colleges furnish the cases. . . . 
 
 "Break-down is notoriously common in young women, and 
 
 1 Notlinagel, in Ziemssen's Cyclopsedia. 
 
EDUCATION AND SCHOOL-HYGIENE. 187 
 
 excess of work or some other distinct cause is usually traceable. 
 It may occur shortly after the graduation, rather unexpectedly. 
 
 " BACKACHE. 
 
 " This is not the name of a disease, but is used here as desig- 
 nating a class of cases described with admirable vigor by 
 Haward,^ — cases, not of spinal disease, nor of uterine disorder, 
 but of over-fatigue. 
 
 " ' It is veny common,' says Haward, ' to see cases in which 
 such symptoms (backache and weakness of the spinal muscles) 
 are the more obvious evidences of over-fatigue, and in which a 
 careful examination will, reveal other signs of the same evil. 
 This is especially the case with young girls of feeble circula- 
 tion (evidenced by their cold han^s and feet), whose enthusiasm 
 for work is in excess of their physical powers. They rise early, 
 study before breakfast, sit long hours before the piano or easel, 
 or attend long and frequent religious services, retire to rest 
 late, take insufficient or innutritious food, and still further ex- 
 haust themselves by irregular and fatiguing exercise under- 
 taken with the idea of " working off the effect of over-study." 
 At last comes the break-down ; the poor girl who has been 
 cramming into one day the work of six, and who has been held 
 up by the fond and foolish mother as an example of industry, 
 piety, and intellectual excellence, finds herself exhausted and 
 ill. She cannot sit upright, her back aches terribly, her brain 
 feels weak, and in her depression and anxiety she thinks she 
 has some serious spinal disease.' 
 
 " DISORDERED MENSES. 
 
 " Painful or irregular menstruation is to be classed with neu- 
 ralgia, anaemia, headache, and the like, as a symptom of over- 
 pressure. 
 
 " In 1873 a work was published which attracted universal at- 
 tention in America, attacking, as it seemed to do, some cherished 
 
 ^ Treatise on Orttopsedic Surgery, p. 148. 
 
188 MOTHER AND CHILD. 
 
 features in American education. The book, Dr. Clarke's ' Sex- 
 in Education,' was certainly written with the intention of stir- 
 ring up discussion; and it succeeded. The author aflSrmed 
 that he had seen vast numbers of women whose health had 
 broken down, as he thought, owing to neglect of the menstrual 
 function at the formative period, and especially owing to over- 
 study, or, rather, uninterrupted study, during this period. The 
 purpose was to show that girls needed special care while the 
 menses were developing; that the healthj- performance of the 
 function is so important that no sacrifices are too great which 
 further its proper establishment ; that for many girls hard 
 study was one of the worst things that could be done during 
 the monthly periods ; that a rest was imperatively called for 
 by nature, and must be granted ' for a single day, for two or 
 three days, or half work for two or three days.' The inference 
 drawn from these -important truisms was that girls cannot 
 stand the strain of working side by side with boys in high 
 schools and colleges, whei'e it seems necessary to treat all alike 
 on every day of the year. If Dr. Clarke had refrained from 
 certain galling expressions, the tone of the rejoinders would 
 have been milder ; but his end was attained, and the public was 
 the gainer from the prominence given to the question. 
 
 " The replies made to Dr. Clarke showed that many women are, 
 apparently, complete exceptions to his rule in regard to an abso- 
 lute need of rest every month. One such exceptional lad}', in 
 her book, incidentally states that she has stood ten hours a day 
 in a store for five years, without the least trouble ; a remark 
 which may be improved by us as the occasion of proposing a 
 new rule for mixed high schools, — namelj', that in the upper 
 classes gii^ls ought never to rise in recitation. Opinions may 
 certainly differ on the point of rules for school-government, 
 but at this day there are many masters who are accustomed to 
 make allowance for girls, even to the extent of never giving 
 penalties for absence. If this does not meet the case, the 
 remedy ought to work through the feminine tact of assistants, 
 A little want of tact may spoil the arrangement; a word of 
 
ED VGA TION AND SCHOOL-HYQIENE. 189 
 
 complaint about frequent absences may appeal to the pride of 
 the girls in such a way that they will accept no more favors. 
 It was Clarke's opinion that girls could get through as much 
 work as boys, on the whole, ' working in their own way.' 
 
 " The principal of the St. Louis Normal School states ^ that 
 ' excuses relieving the students temporarily from work are 
 granted, whenever asked for on account of sickness, without 
 further explanation ; and I may say that it is my belief that 
 this privilege has been of great advantage.' The school in 
 question is exclusively for young women. 
 
 " CONSUMPTION. 
 
 " There is reason for believing that this disease is rather fre- 
 quently caused by school-influences, though it would be hard to 
 say how frequently. The story of the cases brings to mind 
 those of 'general break-down,' — the familiar 'nervous pros- 
 tration ;' the general list of causes is the same, — bad air, con- 
 tinued overwork without rest for repair of waste, — and the 
 difference in the effect is doubtless largely due to hereditary 
 predisposition. 
 
 "Bad air is notoriously influential in causing consumption. 
 ' The impure condition of the air of our houses, be they fac- 
 tories, public buildings, or dwelling-houses, has much to do with 
 the great prevalence of such diseases as phthisis pulmonalis, 
 bronchitis, and pneumonia, which together make up nearly one- 
 quarter of the total mortality. . . . Unventilated and crowded 
 workshops and schools are, moreover, the nurseries of strumous 
 diseases in general, which sap the strength of the community.' 
 
 " The following observations by Parkes bear upon this point : 
 'Usually a person who is compelled to breathe such an atmos- 
 phere [vitiated by respiration] is at the same time sedentary, 
 and perhaps remains in a constrained position for several 
 hours, or possibly is also under-fed or intemperate. But, 
 allowing the fullest effect to all other agencies, there is no 
 
 1 Eeport of Public Schools for 1878-79. 
 
190 MOTHER AND CHILD. 
 
 doubt that the breathing the vitiated atmosphere of respiration 
 has a most injurious effect on the health. Persons soon be- 
 come pale, and partially lose their appetite, and after a time 
 decline in muscular strength and spirits. The aeration and 
 nutrition of the blood seem to be interfered with, and the 
 general tone of the system falls below par. Of special dis- 
 eases it appears pretty clearly that pulmonary affections are 
 more common. Such persons do certainly appear to furnish a 
 most undue percentage of phthisical cases, — that is, of destruc- 
 tive lung-disease of some kind.' 
 
 " Carmichael (1810) and J^eil Arnott (1832) describe cases 
 where the diet of schools was excellent, and the only causes 
 for the excessive phthisis were the foul air and the want of 
 exercise. In fact, medical testimony lies all in the same direc- 
 tion. The presence of dust in the air is a very frequent cause 
 of bronchitis, asthma, or pneumonia in various trades, and 
 ought to be mentioned here. Consumption has been a ten'ible 
 scourge to the British and other foreign armies, chiefly owing 
 to the impure air of the barracks. The same is true of the 
 navy ; of prisons in general ; of monkeys in menageries, and 
 other unhappy confined creatures. 
 
 " In America the experience of Prof. H. I. Bowditch as a 
 specialist has led him to utter repeated warnings to the mis- 
 guided parents who urge their weakly children beyond their 
 powers. The following quotation outlines the history of this 
 class of cases : 
 
 " ' A young person, male or female, walks into my study for 
 the purpose of consultation in regard to health. I observe 
 great paleness of face, extreme emaciation, and trembling steps, 
 combined with a slight cough, and evidently more or less diffi- 
 culty of breath. These, if combined with a certain intellectual 
 expression of the face, almost immediately enable me to fore- 
 shadow a history somewhat as follows : 
 
 " ' Stimulated by ambition to be in the front rank of scholar- 
 ship, and desiring, owing to poverty or the known wishes of 
 parents, to obtain rapidly an education, the poor, scarcely de- 
 
EDUCATION AND SCHOOL-HYGIENE. 191 
 
 veloped child has been laboring for months, always overwork- 
 ing intellectually, and at times also physically. Perhaps the 
 victim has been carried many miles daily to and from school. 
 Study at school, in the cars, and afier return at night, some- 
 times twelve to fourteen hours, has been the daily rule. [In 
 one case the girl went forty miles daily to and from school, in 
 all weather, winter and summer.] 
 
 " ' Of course, utter prostration is the result. The appetite 
 fails or becomes capricious under severe fatigue and irregularity 
 of meals. Gradually a cough is noticed, and it is th(jught " a 
 cold has been taken." . . . 
 
 " 'The cough and the educational race continue on together. 
 Finally a failure of strengtla manifests itself, and then, for the 
 first time, the parents begin to look with concern at the ap- 
 pearance of their child. But neither child nor parent thinks 
 of giving up school. Perhaps it is towards the end of the 
 term. " Only a few weeks more," and the coveted prize will 
 be gained, and then rest and cure can be attempted. ... At 
 last the long-wished-for goal is reached. The first honors are 
 gained, but they are now of little comfort, for all strength, 
 which has been artificially kept up by the excitement of the 
 race, suddenly leave the patient, and the pupil does nothing 
 afterwards. . . . All ideas of cure, or even of partial relief, 
 have disappeared.' . . . 
 
 " It is important to note that the blame for such abuse of 
 life is placed upon the parents, rather than upon any stimulus 
 supplied by the teachers. 
 
 " If a child has hereditary tendencies to consumption, it is 
 imperatively necessary to select 'a proper, reasonable, well- 
 ventilated school (especially one in which the frequent opening 
 of windows is avoided). No overwork of mind or body should 
 be permitted. If the health fail at all, absolute removal from 
 school is required ; travel or anything else should be under- 
 taken that will interest and keep the pupil from books and out 
 of doors, and let the education, so called, take care of itself 
 
 " In another place the same eminent authority remarks that 
 
192 MOTHER AND CHILD. 
 
 'in a consumptive family the steadfast rule should be, that the 
 nwid be icholly subservient to the body's welfare.' 
 
 " In a report on the causes or antecedents of consumption, 
 the opinions of two hundred and ten correspondents were 
 summed up as follows. The question having been put, ' Is 
 consumption ever caused by over-study at school or college?' 
 the answer ' yes' was given by one hundred and forty-six ; 
 ' yes, indirectly,' by seven ; ' no,' by twenty-one ; ' doubtful,' 
 by ten; and twenty-six gave no answer. 
 
 "The circumstance that residence on a damp soil is one of 
 the most powerful predisposing agents to consum23tion ought 
 to have its influence when the site of the school-house is 
 selected. 
 
 " Here we may end the description of the ailments commonly 
 grouped together when the effects of overwork are described. 
 Spinal deformity and near-sight are susceptible of being classi- 
 fied with these, for weakness is an element in both. It is more 
 suitable, on the whole, to describe them separately, on account 
 both of their special importance and of their mechanical rela- 
 tions to desks and seats. 
 
 " SPIXAL DEFORillTIES. 
 
 " Under this heading belong two distinct affection?, — lateral 
 curvature and round shoulders. With the latter is associated 
 the 'hollow back' or excessive curve at the loins. Lateral 
 curvature is the object of our present study. 
 
 ^^ Lateral curvature, in the popular eye, is an inelegance of 
 person, surmountable by the aid of the dress-maker. The 
 physician sees in it a consequence and a cause of low vitality. 
 
 '• The great majority of cases of this curvature originate in 
 children from the age of five or six upward, and in young 
 persons who have lately been in school. This might be 
 thought a mere coincidence ; for the school-period is necessarily^ 
 the period of development, and the curvature is a disease of 
 development. But there is evidence that school work and 
 
EDUCATION AND SCHOOL-HYGIENE. 
 
 19- 
 
 Fig. 17. 
 
 Fig. 18. 
 
 customs are genuine causes,— not by any means the sole causes, 
 but rather prominent ones. 
 
 " The origin of lateral curvature depends chiefly on two 
 things,— weakness of the muscles which support the spine, 
 and bad positions of the body. Weakness, however, is not a 
 necessary circumstance, though an extremely common and 
 often important one. A bad posi- 
 tion constantly maintained will 
 twist the most athletic frame. A 
 very muscular person may be forced 
 to stand in a one-sided position by 
 the circumstance of having one 
 leg shorter than the other. Fig. 17 
 gives a rough but sufficient idea of 
 the way in which the body is sup- 
 ported on the legs. If the right 
 leg is shortened (Fig. 18), the pelvis 
 or hip-bone will be tilted to the 
 right, and the lower part of the 
 spinal column, being firmly attached 
 to the pelvis, will tilt with it. If 
 the whole spine remained straight, 
 
 the person would be thrown off his balance; the spine must 
 therefore curve to the left at a higher part; and further- 
 more, to make up for the overweight thrown to the right 
 below, there occurs a ' compensating' curve to the left at 
 the height of the shoulders. In addition to this, the spine 
 is in parts twisted, with a gimlet-motion; but this is not 
 represented here. 
 
 "A similar thing happens when children stand on one leg, — 
 a position which practically shortens the other leg. 'A most 
 pernicious habit, and one which is very often to be noticed in 
 school-girls (I think I have observed it in girls more frequently 
 than in boys), is that while we are talking to them, or during 
 recitations, especially if they are much interested in w^hat is 
 going on, they are standing on one leg. The position is assumed 
 in 17 
 
194 
 
 MOTHER AND CHILD . 
 
 involuntarily, and it is alwavS; or almost always, one and the 
 same leg on -whicli the weight is thrown. The effect of this 
 is easily understood : one side of the pelvis is lifted up, curv- 
 ing the spine in the loins; the opposite leg is advanced in 
 front of the other, twisting the pelvis and rotating the verte- 
 brae. Of course the curve of compensation takes place be- 
 tween the shoulders. One is depressed, the shoulder-blade 
 gradually projecting, and with the change, and in fact assist- 
 ing to produce it, occurs the spiral twist.' ^ 
 
 " Many curvatures begin in the region of the shoulders ; of 
 these, beyond doubt, the cause is largely to be found in false 
 positions in writing or drawing. ' I have visited rooms in 
 which drawing was taught,' writes Brown, ' where all, — male 
 and female, — with scarcely an exception, were sitting in a 
 position not only to curve but to twist or rotate the spine, and 
 in most the position was such as to produce a triple curve.' 
 The deformed attitudes (so to speak) assumed in writing are 
 
 powerfully described by Lie- 
 breich. Such occupations can 
 hardly be conducted in entirely 
 normal postures, but a great 
 deal can be done to correct the 
 grosser faults. One cause of 
 the defect is the raising of the 
 right shoulder by a high desk 
 or table, as is seen in the 
 sketch (Fig. 19) borrowed from 
 Guillaume. 
 
 " Another frequent cause ex- 
 ists when the desk is too far 
 from the seat, and the pupil is 
 forced to bend over his work 
 in an unbalanced posture, which cannot be maintained ; in a 
 short time, if not at once, he leans one side forward, puts elbow 
 
 EiG. 19. 
 
 ^ Lecture before the American Social Science Association, 1879. 
 
EDUCATION AND SCHOOL-HYGIENE 195 
 
 on desk or knee, and head on hand, and gets bis spine into the 
 shape of a corkscrew. 
 
 " It is desirable that every person directing or teaching a 
 school should have a notion of the proportions suitable for 
 desks and seats. Farther on, this matter is illustrated with a 
 few representative figures. But it is of the greatest conse- 
 quence to remember that no seats or desks can be devised 
 which will remove the original loeakness of muscle, which, 
 ranks as one of the two chief causes, and. would by many be 
 named as the one important cause. Children cannot be made 
 strong by supports. . . . 
 
 " That muscular weakness is a chief cause is further shown 
 by the treatment which is successful, consisting essentially of 
 prolonged and perfect rest to the weak muscles, by reclining, 
 combined with occasional moderate yet active exertion of the 
 muscles by appropriate exercises. Cases that are not far ad- 
 vanced may do well by using scientifically directed gymnastics. 
 Some need never be told that they have ' anything the matter 
 with the spine,' provided they can be got to change their habits 
 of living. 
 
 '' These principles need to be applied to the prevention of spinal 
 curvature in schools. The preventive treatment should consist, 
 when possible, of very varied muscular activity of an active 
 sort, taken at proper times. The best kinds are out-door 
 games of an athletic tendency, — leaping, running, coasting, 
 skating, climbing, and all sorts of 'hard play.' For boys, 
 wrestling, foot-ball, and boxing, and many more, may be 
 added. ISTo doubt, children must be kept from excesses, such 
 as trying to make a high score with the skipping-rope. Some 
 sports have a tendency to develop curvature, — croquet, decid- 
 edly; tennis, — when played with one hand; base-ball; horse- 
 back-riding on a one-sided saddle. Ladies should use two 
 saddles, one for each side alternately. Sports liberally indulged 
 in are, with this class of exceptions, the usual and natural pre- 
 ventive of spinal curvature among boys; if girls played out 
 of doors as boys do, they would have little trouble of that sort. 
 
196 MOTHER AND CHILD. 
 
 " The physical indolence of girls, however we may deplore it, 
 is not to be overcome at once. It arises in part from their 
 unwillingness to assert themselves as boys do ; their readiness 
 to submit to custom; and their power of sacrificing comfort 
 (i.e., health) for the sake of propriety. The misguided sense 
 of decorum, which prevents even walking in many cases, is 
 the same feeling that, neglecting certain of the lower func- 
 tions of the body, leads to the prevalent habit of constipation, 
 and occasionally to disease of the bladder. Every argument, 
 therefore, in favor of bodily training, or of the teaching of 
 gymnastics in schools, should apply with double force to the 
 female sex. 
 
 " The programme of a girl's life consumes the greater part of 
 the day in sedentary occupations. Sewing, piano-practice, 
 drawing-lessons, embroidery, are among the added burdens of 
 the life of girls at home. If parents cannot be induced to 
 take active steps for their children's physical training (and 1 
 fear they cannot), the school must undertake the task, on be- 
 half, at least, of the girls. 
 
 " The existence of sj)inal deformity has not yet received due 
 attention from our public. It is hard to get at the facts. 
 There are very few collected observations of masses of chil- 
 dren. Parents would dread the exposure of their children ; 
 but perhaps the popular mind would not object to a lady sur- 
 geon for girls. ~So figures are procurable from female colleges, 
 though the very great prevalence of curvature is admitted. 
 The late Dr. J. C. Warren in 1830 stated that of the well- 
 educated females within his sphere, about one-half were 
 affected with some degree of distortion of the spine. It is 
 not a wild guess to suppose that this is nearlj" true at 
 present. 
 
 " Spinal curvature is not only a product of low vitality, but it 
 does harm by permanently fixing -vitality at a low standard. 
 The spii'ometric observations of Schildbach (Amsterdam, 1862) 
 showed that the respiratory capacity of this class of children 
 at the ages of from thirteen to seventeen was lessened by one- 
 
EDUCATION AND SCHOOL-HYGIENE. 197 
 
 third, apd in some cases by one-half, — a matter of the gravest 
 importance in the maintenance of Hfe. 
 
 " Brown calls attention to the fact that too much mental 
 stimulus has an undoubted effect as one of the predisposing 
 causes of spinal curvature. Mental rest combined with other 
 appropriate conditions will sometimes cure the trouble in its 
 incipient stage. 
 
 " The disease may exist in a fully-developed form without any 
 apparent change in the direction of the spine as seen from be- 
 hind, even when the body is stripped: this is because the 
 twisting may be confined to the bodies of the vertebrae, which 
 are out of sight. The first thing usually noticed is that "the 
 shoulder grows out," or else is higher than the other one. 
 The ribs partake, and the chest is twisted out of shape. 
 
 "Patients may sometimes be kept in school who need special 
 seats. This is a matter for the surgeon to decide. 
 
 "DESKS AND SEATS. 
 
 " The improvement which has been made in American school- 
 desks and seats within half a century is very great. Few city 
 schools are now unprovided with ' modern' furniture, which 
 in most cases is decidedly better than the old. It is to be 
 hojjed that the excellence already attained will not stand in 
 the way of further progress. We have been quite successful 
 in reaching our ideal of comfort ; but we ought not to forget 
 that the subject has been much studied, from various other 
 points of view, by German and other investigators, and with 
 results which certainly differ from ours. 
 
 "Bad desks are chargeable with aiding the formation of 
 two of the most important ' school-diseases,' — near-sight and 
 spinal curvature. They cause the first by compelling pupils 
 to hold the eyes too near the object, and by favoring a stoop- 
 ing position at work. Spinal curvature is very much assisted 
 by the twisted postures which children take, especially in 
 writing. 
 
 "Let it be understood that it is not our object to make desks 
 
198 MOTHER AND CHILD. 
 
 and seats -which a scholar can occupy with comfort, assuming 
 and maintaining one 'normal' position, for hours at a time; 
 no, Dor for one hour. It is not possible to do this ; and, if it 
 were, it must needs injure the child. The discipline of a 
 school is a precious thing, but it should not interfere with the 
 child's need for change of attitude ; nor must the teacher 
 fancy that in prescribing fixed attitudes he is following the 
 dictates of 'medical science.' Attitudes assumed for a few 
 moments, for purposes of respect and attention, may properly 
 be foi-mal ; attitudes in study should be decent, but may be as 
 varied as possible, subject to correction when they become in- 
 jurious. The teacher should be a judge of the latter fact. 
 Esj)ecially should liberty be given to the younger classes. 
 There is indeed a great diiference between the mobility of a 
 kindergarten and the studious self-possession of a high-school 
 class at the age of sixteen or eighteen. 
 
 " Strength cannot be gained by maintaining any one posture, 
 unless in the sense that a comfortable posture gives strength 
 by resting the muscles. If a comfortable position is given, let 
 the child not be kept in it till rest itself is fatigue. 
 
 "As standing is undesirable exercise, so is sitting in a chair 
 without a back. It will not make the child's back strong, but 
 only causes fatigue, and drives the child to take all kinds of 
 unsuitable positions for relief. 
 
 " The young pupil should have a seat and desk so well adapted 
 to its form that it will be tempted to take the most correct 
 position, as being the most comfortable. It will not keep this 
 position long, however comfortable it maybe, but it will return 
 to it after making its little excursions and changes, and will 
 by degrees become accustomed to a normal position without 
 much being said about the matter. 
 
 " Little children may properly be taught to sit still, facing 
 squarely to the front, for five minutes at a time, when circum- 
 stances favor it. They may be taught, by degrees, to sit ten 
 minutes, but not through a school-session ; every rest must be 
 made up by a corresponding activity, — a change or a move- 
 
EDUCATION AND SCHOOL-HYGIENE. 
 
 199 
 
 ment, a song or a bit of gymnastic drill. Movement is a 
 child's way of resting : rest is a kind of work, to be taught by 
 degrees. 
 
 "As regards faulty positions, sfoopm^ contracts the chest and 
 compresses the abdominal organs. The child, sitting erect, 
 and wishing to bow the head towards the book, may be shown 
 that a very slight movement will accomplish that object, — a 
 hinge-movement at the upper part of the neck, and not at the 
 shoulders. The trunk does not need the support of the elbows 
 on the desk. One-sided positions easily become habitual, and 
 are then exceedingly objectionable : they are chiefly caused by 
 propping the arm or elbow on the desk. 
 
 " A comfortable back for the chair is best secured, not by 
 giving a series of marked curves intended to follow the natural 
 
 Fig 20. 
 
 curves of the body, but by giving, first of all, an emphatic 
 support to the lower part of the spine. The writer was re- 
 cently shown a rather stiff-looking seat, of which the dealer 
 remarked that all those who sat down in it at first said ' no,' 
 but if he could induce them to remain sitting fifteen minutes 
 
200 
 
 MOTHER AND CHILD. 
 
 he was sure to sell it. The seat in question has a flat bottom, 
 sloping a little down and back ; the back is tilted, and is com- 
 posed of two flat surfaces set together at an angle so small as 
 hardly to be noticeable, — the projection being one-quarter of 
 an inch from a straight line. (See Fig. 20.) This chair, suj)- 
 porting the pelvis solidly, gives gi^eat comfort. A somewhat 
 greater projection of the lower middle part of the back might 
 be useful. 
 
 "This principle, which the writer is convinced is of the 
 greatest value, may be carried out in other ways. The matter 
 
 Pig. 21. 
 
 Fig. 22. 
 
 Liebreich's desk and seat. 
 
 Varrentrapp's desk and adjustable seat. 
 
 is not wholly settled, as may be seen by comparing Figs. 21, 22, 
 and 23, given by different authorities. Liebreich's chair (Fig. 21) 
 is intended to sujjport the pelvis by following its outline by 
 a curve up into the small of the back : the projection of 
 the curve may be too great. Fig. 22 (Yarrentrapp's), and the 
 unshaded spaces in Figs. 23 and 24, give the impression of stiif- 
 ness ; they come to the height of the elbow, and give support 
 solely by a horizontal cross-bar at the top, allowing a Httle 
 open space below the bar. It is noticeable that many of the 
 later German plans proposed by scientific men give support in 
 
EDUCATION AND SCHOOL-HYGIENE. 
 Fig. 23. 
 
 201 
 
 Varrentrapp's seat and desk compared with a Boston school-chair and desk 
 (see Fig 25) for corresponding ages. 
 
 Fig. 24. 
 
 American curved-bacl: seat and desk (shaded), and Buchner's pattern, 
 for corresponding ages. 
 
20^ MOTHER AND CHILD. 
 
 this way. Their object is to enable the child to sit erect while 
 writing, with the aid of a partial support, not necessarily used 
 at all moments : it is thought that such a support gives the 
 habit of a correct attitude. Buchner was an inspector of 
 schools : he says, ' The children very soon feel that the per- 
 pendicular piece supporting the small of the back corresponds 
 with the structure of the body much better than the slanting 
 back which supports the shoulders. I often used to ask the 
 children whether they would not like to have a rest for the 
 shoulders, as well as for the back, but the girls always, an- 
 swered in the negative.' Cohn and Fahrner are also in favor 
 of the low support. It is of wood, two and a half to three 
 inches broad, and long enough to be reached by both elbows, 
 which may rest upon it when the child is not writing. It 
 must not be placed too high, or it fails to give due support. 
 
 " It may be doubted whether a low back-rest of this kind 
 or a slightly-inclined rest for leaning back, supporting shoul- 
 ders as well as pelvis, is, on the whole, the better. The present 
 writer is not in a position to decide ; yet a choice must be 
 made, since it seems impossible to secure a resting-chair which 
 shall also give support in writing. 
 
 " The popular American school-seat, with its back curved like 
 a long italic/, is not an ideal model. It is comfortable, — at 
 least some are, for there are varieties. Some of them let the 
 body slide down so that upright sitting is impossible ; others 
 are too low, which tends to increase the constriction of the 
 abdomen ; as a rule, they give the body a round-shouldered 
 position, being essentially lounging-chairs with the head-rest 
 cut off. Pig. 24 gives a good pattern. 
 
 " Our common wooden chair, with the back-sticks set in a 
 curved line, quite, fails to support the pelvis ; in fact, its defi- 
 ciency in this respect is a positive annoyance. Fig. 23 shows a 
 chair with this fault. It is built thus to give strength ; this is 
 better secured in an old pattern which prolongs the middle 
 piece down to the pedestal, following the dotted line, and so is 
 able to bring the side-pieces in line with the middle piece. 
 
EDUCATION AND SCHOOL-HYGIENE. 
 
 203 
 
 " Fig. 21 gives Liebreich's desk and seat, as designed for the 
 London School Board. The desk remains the same; the ac- 
 commodation for different ages is made by changing the chair 
 and moving the foot-rest. The shape of the seat is slightly 
 different for the two sexes. Thelid is hinged so that it can be 
 thrown into a convenient book-holder for reading. In writing, 
 the chair is placed so near that the edge of the desk just 
 touches the body. The height of the seat is correct when the 
 sloping line of the desk, prolonged, just touches the elbows. 
 
 " Fig. 22 gives the design for the desk and seat published by 
 the late Dr. George Yai'rentrapp, of Frankfort-on-ihe-Main, 
 in the Yierteljahrsschrift fur Gesundheitspflege for 1869. It is 
 the one from which the unshaded spaces in Fig. 23 are taken. 
 The desk remains the same for different ages ; the seats are of 
 different sizes, the dotted outlines corresponding to larger pupils. 
 
 " Fig. 23 gives a side-view, drawn to scale, of a highly-ap- 
 proved American school-seat, of a size intended for pupils from 
 ten to twelve years old. The position of the lid of the desk is also 
 given. The unshaded spaces show the position of correspond- 
 ing parts of the model designed by Yari'entrapp, of dimensions 
 suited for children of the average height of one hundred and 
 forty-three centimetres, which for American c-hildren repre- 
 sents a little over twelve years. The lower edge of the desk, 
 measured from the seat, is 4^ centimetres = 1.8 inches higher 
 in the American than in the German seat. The German back- 
 rest is on a level with the desk, and the pupil while reading 
 can easily prop his elbows upon it, maintaining an erect posture. 
 
 " The dimensions, in centimetres, are as follows : 
 
 
 6* 
 
 fa 
 
 
 
 
 1 
 
 
 O 
 
 o 
 
 " Z SI 
 
 ii 
 
 KM 
 
 n < 
 
 Seat 
 projects 
 
 UNDEli 
 
 Desk. 
 
 American . . . 
 
 36.9 
 
 64.8 
 
 27.9 
 
 (35) 
 
 30 
 
 5.2 
 
 Varrentrapp . . 
 
 40.2 
 
 63.6 
 
 23.4 
 
 23.4 
 
 28 
 
 2.6 
 
204 
 
 MOTHER AND CHILD. 
 
 " Pig. 24 gives the side-elevatiou of two full-sized desk-seats, 
 drawn to scale. The American desk is the largest size of one 
 of the most popular kinds. To correspond with this, Buchner's 
 tables were taken, and the dimensions calculated for a person 
 five feet six inches in height ; the lines of desk and seat are 
 given with shading for the latter case. The difference between 
 the heights of the desks is nearly 4 centimetres = 1.6 inches. 
 The difference is increased, practically, by the downward and 
 backward curve of the American seat. 
 
 "The dimensions, in centimetres, are as follows: 
 
 ' 
 
 S 
 
 O 
 
 «5h' 
 
 fc !^ :i 
 
 Height of 
 Back-rest, 
 
 i 
 
 SHAT 
 
 PROJECTS 
 
 UNDER 
 
 Desk. 
 
 American . . . 
 
 43 
 
 76 
 
 33 
 
 (44) 
 
 44 
 
 1 or 2 
 
 German .... 
 
 42.9 
 
 72.1 
 
 29.2 
 
 32.1 
 
 23.8J 
 
 6.2 
 
 " Fig. 25 is the American model from which the drawino- Fiff. 
 23 is taken. The fact that the desk-lid is considerably higher 
 than the pupil's elbows is correctly shown. The occupant 
 cannot be supported while sitting upright, and when sitting 
 back his eyes will be too far from the book for ordinary work. 
 
 " Fig. 26 shows the Belgian model in the Philadelphia Exhibi- 
 tion of 1876. It carries out very well the idea of supporting 
 the sacrum ; there is a turn-back lid, and the under side of the 
 hinged part has a cushion at x for the use of the girls in sew- 
 ing; there is a peg for the hat at o. The seat, however, is 
 much too far from the desk. 
 
 "Stooping, cramped, Awkward positions are not very likely 
 to be assumed in a desk and seat well adapted to the occupant, 
 except in the acts of writing, ciphering, and drawing. Bad 
 postures in these occupations are far worse than in others, 
 from the seeming naturalness with which they are as-sumed, 
 and the certainty with which they become habitual. If a 
 
EDUCATION AND SCHOOL-HYGIENE. 
 
 205 
 
 child can be taught from the beginning to write in a proper 
 attitude, one of the commonest and worst of school-faults will 
 
 Fig. 25. 
 
 Fig. 26. 
 
 be broken up. If there is to be a reform in this matter, let it 
 begin at the beginning ; let the youngest classes be the first to 
 
 18 
 
206 
 
 MOTHER AND CHILD. 
 
 receive the ideal desk (whatever that be), and let the change 
 go on, following their progress in the schools. Time ought lo 
 be devoted to acquiring the habit of sitting well, especially at 
 the beginning of school-life. 
 
 "The correct posture in writing is one which does not twist 
 the body or neck. The pupil faces the desk squarely; the 
 shoulders are equally distant from the lid of the desk ; the 
 trunk is erect and nearly touches the desk. The lid must be 
 high enough just to support the forearms, but not so high as 
 to raise them ; they rest lightly on the lid, but do not sustain 
 the weight of the body. This posture cannot at first be main- 
 tained long. Perhaps five minutes at a time is all that we can 
 expect of beginners; at all events, nothing is more certain 
 than that children begin to lapse .fi-om this uprightness by 
 that time. What can be done then ? The effort to force fifty 
 children to keep in one position cannot succeed beyond a brief 
 time, and the bad position must not be permitted : hence, as 
 soon as fatigue begins, it is best to give a total rest by letting 
 
 the children sit back, stand, etc., 
 and then resume wi'iting. 
 
 " The ' systems' of penmanship 
 in vogue do not satisfy the de- 
 mand here made; they do tend 
 to twist the spine. In some cases 
 the pupil is directed to turn 
 squarely to the left, letting the 
 whole right forearm swing over 
 the desk-lid, on the elbow as a 
 pivot. This raises the right shoul- 
 der. In others the direction is 
 to turn partly to the left, or 
 partly to the right. The posi- 
 tions assumed in these cases are 
 almost invariably faulty : one or 
 the other shoulder is raised; the head leans to the right or 
 left, and sinks by degrees until the ear may come in contact 
 
 Fig. 
 
EDUCATION AND SCHOOL-HYGIENE. 207 
 
 with the hand and the nose almost grazes the paper, the spine 
 meantime assuming various curves. 
 
 "Fig. 27 illustrates the position of the manuscript on the 
 desk. It is copied (with a little simplification) from an article by 
 Staffel in the Centralhlatt fur allgemeine Gesundheitspflege, 1884, 
 p. 45. If the pupil sits in the correct position, facing squarely 
 to the edge of the desk ab, and looking in the direction hg, df 
 represents the axis of the right arm, / being the point of the 
 pen and e the place where the wrist touches the paper. The 
 left hand steadies and adjusts the paper, and must be near the 
 right hand, so that the two forearms point inward and nearly 
 naeet at the hands. To correspond with this, the paper is 
 tilted thirty degrees from the perpendicular, towards the left, 
 which enables the hand more easily to follow the direction of 
 the ruled lines on the paper. This tilting of the paper is a 
 natural device, — the reader has probably often practised it 
 without special thought; it is, however, mechanically and 
 physiologically the correct plan for easy writing. 
 
 " The letters acquire a slant of thirty degrees when the paper is 
 held in this position. This is owing to the fact that the most nat- 
 ural and easy way of making down-strokes is to make them par- 
 allel to the line gh^ — or perpendicular, as the paper is commonly 
 held. Children and blind learners begin with these strokes. 
 
 " Some additional points require mention : 
 
 " 1. The chair is often too high for young scholars. The 
 most convenient plan may be to provide footstools. 
 
 " 2. The seat, from back to front, ought to be long enough to 
 support nearly the whole thigh. A more or less spoon-shaped 
 hollow in the seat is commonly thought desirable. The curve 
 of many settees is such as to produce pain at the point where 
 the bones (tuberosities of the ischium) rest on the wood : the 
 support is not wide enough. 
 
 " 3. Seats must have backs. The straight upright back reach- 
 ing to the shoulders is bad ; a straight back slightly tilted is 
 not bad. American seats are commonly curved, with curved 
 backs, as in Figs. 24 and 25. 
 
208 MOTHER AND CHILD. 
 
 "4. The edge of the desks should come up to, or overlap, the 
 edge of the seat. The recognition of this fact is a recent dis- 
 covery : desks used formerly to be separated from seats by 
 a space sufficient to enable the occupant to rise in his place, 
 but since desks are now made separate or in pairs, it is only 
 necessary to step into the aisle. 
 
 " 5. Most of our best desks are too high, relatively to the seat. 
 The reason for making them high is, doubtless, to prevent the 
 pupil from stooping. Something is certainly gained in read- 
 ing, by this plan, — at least, in convenience of reading, — but it 
 interferes with correct positions in writing. The elbows, 
 hanging freely, should be only just below the level of the lid. 
 
 " For near-sighted children, the higher desk may be a neces- 
 sity in writing. If the de§k is made as low as is here recom- 
 mended, a portable arrangement resembling a wriling-desk 
 may be placed on the desk. 
 
 "DISEASES OF THE EYES. 
 
 '■^Near-sightedness, with some other difficulties, composes one 
 of the most important divisions of our subject. To some extent 
 the production of myopia is doubtless due to constitutional 
 weakness or to depressing causes acting temporarily. Landolt 
 considered hardships and poor fare the leading causes, but 
 his opinion seems an exaggerated one. Loring has argued 
 forcibly in favor of more active sport for growing youth, and 
 has shown how confinement to the house, short hours of relax- 
 ation, and undesirable fare, must be considered important 
 causes of the excessive prevalence of near-sight on the Euro- 
 pean continent. 
 
 " Other facts which may illustrate this point are the excess 
 of near-sight in cities ; the general prevalence of poor health 
 among the same classes of students that are subject to near- 
 sight; the readiness with which the eye may be injured by 
 work performed before breakfast, during fatigue, or after 
 recovery from acute fevers. An associated fact is the low 
 
EDUCATION AND SCHOOL-HYGIENE. 209 
 
 vitality prevalent among blind people, — which maj^, however, 
 be an effect rather than a cause. 
 
 '• As regards map drawing, the best plan is to use large paper, 
 make strong outlines, and insert few details, the object being 
 by no means the production of handsome work, but the fixing 
 of leading facts on the pupil's mind. In penmanship and 
 sewing, and still more in embroidery, harm may easily be 
 done. 
 
 " Interesting remarks upon the most desirable form of type 
 for clearness are made in Dr. Jeffries's article, Massachusetts 
 Board of Health Eeport, 1882-83 : they are from Javal. Many 
 school-books are excellent in this respect ; many are still bad. 
 
 " The pupils' most common neglect (says Soldan) is in regard 
 to their eyesight. They injure the eye by reading by a lamp 
 close to the head, without a shade : the object of the latter is 
 quite as much to keep off heat as light. They work in the 
 evening instead of by day. They read novels six hours and 
 then study two. They defer the most taxing work (such as 
 drawing) to the last minute. 
 
 ^^ Light. — Defective lighting is one of the chief faults of 
 school-buildings. The difficulty of satisfying the requirements 
 in cities is stated under the head of ' Site for Schools.' For 
 a northern climate, a very free exposure to sunlight is desir- 
 able. Large trees often need removal. If possible, direct 
 sunlight should enter every room at some hour of the day. 
 
 " A sufficient light implies light which easily reaches the back 
 of the room. Lighting from one side, as practised by the 
 Germans, is thought by most of our architects insufficient. 
 In fact, ^ room with sixty scholars and an allowance of two 
 hundred and fifty cubic feet of space per head will necessarily 
 be too deej) for good unilateral lighting. The simplest remedy 
 is to make windows on one side and at the back. This prin- 
 ciple, carried out, gives us the square school-house with four 
 corner rooms on a floor, or, as in the Cleveland model, with 
 six rooms on a floor. It has the advantage of natural draughts. 
 If the combined size of all the sashes equals one fifth or one- 
 18* 
 
210 MOTHER AND CHILD. 
 
 sixth the area of the floor, it is usually said that the supply 
 of windows is sufficient. Small windows are not the fault of 
 modern school-houses. 
 
 '• To get the best effect, windows must reach within a few 
 inches of the ceiling. They ought to have square tops, not the 
 Gothic shape adopted in the St. Louis model; they must have 
 no heavy projecting outside ornaments to cut off light. In- 
 stead of Italian awnings for summer, they should be guarded 
 with blinds on the inside. It is hard to find screens that will 
 at once exclude the sun's rays and admit enough light and 
 wind. Neither white nor yellow nor red screens are pleasant 
 when the sun is on them : a neutral gray is best. A neutral 
 light tint is suitable for the walls. 
 
 "Lighting from both sides is well enough for small school- 
 houses of one room. There is, however, a preference for light 
 coming from the scholar's left hand, especially in writing. 
 Hear windows may be added if thought necessary; the}^ give 
 a general increase of light: their worst point is that they try 
 the eyes of teachers, but that can be relieved in two ways, — 
 either by a rather dark shade rolling up from the bottom, or 
 by i^lacing the windows about six feet above the floor, so that 
 the direct rays do not strike the teacher's eye when looking at 
 the class. It is a cardinal rule that no one shall be forced to 
 face the windows while reading or otherwise exercising his 
 sight : therefore no windows must be in front of the scholars. 
 Black-boards are generally put wherever there is room ; those 
 between windows ought to be little used ; their surface must 
 be a dead black, not glossy. 
 
 "This, however, gives but one aspect of a wide question. 
 ^Other important causes — perhaps much more important — are 
 the following. 
 
 "Excessive use, even under favorable conditions, wearies the 
 eye. It seems well proved that, in general, students who spend 
 longer hours over home lessons are affected by near-sight in 
 larger proportion. The practice of working without rest for 
 long periods is worse than working many hours with pauses. 
 
EDUCATION AND SCHOOL-HYGIENE. 211 
 
 " Poor light has always been considered one of the leading 
 causes. It not only fatigues the eye, but also induces the pupil 
 to bring the eye close to the book. 
 
 " Constant attention to near objects doubtless has its effect, 
 even when they are ' near' only in the sense of being bounded 
 by the walls of streets. City children live in a narrow horizon. 
 The youthful eye has a marvellous power of seeing things at 
 the distance of two or three inches ; and many things in school- 
 life conspire to bring about habits based on this power of adap- 
 tation, — badly-proportioned desks, poor type and ink and paper, 
 poor light, excess of light. The eye that is laboring at too short 
 a distance is enabled to do so by the action of the ' muscle of 
 accommodation' in the eyeball, which arranges the focus by 
 changing the shape of that organ. Such an eye is working in 
 a state of tension, which tends, if long continued, to produce a 
 permanent change in the form of the globe, making it longer 
 from back to front, which constitutes the chief characteristic 
 peculiarity of the near-sighted eye. Yery few, if any, children 
 will obey physiological laws of distance without being com- 
 pelled to do so. There are certain faults in school furniture 
 that favor the bad habit : too great height of desk relatively 
 to seat ; separation of desk from seat by an interval, instead 
 of having the desk partly over the seat. These, and bad posi- 
 tions in writing, have been mentioned already. 
 
 " Anything tending to cause congestion of the eye aids in 
 forming near-sight. Among these causes are tight clothing 
 (corsets, neckties, collars, belts) ; indigestion, particularly con- 
 stipation ; overheated rooms, with bad ventilation ; overwork 
 of the brain, especially if it causes headache. Fulness of the 
 blood-vessels stretches the eyeball and assists the tendency to 
 a change of shape as above noticed. 
 
 "All these influences have their effect chiefly during child- 
 hood : few persons become near-sighted after they are grown 
 up, though an increase of near-sight is not rare. This circum- 
 stance is one of many which warn us that bodily development 
 is liable to be impeded or distorted in every direction by false 
 
212 MOTHER AJS'D CHILD. 
 
 education. Every plan which aids in strengthening the con- 
 stitution of children may be considered as a contribution to 
 the health of their ej^es. During childhood the tissues are less 
 firm, more elastic, than later in life ; they are more quickly 
 renewed, more easily distorted. The geometrical deformity of 
 the eyeball is produced by pressure at this tender age. The 
 remedy seems to require not only that we lessen the daily 
 amount of pressure, but also that we encourage those active 
 habits which will make the fibre stronger and more resisting. 
 
 " Hereditary influence is undeniably powerful. What may be 
 the effect of several generations of accumulated tendency in 
 studious families cannot be predicted : a learned friend of the 
 writer's suggests that the result may not be blindness, but a 
 permanent type of myopism, in which children will be born 
 short-sighted and will not need to become so. But in specu- 
 lating about the future it is necessary to take account of other 
 tendencies. Far-sight is quite common among children ; and 
 the action of inheritance seems not to be limited to the repeti- 
 tion of identical defects, but to reproduce both anomalies — ^the 
 long eye and the short eye — with a certain degree of indiffer- 
 ence. The existence of a tendency to the normal eye is prob- 
 able, independently of the elimination of unfit persons from 
 the race. 
 
 " Blindness^ or an approach to it, is the tendency of a certain 
 number of cases of near-sight; the retina becomes gradually 
 detached from the back of the eye, and becomes incapable of 
 receiving exact impressions. On this account (as well as for 
 reasons above given) the ' near-sighted eye is a diseased eye.' 
 
 " Test-types, or large cards on which lines of letters of graded 
 sizes are distinctly printed, are a ready means of estimating 
 the degree of near-sight in the hands of school-principals. To 
 give such observations full value, atropine and the ophthalmo- 
 scope, in expert hands, are required. A much-used eye is apt 
 to be in a state of tension which makes it temporarily more 
 near-sighted than it reallj" is ; atropine relaxes the tension. 
 
 " There exists a prejudice against the use of glasses, which is 
 
EDUCATION AND SCHOOL-HYGIENE. 213 
 
 natural enough. But if near-sight is considerable, so that a 
 child really cannot work well in an erect position, it is necessary 
 to allow a pair of very weak glasses. The matter cannot be 
 determined by directions given in an article like the present : 
 the decision and choice must be left to the physician. A limit 
 or minimum distance at which the book may be held from the 
 eye should be stated, and children advised and corrected of their 
 bad practices. The least distance, recommended by the Com- 
 mission d'Hygiene des Ecoles of Paris in 1884, was twenty-five 
 centimetres for children in the lowest schools and thirty-three 
 for those from eight to twelve years old, — about ten and thir- 
 teen inches respectively. Fifteen inches is proper for those of 
 larger stature, but would be impossible for little children. 
 
 " Hypervietrojpia, or long-sight, is not uncommon among 
 school-children. Its effect, when it is of a high degree, is to 
 make the act of reading difficult or painful, and sometimes to 
 put an end to a child's career in school. Those subject to it 
 read fairly well for a time, but after a while become conscious 
 of effort in the act of seeing. The eyes feel strained, and the 
 letters become somewhat blurred. There is a desire to rest 
 the eyes, or to close them firmly, or to compress them with 
 the hand. A fresh start is made, and a second rest has to be 
 taken after a shorter period. Sometimes the habit of holding 
 the book close to the eye is acquired, which makes the case 
 seem to be precisely the. opposite of long-sight. The choice 
 of glasses (convex, or old-sighted) should be directed by a 
 competent physician, for the purpose of enabling such children 
 to work without suffering. One effect of the disease is the 
 production of internal squint. 
 
 ^'■Astigmatism is rather common, and gives as much annoy- 
 ance as near-sight. It depends on an incorrect curvature of 
 the front of the eyeball (cornea). It is known by producing 
 a blurred look in lines that run in one given direction : some 
 people see horizontal lines badly, some perpendicular ones ; 
 in others there is an oblique axis of indistinctness. If at all 
 troublesome, this defect ought to be remedied by glasses, — 
 
214 MOTHER AND CHILD. 
 
 as it can be perfectly. It is not a disease in the sense that 
 near-sight is. 
 
 " PHYSICAL TRAINING. 
 
 " The connection between physical training and. general 
 education is obvious. The principle being granted, it remains 
 for us to consider how much the school and the college of 
 to-day should be required to give of their energies to the 
 furthering of this end. 
 
 "A system of calisthenics is at present widely used in public 
 schools, with distinct benefit. It is not probable that the 
 system will ever be abandoned. Most readers must have 
 seen the pleasant sight of a roomful of children engaged in 
 the simple but vigorous movements of the arms which serve 
 so well as vents for superfluous energy. These trained move- 
 ments are an indispensable part of primary-school work, and 
 are of great use in the intermediate grades, but are of subordi- 
 nate value (as now practised) for older pupils. They are quite 
 difficult enough for little children, but above the age of twelve 
 scholars begin to look down on them as childish, and with good 
 reason, for they lack one essential element, — they do not call 
 forth exertion to overcome resistance. For better work, 
 scholars should have light dumb-bells and wands, and more 
 space to use them, than can be found in an occupied room. 
 
 "The immediate benefit of exercise, however, does not de- 
 pend on any large amount of development that it imparts. 
 Very simple exercises, without any apparatus, practised twice 
 a day or oftener for five minutes at a time, do a great deal of 
 good. Far from breaking up the discipline of the school, they 
 make it easier, by relaxing the tension of mind and by 
 introducing the element of pleasure. The eyes are relieved 
 at the same time. A piano adds pleasure, but is not essential. 
 The windows should be opened at the instant the signal is 
 given, by having one boy assigned to each. 
 
 " The facility with which calisthenics are practised should 
 not blind us to the imperfections of the system. The move- 
 ments employed are limited to such as can be safely made in 
 
EDUCATION AND SCHOOL-HYGIENE. 215 
 
 a room full of desks : the pupils ought to have a much wider 
 range of action, in an open hall, large enough for fifty or 
 sixty to exercise in. 
 
 " A good type of light gymnastics adapted to use by classes 
 is furnished by Amherst College. In that system every student 
 is required to attend unless physically unfitted. The work is 
 done in classes, to the sound of the piano, under a leader ; 
 students attend four days in the week, half an hour at a time. 
 Most of the work is done with wooden dumb-bells ; there is 
 also considerable running, and some marching. The exercises 
 are eminently cheerful ; comj)ulsory attendance meets with the 
 acquiescence and support of almost all the students. In fact, 
 the exercise is a union of recreation and amusement with work. 
 
 " This moderate amount of exercise is sufficient for nine- 
 tenths of the men. For those of unusually muscular frame, 
 heavy gymnastic apparatus is provided ; for a few, special 
 developing apparatus is needed ; all are sufficiently under 
 control and observation. No serious accident has occurred 
 since the opening of the gymnasium in 1859. 
 
 " The direction is in the hands of Prof. Edward Hitchcock, 
 M.D. ; the duties of his position include teaching gymnastics, 
 physiology, and elocution as connected with bodily movement ; 
 he is expected to be acquainted with the health of each stu- 
 dent, and is required to furnish the excuse whenever sickness 
 compels a student's absence. The department is dignified by 
 marks given for attendance and deportment, and its head is 
 a member of the faculty. 
 
 " The object aimed at has always been the promotion of 
 health and power of work, rather than the development of 
 muscle or the performance of feats of agility and strength. 
 As evidence of the success which is attained, Prof Hitchcock 
 states that sickness among the classes diminishes regularly 
 from the Freshman year up, being in the Senior year little more 
 than half as great as in the Freshman. 
 
 " A system of this sort reaches a large number of young 
 men who much need it. Few are so judicious and persevering 
 
216 MOTHER AND CHILD. 
 
 as to lay down a plan of gymnastics and adhere to it. Much 
 of the apparatus in ordinary gymnasiums is unsuited for the 
 beginner : its effect is to exhaust and rack his frame and dis- 
 courage his efforts. The most complete outfit of apparatus, 
 and the best instruction, will not insure the attendance of the 
 very class of men who need the training most. Nothing is, 
 on the whole, so well suited to the average needs as a class- 
 system resembling that of Amherst. 
 
 " At Harvard there is everything except compulsory class- 
 work. Careful measurements of the person enable the super- 
 intendent. Prof. Sargent, to assign s]3ecial exercise to each 
 young man, defined in kind and amount, for the purpose of 
 strengthening his weak points. His apparatus and methods 
 have been adopted by a considerable number of colleges, 
 including some for women. 
 
 "A new feature of Dr. Sargent's work consists in taking of 
 photographs of gymnasts at the beginning of their course, 
 to be compared with those hereafter to be taken on leaving 
 college. It has been the writer's privilege to look through 
 this list, now numbering several hundred ; and it must be 
 confessed that the most striking thing about them is the rarity 
 of a handsome body, or of even a well balanced and pro- 
 portioned body. Deflection of the spine is quite common. 
 Athletic oarsmen show, by the twist in their upper backs, which 
 side of the boat they are accustomed to row in ; but most of the 
 curvatures do not seem to arise from excess of muscle. A preva- 
 lent droop of the right shoulder is noticeable. It is thought 
 that this may originate in carrying weights in the right hand, 
 and perhaps in the musket drill of the public schools. 
 
 " Another noticeable thing is the frequency of the hollow 
 back, — a peculiarity of form which may be hereditary, but 
 may originate in weakness of the supporting muscles of the 
 spine. Weakness of the upper part of the trunk, allowing 
 the shoulders to fall forward and the neck to stoop, may be 
 the first step, and the saddle-back may be merely the com- 
 pensatory curve. 
 
EDUCATION AND SCHOOL-HYGIENE. 217 
 
 " Smallness of the chest, and consequent want of lung-power, 
 constitute a failing that it is really of great importance to 
 correct. There can be no safe athletic training for men whose 
 chests are small : they run the risk of inflicting permanent 
 injury upon heart or lungs by the efforts made with their 
 large muscles. It is well known that a small chest predis- 
 poses to consumption. Our boys need not be athletes, — it 
 would be better for the mass not to attempt to compete in that 
 line, — but they ought to have better breathing-capacity than 
 they now have. Play is better than any gymnastics, from a 
 certain point of view ; but a full allowance of the prevalent 
 sports does not give to boys a good chest-development. 
 
 " The late Archibald Maclaren, describing the English school- 
 boy as coming under his observation, said, ' I find that almost 
 ever}' youth at the time of passing from the schools to the 
 University has, as it were, a considerable amount of attainable 
 power and material capacity undeveloped ; his body, or rather 
 a portion of it, is in arrears in this respect, and as arrears, 
 and as a recoverable debt, the youth may fairly view it.' 
 During the youth's first term of two months, with pi-operly- 
 administered exercise, the chest will expand, in all ordinary 
 circumstances, two inches, and in peculiar circumstances he 
 has known the increase to reach double that amount. 
 
 "Most sports develop the legs satisfactorily, — walking, run- 
 ning, leaping, foot-ball, cricket, fencing, tennis, racket, fives, — 
 but some of these give in addition an excess of work to the 
 right arm. The result of sports without gymnastic training is 
 a fi-equency of pigeon-breast, hollow breast, drooping shoulders, 
 and stooping. There is also an occasional excessive upward 
 growth without corresponding exjDansion of the chest. These 
 are the results of abundant play in English schools for the 
 better classes, where play is a regular part of the day's busi- 
 ness ; they represent the best that a boy's play can do for his 
 development. 
 
 "Military drill was brought into favor by the war ; its sup- 
 posed end is to furnish large numbers of men ready trained to 
 K 19 
 
218 MOTHER AND CHILD. 
 
 service in case of emergency. Some military men find that 
 the real result is a conceit of knowledge and indisposition to 
 enter the militia. Its best side is the moral side : it raises 
 self-respect, and promotes obedience by showing the practical 
 need of it. It is, further, as good exercise as many games 
 are, and shares with sport the element of interest and pleasure. 
 Schools known to the writer have given two hours out of the 
 weekly programme to drill, and have found that the week's 
 work as a total was not lessened. The objections are that the 
 exercise is taken in a cramped position, every movement being 
 executed to pattern, and that the number of movements is 
 extremely few, so that the exercise is not at all a typical 
 one for developing the body ; also, that the musket is too 
 heavy, and that it is carried chiefly in the right hand for 
 convenience. The so-called setting-up drill consists of light 
 gymnastics, the object of which is to give the soldier a good 
 position at the outset : this is not and cannot be pi'operly 
 carried out in schools unless time is taken, — and the time is 
 already taken for musket drill. 
 
 "The amount of time taken by Maclaren to correct the 
 shape and growth of boys in his own school was one hour of 
 gymnastics weekly, — this, in addition to abundant play. 
 
 " The children in the turner classes practise an hour twice a 
 week, somewhat after the general plan of Amherst, aiming to 
 give the girls more of grace (e.g.^ by a variety of dancing 
 movements) and the boys more of muscularity. Their work 
 is well worth inspecting. 
 
 " The British soldier, on entering the army, is put through 
 daily gymnastics from one to one and a half hours daily for 
 three or six months. It is unnecessary to describe the practice 
 in other armies. 
 
 " In our public schools the friends of reform should not be 
 satisfied with less than half an hour twice a week, under 
 trained teachers. An hour twice a week might afterwards be 
 thought desirable, — the method to be that of light gymnastics, 
 to some extent imitating that of Amherst. The teachers may 
 
EDUCATION AND SCHOOL-HYGIENE. 
 
 219 
 
 be specialists at a moderate salary ; or the work may be done 
 by such of the regular teachers as have special gifts for it, as 
 is the ease in Grermany. As regards the amount of work to 
 be done, or the teaching force, the city of FrankfDrt-on-the- 
 Main is a good illustration : there are twelve thousand children 
 in the public schools of that place, and the number of hours 
 given to gymnastics is equivalent to the constant services of 
 seventeen and a half teachers. The city has special halls with 
 apparatus, of the length of from twenty to twenty-five metres, 
 nine or ten metres wide, and from five to five and six-tenths 
 metres high. 
 
 " The Routine of a School-Bay. — It will not be without 
 profit to study the arrangement of time and occupation made 
 for cases where a young person's whole time is under control. 
 In making the plan it is necessary to have a clear idea of the 
 amount of work that is desirable. Time must be assigned for 
 play, and for gymnastic lessons : either or both may be made com- 
 pulsory (as foot-ball is in some of the great English schools). 
 
 " The following is an outline of a day's work in one of the 
 best American boarding-schools for preparation for college : 
 
 Summer. 
 
 WiNTEE. 
 
 6.30 
 
 7 
 
 7 
 
 7.30 
 
 7.45 
 
 8.15 
 
 8 
 
 8.30 
 
 12.45 
 
 1 
 
 1 
 
 1.15 
 
 2 
 
 . . . 
 
 2.30 
 
 2.15 
 
 
 5 
 
 e' 
 
 6 
 
 6.30 
 
 6.30 
 
 6.45 
 
 6.45 
 
 7 
 
 7 
 
 8.30 
 
 8.30 
 
 9.15 
 
 9.15 
 
 10 
 
 10 
 
 Eise. 
 
 Breakfast. 
 
 Prayers. 
 
 Study and recitations four and three-fourths or four and 
 one-half hours. 
 
 Intermission. 
 
 Dinner. 
 
 Study-session in summer one-half hour (none in win- 
 ter), then play-time. 
 
 Play-time, summer three and one-half, winter two and 
 three-fourths hours. 
 
 Quiet in session, study optional. 
 
 Supper, one-half hour. 
 
 Intermission. 
 
 Prayers. 
 
 Study-session in school-room until bedtime. 
 
 Youngest boys (twelve and thirteen) go to bed. 
 
 Middle boys (fourteen and fifteen) go to bed. 
 
 Older boys go to bed. 
 
220 MOTHER AND CHILD. 
 
 "The amount of sleep allowed for is from eight and a half to 
 ten and a half hours, according to age and season. The boys 
 all have the gift of sleep, and use all the time allowed. Study 
 and recitations for the youngest boys, six and a half or six 
 and three-fourths hours; for the oldest, about eight hours. 
 Play, two and three-fourths or three and one-half hours, ac- 
 cording to season, in a solid lump, besides some intermissions 
 too short for serious play. There is a twenty-acre lot to play 
 in ; in winter they use the gymnasium at their option, under 
 control of a tutor. Detention for punishment is assigned to 
 the afternoon play- hour : most boys average one hour a week 
 at most ; mischievous boys suffer longer detention, but in no 
 case to their physical harm. Sweetmeats are not expected to 
 be sent from home ; if discovered, they are confiscated, or are 
 served at the boys' table so that many share. 
 
 " Compare with this the routine of a large boarding-school for 
 girls, of very good standing, in the same part of the country: 
 
 6.30 
 
 7.10 
 
 8 
 
 8.45 
 
 9 
 
 1 
 
 2.15 
 
 3 
 
 5.15 
 
 6 
 
 7 
 
 7.15 
 
 9 
 
 9.30 
 
 Eise. 
 
 Breakfast. 
 
 Kecitation, forty-five minutes. 
 
 Prayers. 
 
 liecitations aud study, four hours. 
 
 Dinner. 
 
 Walk, in which all join. 
 
 Study and recitation, two and one-fourth hours. 
 
 Recreation, — free time. 
 
 Supper, followed by recreation. 
 
 Prayers. 
 
 Study, one and three-fourths hours. 
 
 Bedtime. 
 
 Liffhts out. 
 
 "Here are nine hours assigned for sleep, and eight and three- 
 fourths hours for study ; but three-fourths of an hour is taken 
 out every day for gymnastic exercise in classes. All take a 
 walk of three-fourths of an hour. There is apparently a con- 
 siderable amount of time left free. The contrast between girls 
 and boys is seen in the compulsion exercised in regard to all 
 exercise, which is doubtless necessarj^. The required hours of 
 work are likely to be too long for some girls ; and if music 
 
EDUCATION AND SCHOOL-HYGIENE. 221 
 
 and letter- writing and literary societies and prayei'-meetings 
 are added, girls are likely to be burdened. Yisits to the pupils 
 homes in term-time are properly forbidden. 
 
 " Detention is an effective means of punishment when not 
 carried too far; but when a boy's Saturday forenoon, or even 
 his whole day, is spent in silent confinement for a series of 
 small faults, the effect is bad, morally and physically. An 
 occasional good whipping is far better. 
 
 " The chief objection to corporal punishment is perhaps its 
 effect on teachers. Without exactly making them cruel, it 
 presents a temptation to hasty and often excessive action, 
 afterwards regretted. Girls should not be punished in that 
 way; boys seldom, and with conscientious reflection, without 
 anger. 
 
 " The city of Cleveland requires that every case of corporal 
 punishment shall be reported to the superintendent of schools, 
 in blanks containing the following headings: date; offence; 
 general character ; home influences ; means employed for 
 reform ; whether parents were previously notified of miscon- 
 duct, and what answer was given ; whether ever previously 
 referred to the principal of the school or the superintendent, 
 and how often ; result of punishment.^ This represents fully 
 the present tendency to caution. . . . 
 
 " VENTILATION AND HEATING OF SCHOOL-ROOMS. 
 
 "This subject is admittedly of the first importance. The 
 school is the place for work, and bad air at once impairs the 
 working-power. More than this, the effect of bad air is to 
 deteriorate the whole constitution : there is little exaggeration 
 in the statement that all diseases are either caused or are made 
 more severe by bad air. Several notorious ' school-diseases' 
 are rather closely connected with this cause, — dyspepsia, head- 
 ache, nervous debility, anaemia, scrofula, consumption, various 
 
 1 Report of Schools, 1875-76. 
 19* 
 
222 MOTHER AND CHILD. 
 
 affections of the eyes, — the special discussion of which is found 
 elsewhei'e. 
 
 " The impurities of air may be divided into three classes : 
 1, dust, smoke, stenches, gases from heaters, and other defile- 
 ments which are independent of the presence of scholars, and 
 should be entirely got rid of; 2, carbonic acid from the lungs; 
 and, 3, organic matter exhaled from the lungs and skin. The 
 last two are unavoidable, and must be allowed for in venti- 
 lating. 
 
 " Carbonic acid gas, in the quantity found in ordinary badly- 
 ventilated rooms, is not pi'obably of itself a serious source of 
 injury. Men who go incautiously to the bottom of wells or 
 vats sometimes become unconscious, and perish unless rescued, 
 owing to the presence of nearly pure carbonic acid ; but in 
 rooms the amount present seldom exceeds five or six parts in 
 one thousand, which quantity cannot be very actively injurious 
 except in so far as it slightly lessens the proportion of oxj'gen. 
 The lethargy of a close lecture-room seems to resemble the 
 stupor of asphyxia, but in reality it is genuine sleep, caused 
 by heat, bodily fatigue, an easy seat, a monotonous voice, 
 weariness from continued passive listening, — all greatly aggra- 
 vated by the bad air, no doubt. But carbonic acid by itself 
 does not produce the violent symptoms of poisoning which are 
 familiar from the description of the ' Black Hole.' Expired 
 air freed of carbonic acid does produce such symptoms. The 
 eminently noxious agent, then, appears to be, not carbonic 
 acid, but the animal exhalations which accompany it in the 
 breath. 
 
 " The process of analyzing air for the organic impurities is 
 difficult and uncertain. It is therefore necessary to depend 
 upon the. comparatively easy and certain test for carbonic 
 acid, which corresponds quite nearly in proportion with the 
 organic impurities and is safely taken as their index. 
 
 " The atmosphere, when pure, contains normally about four 
 parts of carbonic acid in ten thousand. Eecent analyses seem 
 to indicate that three and a half parts is nearer the truth ; 
 
EDUCATION AND SCHOOL-IIVGIENE. 223 
 
 but it varies somewhat, being larger in cities. Assuming four 
 as the rule, the question arises, ' Supposing the air of a room 
 to be constantly polluted by breathing, at what stage shall 
 we say that it becomes unsuitable for further use?' The 
 question is answered variously. Pettonkofer proposed seven 
 as a standard of maximum amount of carbonic acid ; Degen, 
 six and six-tenths ; while Parke, who may be regarded as the 
 best authority in our language, sets it at six. That is, the 
 permissible added impurities correspond to the addition of 
 three, two and six-tenths, or two parts of carbonic acid in ten 
 thousand. Parke bases his standard upon the personal expe- 
 rience that air at six seems pure, so that a person coming from 
 the outer air perceives no trace of odor, or diiference between 
 the outer air and the room in point of freshness, while if the 
 carbonic acid exceeds six the air usually begins to be per- 
 ceptibly impure. When it reaches nine or ten the air is what 
 is called close and fusty; above this it becomes disagreeable. 
 After a person has^ been a few minutes in a room the odor 
 becomes imperceptible, and he no longer can judge ' by the 
 nose.' 
 
 " It is abundantly proved that in our climate, and for large 
 bodies of persons, ordinary (so-called ' natural') means of 
 ventilation by windows, fireplaces, and holes in walls are 
 entirely inadequate, and must give place to the systematic 
 use of flues of sizes suited to the supply required. 
 
 " The allowance of fresh air per head is based on the datum 
 just given for permissible degree of added impurity. It is, 
 unfortunately, the case that the impurity cannot be got rid of 
 by itself; it mixes so rapidly with the air that it seems best, 
 on the whole, to consider that the mixture takes place at once, 
 and that our only remedy is to dilute the air by letting out 
 some that is foul and letting in some that is pure. . . . 
 
 " It ma}^ be questioned whether children require the full 
 supply of air assigned to adults. They are smaller ; the work 
 of transformation of material, though active, is in some degree 
 proportioned to their consumption of food, which equals that 
 
224 MOTHER AND CHILD. 
 
 of adults at fourteen, but is much below it at six and eight ; 
 they ai*e very active, yet doubtless do not perform as much 
 absolute muscular work as adults. Figures quoted in the 
 Lomb Prize Essays (page 73) show that children under ten 
 expire about one-half as much carbonic acid as adults. . . . 
 
 " Methods of Ventilation. — The heated flue is at present the 
 arrangement applicable to the greatest number of cases of 
 school-house ventilation. Its size must be determined in ac- 
 cordance with the number of pupils in the room or house. In 
 most cases one general discharge-flue is sufficient. It should 
 be located centrally, so as to lose no heat to the outer air. It 
 consists of a straight brick shaft, rising from the cellar to the 
 roof, and capped above the roof to protect it from downward 
 gusts of wind. To increase the current, the air is warmed by 
 having the smoke-flue of the heater pass up through the middle. 
 The velocity of the ascending air depends on many circum- 
 stances : if the weather outside is cold, if the chimney is high 
 if the heat is concentrated, the current is swifter than under 
 the opposite conditions. . . . 
 
 " If a pupil requires one-half of a cubic foot per second, every 
 square foot in the section of the chimney corresponds to ten 
 pupils. A school of four hundred pupils requires a shaft eight 
 by ten feet, inside measurement, not allowing for the smoke- 
 flue and for space taken up by entering pipes and guards." 
 
 After dwelling at length upon the various methods adaptable 
 to the proper ventilation of school-rooms. Dr. Lincoln sajs, — 
 
 "The preceding is an instance of thorough work. The 
 next best thing, for those of limited means, is to avoid blun- 
 ders and waste. The following points are ofl^ered with this 
 purpose. 
 
 '• Fireplaces are partial remedies for bad ventilation. They 
 are now occasionally placed in new school-houses, both for this 
 I'eason, and also in the expectation that they will be used for 
 fires in mild weather ; but the trouble of attending to such 
 fires is too great for an average janitor. Their ventilating 
 power is small compared with the demand,^and maybe roughly 
 
EDUCATION AND SCHOOL-HYGIENE. 
 
 225 
 
 stated as sufficient for ten persons while the fire is going. As 
 a heater the fireplace wastes from seventy-five to ninety per 
 cent, of the heat. 
 
 " Stoves arranged like the ' portable furnaces' that are set up 
 in cellars are useful. The plan is to place a screen of zinc or 
 galvanized iron around the stove, leaving an interval of a few 
 inches for an air-space ; a hole in the floor communicating with 
 a pipe led out of doors, supplies a current of fresh air under- 
 neath the stove, which becomes warmed and rises into the 
 room. The screen comes down to the floor; a valve regulates 
 the supply of cold air. 
 
 " Such a stove is shown in Fig. 28, an old design applicable 
 to the case of a country school-house. The stove is set at 
 a distance from the chim- 
 ney, to get more heat from 
 the pipe ; the latter ought 
 to have a strip of bright 
 tin hung below it, to shield 
 the heads of the scholars. 
 The upper ventilator cools 
 the room. 
 
 " Yentilating - stoves of 
 various patterns are sold, based on the above principle. They 
 cannot supply a quantity of air commensurate with the wants 
 
 Fio. 29. Fig. 30. 
 
 Fig 28 
 
 P 
 
 Smoke Flue 
 
 I 
 of a school, but they are good as far as they go, and doubtless 
 economize fuel. 
 P 
 
226 
 
 MOTHER AND CHILD. 
 
 Pig. 31. 
 
 " Figs. 29-31 show how the principle of ventilating rooms by 
 heated flues may be carried out. They are adapted from Mr. 
 Jacokes's illustrations in the Seventh EejDort, Michigan Board 
 of Health. 
 
 " Fig. 29 shows air entering by a pipe beneath the floor to the 
 casing around the stove, which is four inches and six inches 
 wide all around. Foul air escapes by the heated chimney. 
 The upper outlet requires a valve. 
 
 " Fig. 30 shows the suction of the chimney applied at the 
 level of the floor by carrying a pipe down. 
 
 " Fig. 31 combines two stories. An opening in the enlarged 
 part of the ventilator in the upper 
 story may be utilized for that room. 
 ^' Air-Supply .—T^hQ advice has 
 been given to make the ventilation 
 of a house depend on a single shaft. 
 By doing so we avoid the possibility 
 of having two shafts ' drawing 
 against each other.' Two or more 
 shafts, however, of equal height and 
 equally heated, need not interfere 
 with each other, provided each has a 
 full supply of air. This point may 
 be overlooked, with bad results, as it 
 often is in the chimneys of dwelling- 
 houses. . . . 
 
 "As school-houses now are, win- 
 dows must be opened. In country districts, especiall}^, both 
 sashes ought to move easily up and down. In exposed places 
 double windows are applicable; they must not be fastened, 
 but must be freely movable. A double pair of sashes with the 
 lower outer one raised and the upper inner one lowered gives 
 a tolerably safe arrangement. Window-boards are often placed 
 under the lower sash, filling the space entirely, the air in this 
 case entering by the crack between the two sashes. Or the 
 board may be set at the distance of an inch from the lower 
 
EDUCATION AND SCHOOL-HYGIENE. 227 
 
 sasb, in such a way that when the sash is raised two inches 
 the air is deflected upward. All such contrivances need to be 
 watched closely, or they will occasionally give rise to dangerous 
 draughts. 
 
 " It is a good plan to make the curtains roll at the bottom, so 
 that the tops of windows can be opened freely in summer 
 without injuring the curtains. 
 
 " Pierced window-panes, gauze shields to be placed before 
 cracks in windows. Eureka ventilators (little slanting aper- 
 tures in outer walls), and a variety of other contrivances, have 
 more or less value, but do not meet the wants of school-rooms : 
 if they let in a good supply it causes an unendurable draught. 
 No window-supply can be sufficient in cold weather: a crack 
 opened in every window and well watched is a proper measure ; 
 as a supplementary arrangement it should be an inflexible rule 
 to devote five minutes at the close of each hour to some drill 
 like light gymnastics, the windows being opened instantly at 
 the beginning of the exercise and closed after it. At recesses 
 the same should be done, and scholars should be made to leave 
 the room. . . . 
 
 " Much has been made of the need for moisture in the air. 
 In our climate moisture is so seldom abundant during the 
 school-year that a dry in-door air is not noticed as a contrast. 
 It is probable that good ventilation, with lowering of the 
 prevalent excessive temperature, is what we need to relieve 
 the confined, dull, oppressed feelings that are referred to 
 'burning of the air by furnaces.' At the same time there is 
 some ground for complaint if furnaces are heated excessively 
 or leak gas. The gas which escapes is deleterious, for it con- 
 tains not only the sulphurous acid which gives it the pungent 
 odor, but also some carbonic oxide, which is apt to cause 
 headache. The weight of testimony at present goes to show 
 that the latter gas is not likely to 'pass through the pores of 
 cast-iron furnaces,' either black or red-hot. . . . 
 
 " The temperature of a school-room is commonly required to 
 be about 68° F. in our climate ; in Europe, about 60°, though 
 
228 MOTHER AND CHILD. 
 
 there is a difference between places. Judged from the latter 
 standard, it is curious to find a regulation in Springfield, 
 Massachusetts, that if the temperature does not exceed 60° P. 
 half an hour after the opening of school, the class shall be dis- 
 missed. In summer there ought to be a regulation for dis- 
 missing when the thermometer reaches 82° or 85° F., or some 
 point indicating that study is no longer profitable. 
 
 " A warmer for the feet should be placed in the entry-way. 
 The writer has seen one large enough for twenty to stand on 
 at once, composed of a plate of iron with steam coils under- 
 neath. . . . 
 
 " DRAINAGE AND SEWERAGE. 
 
 '■'■Effects of Air- and Water-Poisoning. — The drainage of a 
 building should be strictly scrutinized when there is a suspicion 
 that the origin of a ' filth-disease' can be traced to the prem- 
 ises. This applies especially to outbreaks of diphtheria or 
 other sore throat, pneumonia, dysentery, or diarrhoea, typhoid 
 fever, scarlet fever, or measles. 
 
 " Foul smells may cause frequent annoyance, or even head- 
 ache and sickness, for years before an outbreak of positive 
 disease comes. The tendency of polluted air is to lower the 
 general vitality. Air from sewers is ' sewer-gas,' and contains 
 a variety of more or less injurious gaseous substances. The 
 term 'mephitic poisoning' may be used to denote their bad 
 effects. 
 
 "In an extreme degree the eflluvia of drains and privies are 
 rapidly fatal. In a school at Clapham, England, ' the clearing 
 out of a privy produced in twenty-three children violent vom- 
 iting and purging, headache and great prostration, and con- 
 vulsive twitchings of the muscles. Two died in twenty-four 
 hours.' ^ 
 
 " ' "When the air of sewers penetrates into houses, and espe- 
 cially into the bedrooms, it certainly causes a greatly-impaired 
 
 ^ Parkes's Hygiene, American edition, 1884, p. 146. 
 
EDUCATION AND SCHOOL-HYOIENE. 229 
 
 state of health, especially in children. They lose appetite, be- 
 come pale and languid, and suffer from diarrhoea ; older persons 
 suffer from headaches, malaise, and feverishness ; there is often 
 some degree of anaemia, and it is clear that the process of 
 aeration of the blood is not perfectly carried on. In some 
 cases I have known decided febrile attacks lasting three or 
 four days, and attended with great headache and anorexia.' 
 
 " ' The air of sewers passing into houses aggravates most 
 decidedly the severity of all the exanthemata, erysipelas, 
 hospital gangrene, and puerperal fever; and it has probably 
 an injurious effect on all diseases.' (Parkes.) 
 
 " It seems probable that the origin of typhoid fever generally 
 depends on the drinking of water contaminated by drainage; 
 yet there is reason to believe that drain-effluvia may cause the 
 disease. ' In a case mentioned to me by a friend, an outbreak 
 of enteric fever in a training-school was localized in certain 
 parts of the school (whereas the drinking-water was common 
 to all), and was traced to imperfection of traps in those parts 
 of the house which were affected. In this case the drains led 
 down to a large tank at some distance and at a much lower 
 level, and the smell of the effluvia was so slight that at first it 
 was not believed that the drains could be out of order.' 
 (Parkes.) 
 
 " ' A marked illustration of disease due to polluted air, when 
 the drinking-water was pure, occurred in the school in this 
 State, in 1864, where fifty-one out of seventy-seven young 
 ladies in the institution were attacked with typhoid fever, of 
 whom thirteen died ; three servants also died of the fever. 
 The vaults of the privies were shallow, filled to overflowing, 
 and emitted a very offensive odor, which at times pervaded 
 the whole building. The kitchen-drain discharged its contents 
 on the surface of the ground, and a few rods from the school 
 there was a foul barn-yard.' The school referred to was the 
 Maplewood Institute at Pittsfield. The statement is quoted 
 from a circular of the Massachusetts State Board of Health 
 for 1879. 
 
 20 
 
230 MOTHER AND CHILD. 
 
 " The "way in which typhoid fever may be caused by polluted 
 drinking-water is well seen in the following case, given by Dr. 
 John L. Leconte : 
 
 " The water-sujDply of a large and prominent boarding-school 
 for girls was obtained from a river, and stored in two cisterns 
 under-ground. The cisterns were built of heavy wooden 
 curbs, with a timber floor, in which it became necessary tem- 
 porarily to make holes, afterwards plugged up. The cisterns 
 had brick cemented bottoms and linings, but the plugs pro- 
 jected inwardly through this masonry. The plugs were 
 removed a year later, without the knowledge of the authori- 
 ties, so that the ground- water had free access to the interior. 
 Eighteen months later, this mistake (which by itself might 
 have caused no harm) was supplemented by placing privy 
 vaults outside of the building, one of which was placed eight 
 or twelve feet from the cisterns. The vaults were of the suj)- 
 posed 'tight' kind, with nine-inch brick walls and bottom, 
 heavily and carefully cemented, and arched over. 
 
 " In three years fi'om this, tj-phoid fever broke out. Under 
 medical direction, water taken directly from the river was 
 substituted for the cistern-water, and the last case of the 
 disease occurred ten days after this precaution was adopted. 
 As an evidence that the use of the cistern-water was the sole 
 cause, it is stated that, although numerous cases occurred 
 among the children, and several among the teachers, not one 
 occurred among the servants. The latter drank only tea and 
 coffee, and very rarely used water, while the children (as 
 usual) drank it freely at all timeS. Among seven absolute 
 water drinkers six were attacked by typhoid. 
 
 " Dysentery and Diarrhoea. — There is sometimes difficulty in 
 strictly separating these complaints; they have, moreover, in 
 some degree, a common origin, and are spread by the faeces of 
 patients infecting the air. More directly to the point is the 
 case mentioned by Clouston, where it seemed to be proved that 
 dysentery was produced in an (insane) asylum by the exhala- 
 tions from sewage which was spread over the ground (a stiff 
 
EDUCATION AND SCllOOL-lIYGIENE. 231 
 
 brick-clay subsoil) about three hundred yards from the asylum. 
 ' The case seems a very convincing one, as the possibility of 
 the action of other causes (impure water, bad food,' etc.) was 
 excluded.' (Parkes.) 
 
 ^'■Diphtheria. — At Groveton, Jl^ew Hampshire, an epidemic of 
 diphtheria occurred in which the centre of infection was the 
 school-house. Twenty-two cases broke out among the scholars 
 in thirty-six hours, appearing at once in widely-separated 
 places ; one hundred and fourteen cases in all, with fourteen 
 deaths. There were several circumstances which combined to 
 make the school-house dangerous to health. A brook had been 
 dammed by the boys so that in rainy weather it ran under the 
 school-house, leaving at other times a stagnant pool There 
 was a boggy meadow near by, polluted by privies which had 
 not been cleaned for two years. The refuse of a saw-mill and 
 tannery was thrown into a mill-pond twenty rods distant ; the 
 water was drawn down to repair the dam, causing an intol- 
 erable stench ; the outbreak of diphtheria followed, succeeded 
 by typhoid fever ; when the pond was kept full, the disease 
 disappeared. . . . 
 
 " CONTAGIOUS DISEASES IN SCHOOLS. 
 
 "The diseases against the spread of which by schools it has 
 been thought necessary to legislate are (in this country) chiefly 
 small-pox, diphtheria, scarlet fever, measles. 
 
 " Whooping-cough, chicken-pox, mumps, German measles, 
 are generally neglected in these precautions. Skin-diseases, as 
 itch, ringworm, and vermin, are of some consequence, and yet, 
 as involving no risk to life, they may be passed over by 
 the legislator and left to the care of charity. The same has 
 to be said of the far more important disease, contagious oph- 
 thalmia. 
 
 " There is abundant evidence of the facility with- which these 
 disorders are spread by means of schools. This being popu- 
 larly known, the first step used to be to propose to close the 
 
232 MOTHER AND CHILD. 
 
 schools. Probably this has a good effect. But the real point 
 to be aimed at, for the good of a community, is outside of 
 schools, and consists in isolating the patients. When patients 
 are also pupils, the function of the school as a co-worker with 
 sanitary authority begins. . . . 
 
 " General Begulations for Preventing the Spread of Conta- 
 gious Diseases in Schools. — 1. Persons affected with diphtheria, 
 measles, scarlet fever, or small-pox (or varioloid) must be ex- 
 cluded from the schools until official permission is given by 
 the Board of Health for their readmission. 
 
 " 2. Persons living in the family or house where such a case 
 occurs are also excluded until similar permission is given. 
 
 " 3. This permission is not to be given until sufficient time 
 has elapsed since the occurrence of the last case to insure 
 safety, nor until the premises have been disinfected under the 
 direction of the Board of Health. 
 
 "4. If a child suffering from one of the above diseases at- 
 tends school, the premises of the school must be. disinfected 
 under the direction of the Board of Health before they are used 
 again. 
 
 " 5. Physicians, teachers, school-officers, and school-children, 
 knowing of such cases of disease, should at once report them 
 to the Board of Health. 
 
 " 6. The Board should also notify the school-authorities of 
 such cases. 
 
 " 7. Notice must be sent to the family by the school-authori- 
 ties, acting conjointly with the Board of Health. 
 
 '• It is hard to say with certainty how soon a patient may 
 safely return to school. . . . 
 
 "The Medical Officers of Schools Association of England, in 
 a code adopted January, 1885, name the following periods 
 after which pupils who have had diseases may safely return to 
 school. 
 
 "Scarlet fever, not less than six weeks from date of rash, if 
 desquamation have completely ceased and there be no appear- 
 ance of sore throat. 
 
EDUCATION AND SCHOOL-HYGIENE. 233 
 
 "Measles, not less than three weeks, if a\\ desquamation and 
 cough have ceased. 
 
 " German measles (rotheln, or epidemic roseola), in two or 
 three weeks, the exact time depending on the nature of the 
 attack. 
 
 " Small-pox and chicken-pox, when every scab has fallen oif. 
 
 " Mumps, four weeks from commencement, if all swelling 
 have subsided. 
 
 " "Whooping-cough, after six weeks from commencement of 
 whooping, provided the characteristic spasmodic cough and 
 the whooping have ceased, or earlier if all cough have com- 
 pletely passed away. 
 
 "Diphtheria, not less than three weeks, when convalescence 
 is completed, — there being no longer any form of sore throat, 
 nor any kind of discharge from the throat, nose, eyes, ears, 
 etc., and no albuminuria. 
 
 " Ophthalmia, until there has been a complete absence of 
 discharge for at least one month, or until the inner surfaces of 
 the eyelids are found on inspection to be quite free from gran- 
 ulations. . . . 
 
 " Scarlet Fever. — This disease is one of the most destructive. 
 It is very contagious. It often leaves behind it very serious 
 injuries, even after apparent recovery. To keep children from 
 having it is a parent's duty, if possible. An instance of what 
 the government may do in the way of checking it is probably 
 furnished by the followiiig account. 
 
 "The Boston Board of Health in 1877 established a regula- 
 tion requiring children from infected houses to be kept out of 
 public schools, and requiring physicians to report their cases 
 of scarlet fever. Since that time the number of deaths from 
 scarlatina has varied from year to year in the most irregular 
 way. But, taking years by groups, it appears that the rela- 
 tive number of deaths has much diminished." 
 
 " Dr. J. Lewis Smith ^ rt-fers to the important facts regarding 
 
 ^ ^ Archives of Pediatrics. 
 20* 
 
234 MOTHER AND CHILD. 
 
 the propagation of this disease. It is contagious from the first 
 day of its occurrence, continues so during desquamation, is 
 probably propagated by ear-discharge if disinfectants be not 
 used. Its area of contagion is limited, — but a few feet ; on the 
 other hand, the tenacity of its poison is remarkable, adhering 
 to persons and things, and thus being carried by physicians, 
 nurses, visitors, clothing that has been stowed away a length of 
 time, letters, library books, and also being retained in the hang- 
 ings, furniture, and wall-paper of rooms, etc. The gases gener- 
 ated by burning sulphur are proved to be not eflScient, although 
 Dr. Squibb suggests that it is because they are used in too dry 
 a state. The sulphur should be burned in a room, with boil- 
 ing water. Chlorine generated by the action of sulphuric acid 
 on a mixture of common salt and black oxide of manganese is 
 probably more eflScient. But Dr. Smith asserts that methods 
 for purifying rooms in which scarlet fever and diphtheria 
 patients are confined can only be successful if preventive 
 measures be employed during the continuance of the case. 
 These consist in the use of disinfectants in the sick-room, or 
 upon the patient from the beginning of the disease. Isolation 
 and disinfection are the measures to be relied upon. The floor 
 and walls of the room should be bare; none but doctor and 
 nurse should enter it ; all books, toys, etc., used by the patient 
 should afterwards be burned ; soiled clothing should be thor- 
 oughly disinfected; thorough ventilation secured; the air 
 purified by vaporizing in a broad dish, over a gas or oil stove, 
 two tablespoonfuls of the following mixture : carbolic acid, one 
 ounce; oil of eucalyptus, one ounce; spirits of turpentine, six 
 ounces ; the vaporizing to be continued uninterruptedly. The 
 bod}^ should be anointed every three hours with carbolic acid, 
 one drachm; oil of eucalyptus, one drachm; olive oil, seven 
 ounces. To the pharynx a solution of corrosive sublimate, 
 two grains to a pint of water, may be applied as gargle or 
 spray every two houi's. It may also be injected into the 
 nostrils. Articles of clothing should be disinfected. Physi- 
 cians should be especially cai"eful to preserve their clothing 
 
EDUCATION AND SCHOOL-HYGIENE. 235 
 
 from contamination, and to cleanse themselves thoroughly 
 before visiting other patients. They should impress upon the 
 family the importance of careful disinfection of the room on 
 the termination of the case. In addition to the ordinary 
 measures, it is advised to rub the walls of the apartment with 
 slices of fresh bread which gather up microbes, and to wash, 
 whitewash, or kalsomine the walls, ceiling, or floor with a solu- 
 tion of corrosive sublimate." 
 
 The Philadelphia Board of Health has issued the follow- 
 ing regulations for the prevention and restriction of scarlet 
 fever : 
 
 "Scarlet fever is a highly-contagious disease, directly com- 
 municable from one person to another, or by infected clothing, 
 rags, etc., or by the discharges from the body of a person sick 
 with the disease. It is always attended with a scarlet erup- 
 tion on the skin, and is generally accompanied by a sore 
 throat. When a child or young person has a sore throat and 
 fever, and especially if it has an eruption of the skin, it should 
 immediately be separated and kept secluded from all other 
 persons except necessary attendants, until it be determined 
 whether or not it has scarlet fever, or some other communi- 
 cable disease. 
 
 " During the progress of this disease, not only the eruption 
 of the skin, but everything that is thrown off from the body 
 of the sick, contains the germs or seeds of the disease, which 
 are capable of propagating it in another person. The dis- 
 charges from the nose and throat are especially dangerous. 
 The secretions from the kidneys, which are frequently seri- 
 ously aifected in scarlet fever, and the discharges from the 
 bowels are also supposed to be capable of spreading the poison, 
 and this power may be retained for a long time. When these 
 secretions have found their way into cesspools, sewers, heaps 
 of decaying organic matter, etc., they may be still capable of 
 giving off the poison and of spreading the disease. It is, 
 therefore, of the greatest importance to destroy the poison 
 before it leaves the sick-room. 
 
236 MOTHER AND CHILD. 
 
 " Attendants upon persons suffering from scarlet fever, and ■ 
 also the members of the patient's family, should not mingle 
 with other people, nor should children be allowed to enter a 
 house in which this disease exists. Children not believed to 
 be infected should be sent away from the house in which 
 scarlet fever exists to families not liable to the disease ; but 
 they should be isolated from the public for at least fourteen 
 days from the time of their removal. Children under ten 
 years of age are in much greater danger of taking the disease, 
 and after they do take it of dying from it, than are grown 
 persons. But adults sometimes have the disease, and even 
 though it be in a mild form, they may communicate the 
 disease in a fatal form to children. 
 
 "In cases of scarlet fever the following directions should be 
 carried into effect : 
 
 " 1. Have the patient placed in one of the upper rooms of 
 the house, the farthest removed from the rest of the family, 
 where is to be had the best ventilation and isolation. The 
 room should be instantly cleared of all curtains, carpets, 
 woollen goods, and all unnecessary furnitui'e. Keep the r om 
 constantly well ventilated, by means of open windows, and 
 fires if necessary. 3Iaintain the utmost cleanliness both with 
 regard to the patient and in the room. A basin charged with 
 chloride of hme, or some other efficient disinfectant, should 
 be kept constantly on the bed for the patient to spit in. 
 Change the clothing of the patient as often as needful, but 
 do not carry it while dry through the house. A large vessel 
 (as a tub), containing a solution of carbolic acid, in the pro- 
 portion of four fluidounces of clear carbolic acid to the 
 gallon of water, or a solution of chloride of lime, in the pro- 
 portion of half an ounce of the best chloride of lime to the 
 gallon of water, should always stand in the room for the 
 reception of all bed and body linen immediately on its removal 
 from the person or contact with the patient. Pocket-hand- 
 kerchiefs should not be used, but small pieces of rag should 
 be employed instead for wiping the mouth and nose ; and 
 
EDUCATION AND SCHOOL-HYGIENE. 237 
 
 each piece, after being once used, should be immediately 
 burned. Two basins, one containing a solution of the purer 
 quality of carbolic acid, in the proportion of half a fluidounee 
 to the quart of water, or of chlorinated soda, in the propor- 
 tion of two fluidounces to the quart of water, and the other 
 containing plain water, and a good supply of towels, must 
 always be ready and convenient, so that the hands of the 
 nurse may be at once disinfected and washed after they have 
 been brought in contact with the patient. All glasses, cups, 
 and other vessels used by or about the patient should be 
 scrupulously cleansed before being used by others. The dis- 
 charges from the bowels and kidneys are to be received, on 
 their very issue from the body, into vessels containing some 
 disinfectant, as a solution of four fluidounces of carbolic acid 
 to the gallon of water, or of four ounces of the best chloride 
 of lime to the gallon of water, and immediately removed. jSTo 
 person should be allowed, to enter the room, except those who 
 are necessarily attending upon the sick. A sheet moistened 
 with a strong solution of carbolic acid, suspended outside the 
 door of the room, or across the passage way leading to it, is 
 useful to complete the isolation of the patient. 
 
 " 2. Food and drink that have been in the sick-room should 
 be at once destroyed or buried. 
 
 " 3. Do not kiss a person who has a sore throat, nor take 
 his or her breath. Do not drink out of the same cup, nor 
 use any article that has been used by such person. 
 
 "4. For the purj^ose of preventing the spread of conta- 
 gious particles from the surface of the body into the air, 
 the skin should be anointed with oil or vaseline, commencing 
 on the fourth day after the appearance of the eruption, and 
 continuing every day until the patient is well enough to 
 take a warm bath. These baths should be given eveiy 
 other day for four times. This proceeding should not, how- 
 ever, be adopted unless with the advice of the attending 
 physician. 
 
 "5. Boiling is one of the surest ways of disinfecting all 
 
238 MOTHER AND CHILD. 
 
 contaminated clothing. After the clothing and bedding have 
 been immersed for two hours in one of the solutions above 
 advised for this purpose, they should be boiled for at least 
 half an hour. Any material which cannot be washed without 
 injury should be exposed to a dry heat of about 240° F., 
 or fumigated in a closed chamber, as directed below. A hot- 
 air disinfecting chamber has been provided on the hospital 
 grounds, where beds, woollen goods, etc., may be disinfected 
 under the direction of officers apj)ointed by the Board. All 
 articles which can be spared should be destroyed by fire. A 
 furnace for this purpose has been constructed at the hospital 
 grounds, and is at the disposal of the public, under suitable 
 restrictions. 
 
 "6. Burial of the dead from scarlet fever should be private, 
 and the body should not be exposed to view. Newspaper 
 notices of such death should state that the deceased person 
 died of scarlet fever. 
 
 " 7. When persons have had scarlet fever, whether they get 
 well or die, the room which they have occupied should be 
 thoroughly cleaned and disinfected. The paper should be 
 removed by moistening with carbolic acid solution, and the 
 furniture and all surfaces should be thoroughly washed with 
 a solution of clear carbolic acid, in the proportion of two 
 fluidounces to the gallon of water, or of chloride of lime, in 
 the proportion of two ounces to the gallon of water. The 
 walls and ceiling, if plastered, should be whitewashed with 
 lime-wash containing the same proportion of carbolic acid. 
 The floors and wood- work should be then thoroughly scrubbed 
 with soap and hot water. As an additional precaution, fumi- 
 gation with sulphurous acid gas may be practised. It should 
 precede the washing of the surfaces. Close the doors, win- 
 dows, and all other openings, and burn not less than three 
 pounds of sulphur for each thousand cubic feet of air-space 
 in the room. In order to insure complete combustion of 
 the sulphur, it should be used in the form of powder, or in 
 small pieces, which should be placed in a shallow iron pan 
 
EDUCATION AND SCHOOL-HYGIENE. 239 
 
 upon a couple of bricks set in a tub partly filled with water, 
 to guard against fire. The sulphur should be moistened with 
 alcohol before it is set on fire. Chlorine gas may be used 
 instead, and may be generated by pouring strong sulphuric 
 acid upon equal parts of common salt and binoxide of manga- 
 nese, to which some water has been added. Finally, the room 
 should be well aired for several days, by throwing oj^en the 
 doors and windows. 
 
 " 8. To disinfect a privy-vault or cesspool, use two and one- 
 half pounds of chloride of lime for every eight gallons — or 
 about one cubic foot — of fecal matter contained in the vault. 
 It should be applied in solution. 
 
 " 9. In regard to food and medicine, always rely on the 
 advice of a physician, who should be sent for as early as 
 possible." 
 
 " Diphtheria. — Children at school may take diphtheria from 
 one another in a variety of ways, — by using the same cup to 
 drink from, by the practice of putting pencils and marbles to 
 their mouths regardless of whose mouths they may have 
 visited previously, by turning pages of books with wet fingers. 
 
 " ' Diphtheria may be diffused by the exhalations of the sick, 
 by the air surrounding them, or directly by the exudation, 
 communicated in the act of kissing, coughing, spitting, sneez- 
 ing, or by the infected articles used, as towels, napkins, hand- 
 kerchiefs, etc. The poison clings with great tenacity to certain 
 places, rooms, and houses, where it may occasion cases after 
 the lapse of months.' 
 
 " These opinions are quoted to illustrate the variety of the 
 dangers that attend school-intercourse with an infected person. 
 They are also pertinent in view of the doubt entertained by 
 some as to the contagiousness of the disease, — a doubt honestly 
 held. 
 
 " In epidemics of diphtheria all cases of sore throat must 
 be looked on with suspicion, more particularly if the children 
 are feverish and depressed. Teachers should take note of 
 this. 
 
240 MOTHER AND CHILD. 
 
 " Contagious ophthalmia is of frequent occurrence in chil- 
 dren's asylums, and occasionally in jDrimaiy schools. It fre- 
 quently causes blindness or great injury to sight. Its existence 
 among the inmates of an institution as an epidemic is due to 
 carelessness about admissions, to overcrowding, j)Oor food, and 
 other causes of enfeebled health. One of the chief ways in 
 which it spreads is by the children's washing together in the 
 same water and using the same towel. 
 
 " Fune7'als are a fruitful source of contagion. It may not be 
 amiss to say that funerals must not be held in the school-house, 
 as seems to be a custom in some places. 
 
 " Children who have been exposed to any contagion may be 
 ordered to remain out of school for a limited time, in the 
 judgment of the Board. 
 
 " Closing school is a measure that seems needless in a jDlace 
 where rules about exclusion are well enforced. It seems to 
 have a beneficial effect sometimes, as the prohibition of public 
 meetings does. 
 
 "It is doubtful if contagious fever is often carried by 
 library-books ; or, rather, the known cases must be very 
 rare. 
 
 " In boarding-schools there ought to be a sick-room in the 
 upper part of the house or in an isolated place. A pupil 
 attacked with contagious disease should be at once isolated 
 and all his effects disinfected. Communication of all sorts is 
 to be cut off between pupil and comrades, and great care 
 taken about food, clothes, and all things that come from the 
 chamber. The parents are to be notified. If a considerable 
 number of cases occur, or the disease is malignant, the parents 
 of all pupils should be notified, that they may remove their 
 children if thej'' choose. 
 
 " The school should have its own medical attendant, who is 
 to take all steps necessary in epidemics. 
 
 "It ma}^ be well to subject pupils to a delay, if when school 
 opens it is found that they have been exposed to some con- 
 tagious disease. This may prevent an outbreak in the school. 
 
SURGICAL EMERGENCIES. 241 
 
 The period required may be as follows, dating from the day of 
 exposure : 
 
 Diphtheria, ] 2 days. 
 
 Scarlatina, 14 " 
 
 Measles, 16 " 
 German measles, 6 " 
 
 Chicken-pox, 18 days. 
 
 Small-pox, 18 " 
 
 Mumps, 24 " 
 
 Whooping-cough, 21 " 
 
 CHAPTEE XXXVII. 
 
 SURGICAL EMERGENCIES. 
 
 Children are frequently meeting with accidents, or emer- 
 gencies of other kinds constantly arise that need immediate 
 attention, and the parent or nurse is often obliged to turn 
 surgeon for the time being. If one carefully reads at leisure 
 moments what doctors call the " indications" for treatment and 
 the proper methods of dressing wounds oi- of antidoting poisons 
 or of resuscitating the asphyxiated, when the accident occurs 
 he or she will know exactly what to do, and keeping cool under 
 such trying circumstances, and doing the ''right thing at the 
 right time," will requii'e no effort, but will come naturally. 
 
 BRUISES. 
 
 A bruise, which is a contusion of the soft parts, causes a 
 rupture of the minute blood-vessels and blood is poured into 
 the tissues beneath the skin. This, if not absorbed, will cause 
 the " black and blue" appearance so characteristic. Of course, 
 the later this color appears the deeper has been the contusion. 
 
 The treatment of a bruise consists in doing all in one's power 
 to arrest the bleeding beneath the skin ; thus preventing in- 
 flammation, causing absorption of the effused blood, and thereby 
 also preventing discoloration in exposed parts of the body. 
 Hot water, as hot as can be borne, and continuously applied, is 
 the most potent remedy. Ice was formerly recommended ; but 
 L y 21 
 
242 MOTHER AND CHILD. 
 
 though it will check the bleeding, it congeals the blood al- 
 ready poured out and arrests the circulation, thus promoting 
 instead of preventing discoloration : so nowadays heat is used 
 instead. The part, if possible, should be bandaged, not too 
 tightly, and the bandage soaked in a lotion of tincture of arnica 
 one part, water three parts, or distillate of hamamelis, or, if very 
 painful, one teaspoonful of laudanum to four tablespoonfuls of 
 dilute lead-water. If the bruise is in the soft parts, not in a 
 joint, and the skin is not broken, the part can be rubbed gently 
 but firmly, after the application of a hot lotion, with any oint- 
 ment like vaseline, tallow, or soap liniment, or chloroform lini- 
 ment may be used instead. If the blow has been in the orbit 
 and a " black eye" is feared, use hot water, — not hot enough to 
 injure the eye, — and then cover the skin with an " alum curd," 
 made by mixing powdered alum with white of egg. 
 
 The bruise of a joint — in other words, a sprain — must be 
 treated by heat, as above, and by mild, soothing liniments or 
 ointments ; it should be loosely bandaged only to give support 
 and not to interfere with the circulation, and then the joint 
 must be kept at perfect rest till the doctor arrives. If it be a 
 limb, it should be wrapped in a pillow and kept elevated, and 
 kept moist by cloths wrung out in hot water and covered by 
 oiled silk or waxed paper, or if the ankle or wrist be sprained, 
 it can be plunged into hot water and kept there as long as 
 bearable, this being repeated until the pain is relieved. 
 
 We cannot do better than quote at length from an excellent 
 little book by Dr. Howard Barrett^ on this subject. 
 
 "CUTS AND OTHER WOUNDS. 
 
 " These are of different kinds : there is the clean cut, as it is 
 called, done with a sharp edged instrument; the lacerated cut 
 or torn wound, done with a blunt-edged instrument or torn 
 by a hook or other object ; the crushed or bruised cut or 
 
 ^ The Management of Infancy and Childhood in Health and Disease. 
 
SURGICAL EMERGENCIES. 243 
 
 wound, as in an injury from a blow with a stick, or a stone, or 
 from the fall of a heavy weight ; violent injuries from ma- 
 chinery, from being run over, and the like, are usually of this 
 class; and there is 1\iq punctured wound, as from the bite of an 
 animal, or from some sharp pointed instrument. Just as cuts 
 and wounds differ in the way in which they are produced, so 
 do they differ in their seriousness, in their way of healing, and 
 in the treatment necessary for each. 
 
 " Treatment of a Clean Cut or Incised Wound. — There are 
 three principal things to be done : (1) To stop the bleeding. (2) 
 To clean the wound and remove extraneous matters, such as clots 
 of blood, grains of sand or dirt, bits of glass, etc. (3) To adapt the 
 lips of the wound and obtain union of its sides. The^rs^ point 
 will be fully treated of in the section on the stopping of bleeding. 
 The second object is usually accomplished by washing out the 
 wound well with a stream of cold water and carefully sponging 
 its sides with a soft sponge ; but the majority of clean cuts do 
 not need this, because no foreign matter has ever got into them. 
 The third point is one of some importance. We should always 
 try, if possible, to get the gash to heal by direct union of its 
 sides ; or, as doctors call it, ' to obtain union by the first in- 
 tention.' This is partly a question of good management and 
 partly one of good constitution. If the child's constitution is 
 healthy, it will be easy to obtain direct union, even if the cut 
 is a large one, — he has ' good healing flesh,' as they say. If 
 his constitution is weakly and poor, it will be very difficult to 
 obtain direct union, even if the cut is only a trifling one. 
 "Wounds healed by ' the first intention' leave no scar ; those 
 healing otherwise usually do. 
 
 " For ordinary small cuts of the fingers or hand, the best plan 
 is to bind them up with a narrow strip of dry lint or linen rag, 
 applied with moderate tightness and left on for twentj^-four 
 hours, after which time it may be detached by soaking in warm 
 water. Longer and deeper cuts should have their edges brought 
 together by strips of plaster, especially if they occur on parts 
 of the body where there is space for the use of plaster. The 
 
244 MOTHER AND CHILD. 
 
 bleeding must first be stopped. Strips of piaster for uniting 
 the lips of a wound of any size must be long, and broad enough, 
 to give support to the edges of the cut. Short, narrow strips 
 are useless. Each strip must be attached first on one side of 
 the cut, and then (a slight ])ull being taken on it, by which the 
 edges are brought together) to the other. The strips of plaster, 
 when once attached, should not be changed, unless they become 
 loose ; if they will, let them remain on until complete union is 
 obtained. In taking off strips of plaster from a wound, loosen 
 both ends at the same time, so that the middle of the strip, and 
 not one end, is the last to leave the skin : in this way pulling 
 the wound open again may always be avoided. Wounds some- 
 times are of such dimensions or in such localities that plaster 
 either cannot be used or is not sufficient for the purpose. In 
 such cases and in those in which it is necessary to bring the 
 edges very accurately together to avoid scar and deformity, as 
 in deep and large wounds of the face, sutures or stitches may 
 have to be employed. 
 
 " The necessity of the entire exclusion of air, when we want a 
 cut to heal by 'the first intention,' must be borne in mind. 
 To this end, among others, we cover it with plaster or wet 
 lint, as the case may be. But we possess a valuable agent in 
 collodion,^ a liquid largely used by photographers. If the 
 edges of a cut that does not gape much are held together, 
 while collodion is painted over them and over a little of the 
 sui'rounding skin also, with a brush ; and if they are so held 
 for a few seconds, until the liquid is dry, it will be found that 
 a firm, horny film is formed, which holds them in position by 
 itself and effectually keeps out the air. The same end is 
 attained by tying, or otherwise fixing, a small piece of lint 
 soaked in collodion across the cut. I n the same manner col- 
 lodion may be applied as a sort of air-tight varnish over the 
 strips of plaster dressing a wound, or over the spaces of a cut 
 
 1 " It must be remembored that collodion will ' sting' the raw surface, 
 so it should not be painted on the edge of a wound. 
 
SURG-ICAL EMERGENCIES. 245 
 
 intervening between sutures, or over almost any small wound, 
 provided it is done soon after the infliction of the injury, but 
 not till the bleeding has entirely ceased. 
 
 " But perhaps, after all, the wound or cut will not heal by 
 'the first intention ;' it shows no signs of uniting, and begins 
 to look rather angry and to pour out either matter or a watery, 
 yellowish-red fluid ; or the edges of the wound may become 
 red, swollen, and puffy, even though there is no discharge. 
 What is to be done ? Eeraove whatever dressings, plasters, 
 or sutures may have been applied, wash it out with warm 
 water, and apply either soft and warm linseed poultices or 
 large pads of lint kept soaked in hot water and covered with 
 oil-silk, for a few hours. Then keep applied to it cold-water 
 dressings, by which is meant linen rag or lint kept constantly 
 wet with cold water. In some cases, after all inflammation 
 has subsided, the edges may once more be brought together 
 by a strip or two of plaster, while a pad of cold-water dressing 
 still lies upon them, above the plaster. 
 
 " Deep wounds of the palm of the hand are often dangerous 
 from the great difficulty experienced in stopping the bleeding. 
 Ko one but a surgeon can deal with them, but pending his 
 arrival the lower part of the arm should be bent as much as 
 possible upon the upper, and bound firmly in this position. 
 This will have some effect in checkinar the bleeding. 
 
 " Torn or crushed wounds are usually more serious than 
 clean cuts, and are always more difficult to deal with. They 
 do not bleed so freely, but they nearly always inflame, and the 
 inflammation may go on even to a limited mortiflcation, or 
 sloughing, of the wound. The fact of a wound being inflamed 
 is rendered evident by the swelled, hot, dry, and glazy appear- 
 ance it presents, and by the heavy, throbbing pain felt in it. 
 If by chance the inflammation goes on to sloughing, the pain 
 and swelling will usually greatly diminish, the wound will 
 begin to assume a dark and livid hue, to pour out a thin, 
 brownish fluid, and to smell very offensively. The usual prog- 
 ress of such a case is for the dead portions of tissue then 
 
 21* 
 
246 MOTHER AND CHILD. 
 
 gradually to come away, after which the wound slowly fills 
 up and heals. 
 
 " Punctured Wounds. — It is very seldom that these will heal 
 by ' the first intention.' Complete rest of the part, dressings 
 of lint, kept constantly wet with cold water,' and support by 
 a bandage applied with moderate firmness, give the best 
 chances of a favorable healing. If the wound, or wounds, 
 begin to pour out matter, use hot linseed poultices, instead 
 of the cold dressings. 
 
 " Grazes of the skin, or places whence pieces of skin have 
 been chipped off, are best treated, if seen very shortly after 
 the injury, by just once brushing the surface over with col- 
 lodion, carbolated vaseline, or benzoated oxide of zinc oint- 
 ment. Either of these protect the surface from the air, the 
 former by a hard film, and the latter by a scab, under which 
 the skin soon forms again. These remedies are rather too 
 sharp, however, for an infant. If the graze has not been seen 
 till it has been done some time, or if it occurs in the case of 
 an infant, it may be kept dressed with a piece of lint, spread 
 with oxide of zinc ointment, which must be changed daily 
 till it heals. 
 
 " ON THE STOPPING OF BLEEDING. 
 
 " If, as the result of some accident, a child bleeds rather 
 freely, alarm, excitement, and confusion usually reign supreme 
 in the house, until the fiow is stanched. This may be natural, 
 but the alarm is generally groundless, and the excitement is 
 mischievous and obstructive of good management. Of course, 
 with such tender and fragile beings as infants and young 
 children, it is essential that bleeding should be speedily 
 stopped ; but still the mother may take courage and comfort 
 from the assurance that by following closely the advice about 
 to be given, she herself may always succeed, on an emergency 
 
 ^ " Into ■which a few drops of creolin have been put. 
 
SURGICAL EMERGENCIES. 247 
 
 and if no surgeon is at hand, in stopping almost any bleeding 
 that is not caused by the wound of an artery ; and even this 
 she may often control, until assistance arrives. If an artery 
 is wounded, it is known by the blood spouting up in the air in 
 successive jets of bright crimson, a jet for every beat of the 
 heart. 
 
 " The remedies at our disposal are: (1) Cold, either in the 
 form of ice, cold water, or a free exposure to the air, or water 
 as hot as can be borne. An excellent plan is to let the hot 
 water from the bath-room spigot run over it. (2) Styptics, 
 or drugs whose application coagulate and stanch flowing 
 blood, such as the strong acid tincture of iron. (3) Pressure, 
 either in the form of pads and bandages, or of the finger 
 pressed firmly on the bleeding point. (4) Ligature of the part 
 injured — if it be the arm or leg, finger or toe — nearer to the 
 body than the injury. 
 
 " Of course many other methods are at the command of 
 surgeons. 
 
 " What to do. — The first thing to do is to nerve yourself to 
 steadiness and self-control, and as far as possible to dismiss 
 all alarm as to the amount or continuance of the bleeding. It 
 is surprising how much show and mess a little blood will make. 
 If the bleeding is rather free, do not attempt to stop it by 
 covering it up with rags and handkerchiefs, — this is worse than 
 useless, — but expose it freely to the air, and let a stream of 
 cold water (the colder the better) or of hot water, and the 
 hotter the better, pour over it for a time. This course, if 
 persevered in for a time, will nearly always moderate or alto- 
 gether stop the bleeding. But supposing that it only mod- 
 erates it, or entirely fails to abate it, what then ? Make a 
 thick, hard pad of dry lint or linen rag, not much larger than 
 the wound, place it upon the bleeding orifice, and bind it 
 tightly on with a few turns of calico bandage. If this stanches 
 the blood, as it generally will, do not remove it for several 
 hours, and when you do, soak it off very carefully in tepid or 
 warmish water. If the bleeding continues to go on uncon- 
 
248 MOTHER AND CHILD. 
 
 trolled, in spite of the pad and bandage, take them off again; 
 wash the wound clean with cold water ; make another similar 
 pad, but this time steep it in distillate of hamamelis, or 
 Pond's extract, and if this fails the strong acid tincture of 
 iron (called by druggists liquor ferri perchloridi), if available ; 
 if not, in creosote, or in turj)entine, or in a strong solution of 
 tannin in water ; wipe the wound dry and apply the pad, bind- 
 ing it tightly on, as before, with a bandage. 
 
 ''If an artery is wounded, the jet of bright blood spouting 
 out with each pulsation of the heart, as above described, is 
 seen; and it is never seen unless an artery is wounded. This 
 is a most serious accident, and can only be treated by a sur- 
 geon, who must be sent for with all speed. Meanwhile, if 
 nothing is done, the child may bleed to death. Binding up the 
 wound with a pad and bandage is utterly useless, so are all 
 styptics. Cold may do us a good turn ; therefore let the wound 
 remain exposed to the air. If the pouit from which the blood 
 spouts can be seen, simply place the finger firmly upon it and 
 keep it there unfalteringly until assistance arrives. Bleeding 
 from a small artery can thus be held in check for any length 
 of time by a sensible person of ordinary nerve ; but if the 
 bleeding is from a larger artery (evidenced by large jets of 
 blood), or if no one at hand is possessed of sufficient sense 
 or nerve, a strong silk handkerchief must be tied so tightly 
 round the injured limb somewhere between the injury and the 
 body, as to stop the circulation. If the handkerchief cannot 
 be tied tightly enough, insert a strong, smooth, round stick 
 between the handkerchief and the skin, and twist it round 
 imtil it screws the bandage sufficiently tight to prevent the 
 flow of blood. If ice can be obtained, place some upon the 
 wound ; it will tend materially to check the bleeding." 
 
 But as the most important part of the treatment of wounds 
 is that immediately following the injury, \ve will impress upon 
 the reader still further the details of their management, and 
 quote from Dr. Charles TV. Dulles as follows : 
 
SURGICAL EMERGENCIES. 249 
 
 " DRESSING-MATERIALS.^ 
 
 " Wouads may be rendered aseptic by washing with boiled 
 water and sometimes by the application of soluti(5ns of corro- 
 sive sublimate (one to two thousand) or carbolic acid (one to 
 one hundred), after which they may be strewn with powdered 
 iodoform or naphthalin or bismuth, while pulverized white 
 sugar or powdered sulphur may be used for the same purpose. 
 After this they are covered with an aseptic layer of gauze or 
 absorbent cotton or fine jute, over which i^ placed an imper- 
 vious layer of rubber tissue or waxed jJaper, thef'ivhole being 
 retained by a suitable bandage. .\:_-r- ^r^-' 
 
 "Such dressings often remain ft place until a wound is 
 healed, or until some rare accident demands their removal for 
 inspection of the wound. 
 
 ^^ Antiseptic gauze is composed of cheese-cloth thoroughly 
 boiled and impregnated with corrosive sublimate or iodoform, 
 and can be procured at a very moderate price from any 
 instrument-maker, or can be made without much trouble. 
 
 " Lint is now used chiefly in making wet applications or to 
 hold ointments, when its bulk, softness, and uniform texture 
 are of advantage. 
 
 " Absorbent cotton, jute, and fine carded wool are used to make 
 and maintain uniform and equable pressure : they are usually 
 applied over the dressing of gauze, or over its protecting 
 rubber tissue or waxed paper. 
 
 " Bandages are made of soft muslin or flannel, and, as a rule, 
 they are more comibrtable and easier to apply if of cheap and 
 rather open-meshed material. 
 
 " Splints are made of thin metal, very light wood, binder's 
 board, or felt fabric. Many useful splints are obtainable from 
 the instrument-maker ; but there are few cases in which a 
 perfectly suitable splint cannot be made out of thin strips of 
 pine wood, or pasteboard obtained from boxes or, if necessary, 
 
 ^ Keating's Cyclopaedia of the Diseases of Children, vol. iii. 
 
250 MOTHER AND CHILD. 
 
 from large books. Tlie function of splints is often overesti- 
 mated, and a little ingenuity will usually secure satisfactory 
 means of fixation and support anywhere. 
 
 ^^ Adhesive plaster, as now in use, is made of resin plaster or 
 rubber plaster spread upon strong twilled cotton cloth. The 
 latter is often preferable to the former because it does not 
 require heat for its application ; but it is less desirable when 
 the plaster must remain long on the skin, as it is likely to 
 give rise to the formation of an acneform or eczematous erup- 
 tion. In removing adhesive plaster dressings, it is especially 
 important in the case of children to remember that it is not 
 always necessary to remove all that has been used, and that 
 it may suffice to cut through the strips over or near the 
 wound, leaving the sides undisturbed, and placing any new 
 strips that may be needed over and upon the old ones. Much 
 irritation may be saved a patient in this way. It is also well 
 to remember that when a strap crossing a wound is' to be 
 removed, the proper plan is to loosen it from both ends and 
 draw on them towards the wound, and never away from it. 
 Another little point of importance is that the removal of an 
 adhesive strip is less painful, as a rule, if it is done quickly 
 and with a steady pull, instead of slowly and by jerks ; also, 
 that to pull in the direction of the hairs causes less pain than 
 to pull against it. 
 
 . "the cleansing op wounds. 
 '' It is a cardinal point of modern surgery that no wound 
 shall be dressed until it is perfectly clean. This rule may 
 sometimes be relaxed in cases in which nature has already 
 covered a wound with a healthy scab, and sometimes after 
 machinery accidents, when the grime which accompanies them 
 is very tenacious. But in most cases, and especially in the 
 wounds of children, a j)reliminary cleansing is imperative. 
 This can often be effected by touching or pressing the part 
 with dry absorbent cotton, or cotton which has been moistened 
 and then squeezed nearly dry, or lint, or either of these very 
 
SURGICAL EMERGENCIES. 251 
 
 slightly moistened ; actual lavement is by no means always 
 necessary. When actual washing is required, there should be 
 two vessels, one to contain the water and another to receive 
 it as it flows from the part. The water may be conveyed 
 through a small hose, or may come directly from a spigot, or 
 it may be allowed to fall in a steady stream from a sponge or 
 a mass of cotton, squeezed in the hand, the size of the stream 
 being regulated by the compression, and its force by the height 
 at which the hand is held. . . . 
 
 "dressing op wounds. 
 
 "Nature's method of protecting wounds is by the process 
 of scabbing ; and when we reflect upon the successful way in 
 which this operates in the lower animals, and often in man 
 too, we may wonder that it should be almost a matter of rou- 
 tine to remove scabs in surgical practice. It may gratify 
 our curiosity, it may even aid our study at times, but it is often 
 of no advantage to the patient, to remove from a disfigured 
 face or a cut head the crusts which are nature's reliable anti- 
 septic dressings. It is often well to leave such crusts undis- 
 turbed, and, if they are objectionable in an aesthetic sense, 
 simply to cover them with something better-looking. An 
 artificial scab made with lint, or tarlatan, or thin muslin, and 
 collodion, forms one of the best dressings which have ever 
 been devised for simple incised and not a few lacerated woun'ds. 
 Many cut heads and simple incised wounds" go to a prompt 
 and uninterrupted healing under the first dressing of this 
 sort. Efficient scabs may be formed by allowing lint to be- 
 come saturated with the oozing of a wound exposed to the 
 air. Dry powdered borax, or boric acid, or iodoform, may also 
 be used to promote the formation of a crust. In all these 
 cases, however, it is important to watch lest the crust bind 
 down offensive discharges, as any scab may do : when this 
 happens, the crust must, of course be removed, and the wound 
 cleaned." 
 
 For this reason it is a mistake for an attendant to immedi- 
 
252 MOTHER AND CHILD. 
 
 ately put adhesive plaster over a wound. A wound, especially 
 of the head, should be carefully washed and dressed with a 
 dry antiseptic dressing till seen by the doctor. 
 
 "Lead-water and laudanum is but little better than cold 
 water, so far as my experience would indicate, although it is 
 suited to cases in which there is much heat and pain. This 
 dressing ought never to be covered up, as it very often is, 
 with impervious coverings. Pure laudanum is often a very 
 soothing application. 
 
 "Dilute alcohol is a refreshing dressing, if it be allowed to 
 evaporate and be removed at the first sign of pain. 
 
 "The ointments in use in simple surgery are very numerous. 
 The best are fresh cold cream, vaseline, oxide-of-zinc ointment, 
 and equal parts of this and carbolic-acid ointment. The latter 
 are stimulating in their action. A piece of lint or muslin 
 should be spread with the ointment and trimmed down to the 
 exact size of the sore. If spread on the adjacent skin, it will 
 often after a while set up an artificial eczema, very annoying 
 to the patient." 
 
 Dr. Dulles in his excellent paper continues as follows, and, 
 as the language is clear and forcible, we cannot do better than 
 repeat it. 
 
 " EMERGENCIES. 
 
 " The accidents and emergencies to which children are liable 
 are different from those of adults, in that there are some to 
 which the former are more exposed than the latter, and some 
 to which children are not liable while adults are. The most 
 usual emergencies in children we will consider, taking those 
 which are more or less surgical in their nature and omitting 
 those which are purely medical. 
 
 "obstructions to respiration. 
 
 ^^ Drowning, Strangulation, Suffocation. — In cases of drowning, 
 if natural breathing has ceased, the first thing to be done is to 
 free the body from any clothing which binds the neck, chest, 
 
SURGICAL EMERGENCIES. 253 
 
 or waist, and to turn it over upon the face for a moment, 
 tlirusting a finger into the mouth and sweeping it round, to 
 bring away anything that may have got in or accumulated 
 there. Then the body should be laid out flat on the back, 
 with something a few inches high under the shoulders, so as 
 to cause the neck to be stretched out and the head to be carried 
 well back. The tongue should now be drawn forward out of 
 the mouth and held by an assistant, or, if there be no one to 
 do this, a pencil or small stick may be thrust across the mouth 
 on top of the tongue and back of the last teeth, to keep the 
 mouth open and the tongue out of the throat. A \Qvy good 
 way to get the base of the tongue clear of the windpipe is to 
 carry the head well back from the chest and to press the 
 angles of the jaw forward with both thumbs applied just be- 
 hind the rami [bones] of the lower jaw-bone. 
 
 " To secure artificial respiration the opei-ator should place 
 himself on his knees behind the patient's head, seize both 
 arms near the elbows and sweep them round horizontally, 
 away from the body and over the head, till they meet above it, 
 when a good, strong pull must be made upon them and kept 
 up for one or two seconds. This effects an inspiration. (Fig. 
 32.) The second manoeuvre consists in returning the arms to 
 the anterior surface of the chest, and making strong pressure 
 against the lower ribs, so as to drive the air out of the chest 
 and effect an act of expiration. This need occupy but a second 
 of time. (Fig. 33.) Another plan is to hook the fingers under 
 the ribs and draw them up firmly, though gently, and then 
 release them. 
 
 " If either of these plans is regularly carried out, it will make 
 about twenty complete acts of respiration in a minute. It 
 should be kept up for a long time, and not abandoned until 
 recovery of natural respiration or until the heart has ceased 
 to beat. The cessation of the pulse at the wrists must not be 
 taken for a sign of death. Often life is present when even an 
 acute ear cannot detect the sound of the heart. Deep pressure 
 with the finger-ends just below the lower end of the sternum 
 
 22 
 
254 
 
 MOTHER AND CHILD. 
 
 ■piQ. 32. 
 
 Fig. 33. 
 
 bC'"^ 
 
SURGICAL EMERGENCIES. 255 
 
 may sometimes reveal pulsation in the aorta when it cannot 
 be found anywhere else. 
 
 " Wet clothing should be removed from a drowned person as 
 soon as possible. This can always be done without interrupting 
 the artificial respiration or exposing the person. Something 
 may be laid over the body and the wet clothes loosened under 
 it and drawn down over the feet. Then the body may be 
 quickly slipped on to something dry, and covered with some 
 other fabric, if the first has become wet, while this, in its turn, 
 is pulled away from underneath. 
 
 '• Warmth is to be secured by any means which ingenuity 
 may suggest, — hot bottles, or plates, or bricks, or stones, or 
 even boards that have lain in the summer sun. At the sea- 
 shore there is plenty of hot sand, and often plenty of baking 
 bathing- costumes. The body and limbs may be gently, but 
 constantly, rubbed towards the heart, to help the blood in its 
 labored circulation. None of these things need interfere with 
 the efforts to secure respiration, which must be uninter- 
 rupted. 
 
 " Some stimulant is to be given as soon as it can be swal- 
 lowed. Half-teaspoonful doses of whiskey or brandy, in two 
 teaspoonfuls of hot water, may be given every ten minutes, till 
 an ounce has been taken. 
 
 "As natural respiration begins to be attempted, it should be 
 aided as much as possible by timing the artificial to it. It 
 may be stimulated by carefully applying smelling-salts, or 
 hartshorn, to the nose, by slapping the skin lightly but smartly, 
 or by dashing hot water upon the chest. Where it is available, 
 there is no stimulus to respiration better than that of a good 
 faradic battery used so as to cause a reflex sobbing, or deep 
 breathing, by the pain it causes. Little by little natural 
 breathing will take the place of the artificial ; but it must not 
 be left unwatched for some time. 
 
 " Nothing but danger from cold, or pressing necessity, should 
 prompt the removal from one place to another of a child who 
 is being resuscitated, before this has been thoroughly accom- 
 
256 MOTHER AND CHILD. 
 
 plished. If removal cannot be avoided, it must be effected with 
 gi'eat care. After resuscitation the child should be put in a 
 warm bed, being carried carefully, with the head low, and a 
 watch should be kept to see that the breathing does not sud- 
 denly stop. 
 
 " Where natural breathing has not ceased, all the steps just 
 described should be carried out, with the exception of artificial 
 respiration. But this should be had recourse to upon the first 
 evidence that natural respiration is failing. 
 
 " Strangulation by hanging, or by anything which compresses 
 the trachea [windpipe] from the outside, is to be treated by 
 re-establishing the respiration in the same way as for droioning. 
 The obstruction is, of course, to be removed, and natural 
 respiration stimulated or artificial resjDiration employed. 
 Hanging is not an unheard-of accident with children, as thej^ 
 may hang themselves accidentally, and a child has been known 
 to hang a younger one in imitation of what it had heard de- 
 scribed by its parents. 
 
 " Suffocation with noxious gases or vapors calls for instant 
 removal to the fresh air and for the establishment of natural 
 respiration, or of artificial until the natural is re-established, 
 as described in speaking of drowning. 
 
 " In strangulation caused by a foreign body in the throat, oesoph- 
 agus [gullet], or trachea, it is not always easy to tell which of 
 these passages is clogged, but usually there is an active irrita- 
 tion, with coughing, when a foreign body lodges in the larynx 
 or trachea, while swallowing can be done quite readily. On the 
 other hand, when the oesophagus is stopped it is usually im- 
 possible 10 swallow, anil there is little or no tendency to cough, 
 no matter how much the breathing may be interfered with. 
 Foreign bodies in the fauces or larynx are not so hard to 
 discover. 
 
 " If a foreign body be within reach of the fingers, it may 
 often be easily removed. If not, a pair of forceps may be 
 used, or, in a pinch, a pair of blunt-pointed scissors. Or a 
 hair-pin may be straightened out and one end bent round so as 
 
SURGICAL EMERGENCIES. 257 
 
 to make a loop, and this used to dislodge the foreign body ; or 
 the handle of one blade of a pair of scissors may be used in 
 the same way. It Las been stated that for foreign bodies in 
 the throat, such as pieces of meat, etc., a simple mode of re- 
 lief is to blow forcibly into the ear. This sometimes excites 
 powerful reflex action, during which the foreign body is ex- 
 pelled. Such a plan is so easy of execution that it is certainly 
 worth trying. 
 
 '• Children not infrequently get buttons, coins, or marbles in 
 their throats. These may be often pulled out or expelled by 
 vomiting induced by titillatioa of the fauces, or by an ordinary 
 emetic. Holding the body up by the legs, with the head 
 hanging down, may sometimes aid other efforts to get rid of 
 such things. Attempts to push the foreign body down may 
 prove successful. 
 
 " If foreign bodies get into the larynx or trachea, a moderate 
 blow on the back with the open hand, or a quick strong 
 squeeze of the chest, sometimes aids the coughing act ; and 
 inverting the body may assist in dislodging the foreign body 
 if it be not too tightly wedged in. 
 
 " When coins, marbles, slate-pencils, or nails are swallowed by 
 children, it is usually a mistake to give an emetic or a purga- 
 tive. The proper plan is to let the bowels alone and to give 
 'plenty of good solid food^ especially vegetables, so that the 
 foreign body may be surrounded with the waste and carried 
 out of the body without injuring the waUs of the intestines. 
 
 " FOREIGN BODIES IN THE EYE, NOSE, AND EAR. 
 
 " Foreign Bodies in the Eye. — Small substances, like cinders, 
 dust, or small chips of stone or metal, can often be removed 
 from the eye by very simple means. Sometimes the flow of 
 tears washes them out. At other times catching the upper' 
 lid by the lashes and pulling it away from the eyeball and 
 down over the lower lid, then letting it go so that as it recedes 
 its under surface is swept by the edge of the low«r lid, will 
 r 22* 
 
258 MOTHER AND CHILD. 
 
 clear it out. If this does not prove successful, a loop made of 
 a horse-hair or of a long human hair can be passed under the 
 lid and swept from the outer side towards the nose and drawn 
 down. This may serve the purpose. If it does not, the upper 
 and lower lids must be everted and examined with a good 
 light and the aid of a lens if necessary. 
 
 "The eyeball must also be examined and any foreign sub- 
 stance removed. 
 
 " One must be on his guard against the sensation which is 
 sometimes left after a foreign body has been removed from the 
 eye. But a most careful search should be made before this is 
 taken to be a self-deception. 
 
 " After removing a foreign body from the eye, the irritation 
 may be sufficient to demand cool, wet applications, or even 
 anodynes. jSTothing is better than a thin mucilage of pure, 
 clean gum-arabic poured freely in the eye. A bandage loosely 
 applied often does much good. 
 
 '• When lime gets in the eye, the eye should be deluged 
 with water, and a little vinegar or lemon-juice and water (a 
 teaspoonful of vinegar or lemon-juice to a teacupful of water) 
 poured over the eyeball. 
 
 '■^Foreign Bodies in the Nose. — Children sometimes place, 
 or have placed, in their noses small bodies, such as marbles, 
 buttons, peas, beans, or small grains. To get rid of them the 
 nose should be blown hard, or sneezing may be excited by 
 tickling the nose or giving snuff, or the child may be told to 
 take a full breath and then be given a smart blow on the 
 back. Some one of these plans may dislodge the foreign body. 
 If it does not, the affected nostril may be closed while the 
 other is blown into, through a rubber tube, and on suddenly 
 releasing the closm'e of the side occupied by the foreign body 
 it may be driven out. If none of these methods succeed, 
 'instrumental extraction will be required. 
 
 " Foreign Bodies in the Ear. — The removal of foreign bodies 
 from the ear is so delicate an operation that, when possible, a 
 specialist should be asked to do it. . . . 
 
SURGICAL EMERGENCIES. 259 
 
 " If live insects get into the ear, oil or glycerin or salt-and- 
 water should be poured in. Or a plug of cotton soaked in a 
 strong solution of salt and vinegar may be placed in the ear 
 and the head turned over on that side. A method which has 
 sometimes been successful is to turn the ear to a bright light, 
 so as to tempt the insect to back out. 
 
 " LOSS OF CONSCIOUSNESS, AND CONVULSIONS. 
 
 " The treatment suitable for all cases in which there is doubt 
 as to the cause of unconsciousness is to secure quiet and rest, 
 the body being laid upon the back, with the head a little 
 raised. If there be great paleness and a cold surface, with 
 slow, sighing breathing, — the signs of prostration, — smelling- 
 salts or hartshorn may be held under the nose, hot tea or 
 coffee given, and heat applied to the body. If there be great 
 heat of the surface, cold may be applied to the body and head, 
 and cold drinks given. 
 
 " Fainting. — A fainting person must be laid out flat at once, 
 so that the heart may not have to work against the force of 
 gravitation in sending blood to the brain. Sprinkling water 
 upon the face and holding smelling-salts to the nose tend to 
 excite the nerves of sensation and rouse the brain and heart 
 to renewed activity. Nothing else is usually necessary ; 
 though if a person is vei"y slow in coming to, it may be well 
 to apply heat in the form of a mild mustard plaster or hot 
 moist cloths to the pit of the stomach. 
 
 " Hysterics are best treated by the exercise of calmness and 
 patience, sometimes by taking no notice of the attack, or by 
 leaving the sufferer in a room alone. Heroic measures, like 
 dashing water into the face, are not to be generally recom- 
 mended. Good is sometimes done by giving valerian or Hoff- 
 mann's anodyne. 
 
 " Epileptic fits are to be treated very much like fainting-fits, 
 because in them also the brain is temporarily bloodless. At 
 the same time, any movements calculated to injure the person 
 
260 MOTHER AND CHILD. 
 
 must be controlled. There is no use in struggling against 
 such as will do no injury ; they had better be simply regulated, 
 and no attempt made to prevent them entirely; but a piece 
 of folded cloth or a piece of soft wood may be — if it can be — 
 thrust between the teeth, to prevent the usual biting of the 
 tongue. When the height of the convulsion is passed, rest, 
 quiet, and perhaps a moderate stimulation may be secured. 
 Here again the flat position of the body must be main- 
 tained. 
 
 " Convulsions of children and infants are generally (in the 
 absence of brain- or kidney-disease) due to some irritation of 
 the digestive apparatus or to teething. They are usually pre- 
 ceded by some other evidence of irritation, such as restlessness 
 and fretfulness. The spasms may affect the whole body at 
 once, or onjy a half, or only one limb at a time. The eyeballs 
 sometimes roll about or squint, or, they are turned far up, so 
 that only the lower part of them can be seen. 
 
 "When convulsions occur, the child should have cold ap- 
 plied to the head and heat to the body. It often seems to do 
 good to place it in a tub of hot water to which some mustard 
 has been added. A large injection of hot soapsuds should 
 also be given, to clear the bowels out, and, if possible, an 
 emetic, in the hope of removing anj' cause of trouble from the 
 stomach. . . . 
 
 "injuries to the brain. 
 
 " Concussion of the brain may be caused by blows or falls on 
 the head, or even by falls upon the feet. or the buttocks. In 
 such cases there is sickness, sometimes fainting, with paleness 
 and depression. There is also usually confusion of ideas, and 
 the sufferer cannot talk continuously and coherently. There 
 may even be unconsciousness. 
 
 "The proper treatment for this condition is rest in bed, 
 quiet, and plenty of fresh air. If the skin becomes cold and 
 clammy, heat should be applied to the body and limbs. No 
 whiskey or brandy should be given. . . . 
 
SURGICAL EMERGENCIES. 261 
 
 "effects of heat. 
 
 ^^ Burns or scalds are usually dangerous in proportion to 
 their extent and depth. Those which involve as much as half 
 the surface of the skin are almost necessarily fatal. 
 
 " After an extensive burn or scald, so much of the clothing 
 as has to be removed must be clipped away, so as not to burst 
 blisters that have formed. These may be punctured at one 
 edge and their contents allowed to run out, and the elevated 
 cuticle to fall down upon the deeper laj^er. Then a dressing of 
 pure sweet oil, castor oil, or vaseline is to be applied on strips 
 of soft old linen, and disturbed as little as possible afterwards. 
 Iodoform is a very soothing application to burns, either in 
 powder or in an ointment ; although its prolonged use has a 
 tendency to promote or prolong suppuration. Cai'ron oil [lin- 
 seed oil and lime-water, equal parts] is also an excellent appli- 
 cation, and stimulants or anodynes may be given as required. 
 In case of a severe and extensive burn, the entire body may 
 be immersed in a bath, to be kept at a temperature of 100° F. 
 
 " Slight burns or scalds are best treated by applying a cloth 
 soaked in a strong solution of baking-soda — the bicarbonate — 
 in the proportion of a heaping tablespoonful in a teacupful of 
 water, or it may be powdered on without using any water. 
 Carron oil is a good application for such burns. So is the white 
 of egg. In an emergency damp earth may be used, or white- 
 lead paint. Anything may be used which will prevent friction 
 and exclude the air; but nothing should be used which will 
 stick in cakes and prevent after-examination or make this very 
 painful. For this reason flour and cotton batting, though often 
 recommended, had better not be used. For small burns, simple 
 cool water is better in every way than these. Indeed, for any 
 but the most extensive burns it is one of the best remedies : 
 an arm or a leg can be immersed in it and left there a long 
 while with great advantage. 
 
 ^^ Burns with acids must be deluged with water and then 
 treated like other burns. 
 
262 MOTHER AND CHILD. 
 
 " Burns with caustic alkalies, such as soap-lye, should be treated 
 with an application of vine2:ar, followed by applications of 
 oil. 
 
 "■Burns with Sot Pitch. — After such burns the pitch often 
 sticks. In such a case it ought not to be removed immediately 
 unless in excessive amount. 
 
 " Sunburn, and the burns caused by external applications, like 
 mustard, may be treated very successfully with bicarbonate of 
 sodium. This may also be mixed in equal parts with vaseline, 
 cosmoline, or lard from which the salt has been boiled out, and 
 used as an ointment. 
 
 " Sunstroke, or more properly heatstroke, is not usually due to 
 the direct rays of the sun, but rather to a prolonged elevation 
 of the bodily temperature, especially in confined places. When 
 it takes place in the open air it is apt to be on oppressive, 
 heavy, or murky days. It is generallj^ preceded for some time 
 by pain in the head and a sense of oppression. The attack, 
 however, culminates in loss of consciousness, with heavy, 
 labored breathing, and an intense burning, dry heat of the 
 skin, while the bladder and bowels are often involuntarily 
 evacuated. The absence of perspiration in the presence of so 
 great heat is one of the most characteristic symptoms of heat- 
 stroke. 
 
 " The treatment consists in first lowering the temperature. 
 As much of the clothing as practicable must be removed, and 
 the patient should be transported to a cool and airy place, if 
 possible. Cold must then be applied to the head and body 
 and ice may be rubbed over the chest and placed in the arm- 
 pits. Pouring or dashing cold water over the body is not to 
 be advised, as it conveys a needless shock to the system; but 
 there is nothing better than to place the body in a cold bath, 
 or to wrap it in sheets kept wet and cold by renewed appli- 
 cations of cold water or ice. The temperature of the body 
 must be watched, as there is some risk of pushing its reduction- 
 too far. When the temperature has been brought down to 
 100° F. or consciousness has returned, the cold may be discon- 
 
SURGICAL EMERGENCIES. 263 
 
 tinued, to be renewed only if the sui-face becomes again very 
 hot. 
 
 ^^Heat-Exhaustion. — This is a condition of great depression of 
 the system due to the action of heat, and, occurring in hot 
 weather, it might be confounded with sunstroke or heatstroke. 
 But in heat-exhaustion, instead of a hot, dry skin, there is a 
 cold, moist one. This calls for rest, fresh air, and a cool apart- 
 ment, but for no application of cold to the surface. Small 
 doses of brandy or whiskey thoroughly diluted ma}^ be given, 
 and the system gradually brought back from its depression. 
 
 ^'■Lightning-Stroke. — This is marked by evidences of shock, 
 with reduction of the force of the circulation, weak pulse, and 
 slow, sighing breathing. It is to be treated with rest and 
 stimulants, and warmth applied to the body. 
 
 "effects of cold. 
 
 " Freezing is best treated by gradually bringing the tempera- 
 ture up to that which is normal and maintaining it there. 
 When fingers or toes are frozen or frosted, warm baths and 
 gentle friction are to be used, afterwards covering with a 
 thick, hot poultice. In such cases gangrene not infrequently 
 follows the freezing. Frozen ears or noses are of less frequent 
 occurrence, but must be treated on the same principles. 
 
 " If the whole body has been exposed to extreme cold, there 
 will follow a depression which requires the most cautious 
 treatment. To restore its warmth is the first demand, and for 
 this a warm bath, made gradually warmer until as hot as can 
 be well borne, surrounding with heated blankets, or exposure 
 before an open fire, may be used.^ At the same time, stimu- 
 
 ^ " This recommendation is contrary to popular belief, and contrary to 
 what is taught in most text-books, as well as in books on the treatment of 
 emergencies. But it has been proved to be correct by experiments made 
 in Kussia, where it was found that the best way to resuscitate dogs which 
 had been frozen was to put them at once into a hot bath. Of twenty 
 
264 MOTHER AND CHILD. 
 
 lants may be given internally, such as hot tea or coffee, "with 
 the addition of small quantities of spirits. 
 
 " SPRAINS. 
 
 " Sprains of the fingers or of the wrist require cold and moist 
 applications. In the latter the hand and forearm should be 
 covered with cotton, bandaged smoothly, and laid on a straight 
 splint and lightly secured to it with a soft bandage or broad 
 strips of sticking-plaster. One of these should go round the 
 hand and one or two round the forearm above the wrist, — not 
 over it. Sprains must be treated by rest, and by heat or cold, 
 whichever gives the most comfort. 
 
 " Sprains of the ankle are not infrequently complicated with 
 a fracture of one of the malleoli [ankle-bones]. This compli- 
 cation may give rise to much trouble, and requires very skilful 
 and patient treatment. The general principle in the case of a 
 sprained ankle is, first, to put the joint at complete rest, to 
 allay inflammation if it arises, and afterwards to promote the 
 absorption of inflammatory products. The foot and ankle 
 should be covered with cotton or carded wool and a bandage 
 carefully and smoothly applied. The use of a splint may 
 usually be dispensed with, if the bandaging is well done. The 
 dressings may remain undisturbed for days if the ankle is 
 comfortable. If the dressings become loose from rapid dimi- 
 nution of the swelling, they should be removed and reapplied. 
 When this is done, careful massage or douching with alternate 
 streams of hot and cold water may be useful. . . . 
 
 " WOUNDS. 
 
 " Wounds may be classified as contusions, contused, lacerated, 
 punctured, poisoned, incised, and gunshot wounds. 
 
 " Contusions are best treated at first, when painful, by the 
 
 animals treated Toy the ' gradual' method in a cold room, fourteen died ; 
 of twenty introduced at once into a warm room, eight died ; of twenty 
 placed immediately in a hot hath, all recovered. 
 
SURGICAL EMERGENCIES. 265 
 
 application of cold wet cloths. Pure laudanum is often a very 
 accej)table application. Later, when the pain has subsided, 
 hot wet cloths are best, as they favor the carrying oif of the 
 blood that has escaped. 
 
 "In contusions of the chest or abdomen internal organs may 
 be injured. Evidence of this may be seen in spitting of blood, 
 or vomiting it, or passing it from the bowels or from the 
 bladder; or there may be great depression. In such cases 
 complete rest must be secured, and the strength of the sufferer 
 sustained by means of warmth applied externally and careful 
 stimulation internally, until the nature of the injury is exactly 
 made out and a suitable line of treatment may be adopted. 
 
 " Contused Wounds. — These are cuts or tears accompanied 
 with bruising of the tissues. They are to be treated like lacer- 
 ated wounds. Unless they bleed freely, warm applications are 
 better suited to such wounds than are cold ones. 
 
 " Incised wounds^ if simple and small, call only for a piece of 
 adhesive plaster and perhaps a bandage. If large, the edges 
 should be brought as near together as possible, and supported 
 so by adhesive plaster or by bandages. If an entire part be 
 cut off, as an ear, a nose, a toe, or a finger, it should be cleaned 
 with lukewarm water, and put in its place, with sutures, band- 
 ages, and a splint. Some very remarkable cases of reunion 
 of such parts are on record, and an attempt to save them is 
 not to be lightly rejected. 
 
 ." Lacerated Wounds. — In lacerated wounds the torn parts can 
 be placed as nearly as possible in their natural position (after 
 removal of any foreign matters that have entered them) and 
 covered with cool wet lint, or with lint soaked in laudanum 
 or in alcohol and water. If the tear has been very great and 
 the sufferer is depressed and cold, teaspoonful doses of brandy 
 or whiskey in hot water may be administered, and lint wrung 
 out of hot water placed over the injured parts. 
 
 " Punctured wounds are made with sharp-pointed objects, like 
 arrows, pins, needles, tacks, fish-hooks, glass, thorns, splinters, 
 or teeth. . . . 
 
 M • 23 
 
266 MOTHER AND CHILD. 
 
 " Fish-hooks may be removed by a simple incision, or the 
 string may be cut and the point of the hook pushed through 
 the skin and the whole drawn out, as a needle would be in 
 sewing. If it can be done, the broad part of the hook may be 
 cut off before trying this. But this is usually not easy for 
 the ojierator or the patient. 
 
 " Splinters are dangerous in proportion to their size and 
 according to the part they enter. Small splinters may be 
 picked out with a needle. Splinters under the nails may be 
 removed by scraping the nail as thin as possible over the splin- 
 ter, then splitting it or cutting a little tongue out. 
 
 " Splinters of glass must be removed by incision, and the 
 wound treated on general principles. 
 
 " Splinters in the eye should be removed with the greatest 
 care, and, if possible, by a specialist. Afterwards the eyelid 
 should be gently closed, both eyes covered with a layer of 
 absorbent cotton soaked in cool water, and a bandage placed 
 round the head, so as to keep the lids as still as possible. This 
 bandage should not be too thick nor put on too tight, and the 
 application should be kept cool, with ice, if need be. 
 
 " Poisoned wounds are usually punctured, and result from the 
 bites or stings of animals or insects. 
 
 " The bites of venomous serpents usually demand the prompt 
 removal of the part bitten. It may be cut out instantly. 
 Before this the part should be encircled above the wound with 
 a tight ligature, and, if small enough, thrust into the mouth 
 and sucked hard, so as to extract the poison. Cauterization 
 may be effected with anything at hand, like a knitting-needle 
 or a nail, heated to redness. Stimulants may be administered 
 if necessary. 
 
 " The stings of tarantulas, scorpions, centipedes, etc., are to 
 be treated with cold, and hartshorn applied to the point where 
 the sting entered. 
 
 " The stings of insects may be treated with cold, wet alkaline 
 applications : wet earth is a very good one. The application 
 of a drop of hartshorn or some wet salt often gives great relief. 
 
SURGICAL EMERGENCIES. 267 
 
 " The bites of cats and rats are sometimes followed by severe 
 inflammation. The treatment consists in cleansing the bites, 
 and treating them as lacerated wounds. 
 
 " The Bites of Dogs. — If any one be bitten by a dog in good 
 health, only the simplest treatment will be necessary. If the 
 dog be sick, local inflammation or severe constitutional dis- 
 turbance may follow. In case of reasonable suspicion, the 
 wound may be thoroughly cleansed and an application of 
 hartshorn made to it, in addition to energetic sucking to extract 
 any irritating material which may have entered it. A pro- 
 longed study and considerable experience with regard to the 
 subject have convinced me that the general practice of cau- 
 terizing dog-bites with nitrate of silver is dangerous and should 
 be abandoned. 
 
 "Most medical men know that it is a foolish thing to kill a 
 dog that has bitten anybody, soon after this has taken place. 
 Such a dog should be caught and kept under the observation 
 of a person of great carefulness, intelligence, and special infor- 
 mation. The too speedy slaughter of a dog has robbed many 
 a sufferer of the assurance that would have been gained by 
 seeing it living and well, and has sent many a one to the 
 grave, as dying of hydrophobia, who never had it, but had 
 been bitten by a healthy and harmless animal. 
 
 " SPECIAL HEMORRHAGES. 
 
 " Bleeding from the nose, in children, is often nature's way 
 of getting rid of an excess of blood ; but it may be so profuse 
 as to threaten life. If this be the case, salt-and-water or 
 vinegar may be snuffed up the nose, injected by a fountain- 
 syringe, or applied by pouring with the head thrown back. A 
 strong solution of alum in very warm water is also useful ; but 
 vinegar is less disagreeable, and will seldom fail to check the 
 bleeding. . . . 
 
 "In hemorrhage from the lungs the blood is bright red and 
 generally frothy. It is rarely profuse, and yet, as it is usually 
 
268 MOTHER AND CHILD. 
 
 coughed up and caught in a handkerchief, it seems to be so. 
 The amount can never be safely estimated in this way. The 
 best treatment is rest in bed with the body raised in the sit- 
 ting posture, and the swallowing of lumps of ice. The appli- 
 cation of cold to the chest, if the patient is not too weak, is of 
 some use, and a saltspoonful of salt and a teaspoonful of 
 vinegar may be given every fifteen minutes. ... 
 
 " In hemorrhage from the stomach the blood is usually very 
 dark, looking like coffee-grounds. If it is mixed with any 
 other contents of the stomach, its appearance may be masked. 
 In such cases ice-water or broken ice may be swallowed, and 
 teaspoonful doses of vinegar. Eest in bed must, and the 
 application of cold to the stomach may, be employed, with 
 tannic acid in five-grain doses. 
 
 " Hemorrhage from the bowels may be treated with ice-water 
 injections and the application of ice to the abdomen. . . . 
 
 " In severe hemorrhage, rest in bed, without a pillow, and 
 with the head lower than the hody^ must also be secured. 
 
 " POISONS. 
 
 "As it is better to prevent accidents than to correct them, it 
 is a good plan to have dangerous articles kept invariably out 
 of reach of children, and to have any bottle containing what 
 may be dangerous marked by a ball and chain, such as the 
 druggists sell, or by tying a stout piece of tape round its neck. 
 This gives warning in the dark as well as in the light. 
 
 "When there is reason to believe that a child has taken a 
 poison of some sort, it may be known what has been taken, or 
 it may not be known. "We will consider first 
 
 " Unknown Poisons. — If the child should vomit, this should be 
 encouraged ; if not, it must be provoked. The simplest way 
 to do this is to give large draughts of lukewarm water, and 
 to titillate the fauces. If there is time, and it is at hand, a 
 teaspoonful or two of ground mustard may be stirred up in . 
 the water, or a teaspoonful of powdered ipecac, or a tablespoon- 
 
SURGICAL EMERGENCIES. 269 
 
 ful of the syrup of ipecac. There is no occasion for fastidious- 
 ness. Any water will do. Water in which hands — or dishes, 
 for that matter — have been washed may by its very repulsive- 
 ness act more quickly than anything else ; and if soap has 
 been used, it will be all the better for that, as soap is an anti- 
 dote for acid poisons. The quantity used must be large ; the 
 sufferer must be urged to drink and drink, a large quantity at 
 a time, until he can contain no more, and has been made to 
 vomit over and over again. 
 
 "After copious vomiting, soothing liquids should be given, — 
 oil, milk, beaten-up raw eggs, — all in moderately large quanti- 
 ties. These are especially valuable when the poison has been 
 of- an irritating character. 
 
 " If the sufferer be much depressed, some stimulant may be 
 administered. Strong, hot tea, without milk, is the best, 
 because it is a chemical antidote to many poisons. Strong 
 coffee is next in value. To either of these can be added 
 brandy, whiskey, wine, or alcohol, in half-teaspoonful doses, 
 mixed with a little hot water. Warm coverings are not to be 
 forgotten; and if the depression be great, hot-water cans or 
 hot bricks, wrapped in one or two thicknesses of blanket, 
 should be laid by the side of the chest, or a large poultice 
 placed round the body, or a blanket wrung out of hot water 
 and covered with a dry one. 
 
 •^Mineral Acids. — For these the proper treatment is to give 
 an alkali. A tablespoonful of hartshorn may be mixed with 
 two teacupfuls of water and given ; or almost unlimited quan- 
 tities of soda, magnesia, potash, whitewash, chalk, tooth- 
 powder, whiting, plaster, soap, or even wood-ashes, stirred up 
 in water. After this should come the provoking of vomiting; 
 then the bland fluids mentioned above should be administered, 
 rest secured, and stimulation employed if necessary. 
 
 " Oxalic Acid. — For this the best antidote is lime in some 
 form. If lime-water is at hand, it may be given freely, or 
 whitewash, tooth-powder, chalk, whiting, or plaster from a 
 wall. The latter may be crushed and stirred up in water, 
 
 23* 
 
270 MOTHER AND CHILD. 
 
 "without regai'd to the grittiness, which ■will not do any 
 harm. 
 
 " Carbolic acid is a very dangerous poison, because it acts 
 rapidly and benumbs the stomach, so that it is hard to pro- 
 voke vomiting. This must be attempted, however, and large 
 draughts of oil, white of egg, magnesia and water, or milk 
 must be given. Eest, warmth of the body, and stimulation 
 must also be secured. 
 
 '•' Alkaline Poisons. — Strong alkalies must be combated with an 
 acid. Yinegar can always be had, and there is nothing better. 
 It should be given undiluted and in large quantities. Lemon- 
 juice may be used, or even orange-juice, though the latter is 
 too mild an acid to be of much service, unless the oranges are 
 very sour. Vomiting should then be provoked, and followed 
 by bland drinks, rest, and stimulation if necessary, 
 
 '■^Arsenic usually excites vomiting and violent pain in the 
 stomach. At once large quantities of milk, white of egg, 
 flour-and-water. or oil and lime-water must be given. The 
 vomiting must be encouraged or provoked, and dialyzed iron 
 should be given freely, in tablespoonful doses, each dose being 
 followed at once by a teaspoonful of common salt in a teacup- 
 ful of water ; or, if this is not at hand, equal parts of sulphate 
 of iron and of carbonate of sodium may be dissolved in 
 separate cups of hot water and then mixed and drunk. After- 
 wards vomiting should be again provoked, and followed by a 
 dose of castor oil. 
 
 " Acetate of lead calls for vomiting, Epsom salt, milk, and cas- 
 tor oil. 
 
 " Corrosive Sublimate. — When this is taken vomiting must be 
 provoked, and some form of tannic acid given. Strong tea is 
 the handiest thing containing this, and its administration should 
 be followed up with eggs and milk. 
 
 " Tartar emetic is best treated in the same way. 
 
 " Phosphorus is sometimes chewed off matches by children. 
 It is a poison which acts slowly. Five-grain doses of sulphate 
 of copper dissolved in water may be given, at intervals of ten 
 
SURGICAL EMERGENCIES. 271 
 
 minutes, until vomiting comes on. Then a dose of magnesia 
 should be administered, but no oil. 
 
 " Nitrate of Silver. — The antidote for lunar caustic is a very- 
 strong brine of salt-and-water, given again and again ; and 
 vomiting should be provoked until the vomited matters cease 
 to have a look like thin milk. 
 
 " Iodine, in the form of a tincture, is also sometimes swal- 
 lowed by mistake. The antidote for this is starch-and-water. 
 
 " Opium preparations, such as opium, morphine, laudanum, 
 paregoric, black drop, must be combated with emetics, used 
 promptly. Strong coffee must be freely given as a stimulant. 
 So long as the breathing does not fall below ten to the minute, 
 there is no immediate danger of death ; but the important mat- 
 ter is to keep up the breathing. The custom of walking a 
 patient up and down and slapping him with wet towels is to 
 be deprecated, because it adds exhaustion to stupor. If an 
 electrical battery can be obtained, the faradic current should 
 be used, and applied so as to stimulate the sensory nerves in 
 the skin, so that they shall excite reflex acts of deep breathing. 
 The next best thing is to lay the patient upon a lounge and 
 slap his skin with the back of a broad brush or with a slipjaer. 
 This is all the rousing that is necessary-, so long as the breath- 
 ing keeps above ten to the minute. Should it fall below this, 
 or if the breathing should cease, artificial respiration should 
 be employed. 
 
 " Chloral. — The treatment for chloral poisoning is the same 
 as for poisoning by opium. 
 
 " Strychnine poisoning should be treated by provoking vomit- 
 ing, giving a purge, and doses of fifteen grains of bromide of 
 potassium or ten grains of chloral, or both. The greatest quiet 
 must be secured. The poisoned person should be put to bed in 
 a darkened room, with doors, windows, and shutters arranged 
 in a way that shall exclude all sights, sounds, and draughts, 
 though permitting good ventilation. 
 
 ^^ Aconite. — In case of aconite poisoning vomiting must be 
 brought on, and followed by the administration of stimulants. 
 
272 MOTHER AND CHILD. 
 
 Strong coffee may be used, hartshorn (a teasjDOonful in a 
 teaeupful of water), wine, whiskey, or brandy. If there is 
 depression, warmth should be used, as described when speaking 
 of unknown poisons. 
 
 " Yerairum viride poisoning is to be treated like aconite poi- 
 soning. 
 
 " Semlock, deadly nightshade, the Jamestown (or jimson) weed, 
 monkshood, and toadstools are sometimes eaten, without knowl- 
 edge of their poisonous character. Tobacco, too, sometimes 
 causes poisonous effects. All produce deep depression, and 
 must be treated by the induction of vomiting, if it has not 
 already occurred, followed by stimulation and warmth, very 
 much as in the case of aconite poisoning. 
 
 ^'Alcoholic liquors are sometimes taken in such large quanti- 
 ties as to be poisonous. When this is the case the course to 
 be pursued is to cause vomiting, give hartshorn-and-water (a 
 teaspoonful in a teaeupful), and keep the body warm. 
 
 " Decayed meats or vegetables usually excite vomiting, which 
 should be encouraged till the stomach is empty, and followed 
 by a dose of castor oil and some jDowdered charcoal. 
 
 " In conclusion, let it be remembered that when there is an 
 alarm of poisoning it is important to keep cool. In many eases 
 of poisoning there is much more alarm than danger. Death 
 from accidental poisoning is very rare. To save time in an 
 emergency, the following table may be consulted, which gives 
 the name of each of the poisons we have already studied, and 
 the proper treatment for it. 
 
 " Poison. Treatment. 
 
 Provoke repeated vomiting ; 
 Unknown J Give bland liquids ; 
 
 Acids : "| 
 
 I 
 
 Stimulate, if necessary. 
 Give an alkali ; 
 
 P ' ' I I Provoke vomitins; 
 
 Nitric, 
 
 3 ) 
 
 Muriatic, f \ a ^ 
 
 ' I becure rest ; 
 
 Oxalic, I s,;,^„iot. ^f 
 
 -{ Give bland liquids ; 
 
 j Secure rest ; 
 
 I I Stimulate, if necessary. 
 
 Carbolic, J L > J' 
 
SURGICAL EMERGENCIES. 
 
 273 
 
 "Poison. 
 Alkalies : . "1 
 Hartshorn, i 
 Soda, !- . . 
 
 Potash, I 
 
 Lye, J 
 
 Arsenic : 
 Paris green, 
 Scheele's green, 
 
 Acetate of Lead : ■\ 
 Sugar of Lead, / 
 
 Cor7^osive Sublimate, 
 Tartar Emetic, 
 
 Phosphorus 
 
 Nitrate of Silver 
 
 Iodine 
 
 Opium, : 
 Morphine, 
 Laudanum, 
 Paregoric, etc., 
 
 Chloral, 
 
 Strychnine 
 
 Aconite, ■\ 
 
 Veratrum Viride, j 
 
 Treatment. 
 Give an acid (vinegar) ; 
 Provoke vomiting ; 
 Give bland liquids ; 
 Secure rest ; 
 Stimulate, if necessary. 
 Provoke vomiting ; -j repeat sev- 
 
 Give dialyzed iron and salt ; J eral times ; 
 Give dose of castor oil ; 
 Secure rest ; 
 Stimulate, if necessary. 
 
 I P " ) I repeat several times ; 
 
 I Provoke vomiting ; J 
 
 1 Give bland liquids ; 
 
 [ Give dose of castor oil. 
 
 j^ Provoke vomiting ; "j ^®P®^* 
 
 ' Give strong tea, without milk ; | several 
 
 J times ; 
 
 Give raw eggs and milk ; 
 
 Give dose of castor oil ; 
 
 Stimulate, if necessary. 
 
 Provoke vomiting ; 
 
 Give five-grain doses of sulphate of copper, 
 or teaspoonful doses of turpentine ; 
 
 Give dose of magnesia, but no oil. 
 
 Give strong salt-and-water ; \ repeat many 
 
 Provoke vomiting ; J times. 
 
 Provoke vomiting ; 
 
 Give starch-and- water ; 
 
 Give bland fluids. 
 
 Provoke vomiting repeatedly ; 
 Give strong coffee, without milk ; 
 Keep up the breathing. 
 
 Provoke vomiting once or twice ; 
 Give a purgative ; 
 Secure absolute quiet. 
 Provoke vomiting ; 
 Stimulate well ; 
 Keep head low. 
 
 -! 
 
274 MOTHER AND CHILD. 
 
 " Poison. Teeatment. 
 
 Jamestown Weed, "] 
 
 Hemlock, 
 
 Nightshade {belladonna), ^ . | Provoke Yomiting ; 
 Toadstools, ^ Stimulate Tvell. 
 
 Tobacco, 
 
 Alcohol j Provoke vomiting ; 
 
 I. Give hartshom-and-water. 
 
 {Provoke vomiting ; 
 Give a purgative ; 
 Give powdered charcoal. 
 
 " To provoke vomiting, warni water may be used, with or 
 without ground mustard (a teaspoonful to half a pint of 
 water), or ipecacuanha (a teaspoonful of the powder or a 
 tablespoonful or so of the syi-up), and titillating the fauces. It 
 is best to give large quantities (half a pint at a time) of warm 
 water whenever vomiting is to be excited. 
 
 " Bland liquids are milk, raw eggs, some sort of oil, gruel, etc. 
 
 '• Stimulants are tea, coffee, whiskey, wine, etc., or hartshorn- 
 and-water. A teaspoonful of hartshorn in a teacupful of 
 water will be enough for a dose. In making tea or coffee one 
 must not wait to do it as if for the table, but mix hot water 
 and the leaves or grounds, squeeze them well, stir together, 
 and give the whole, — leaves, grounds, everything. At the 
 same time, some may be made regularly, if there are con- 
 veniences for it. 
 
 " Alkaline antidotes are hartshorn-and- water (a tablespoonful 
 in two teaeupfuls of water), soap-and-water, lime, whiting 
 soda, chalk, tooth-powder, plaster, magnesia, whitewash, and 
 even wood-ashes. 
 
 " Acid antidotes are vinegar and lemon-juice. 
 
 " In giving an antidote, never wait for it to dissolve. Just 
 stir it up in any fluid at hand, except oil, and have it swallowed 
 immediately." 
 
FRESH AIR, VENTILATION, OVT-DOOR EXERCISE. 275 
 
 • CHAPTEE XXXYIII. 
 
 TRESH AIR, VENTILATION, OUT-DOOR EXERCISE. 
 
 There is no more important subject for us to study than 
 that of ventilation, by which we mean the getting rid of foul 
 air and the entrance of pure air in as easy a manner as pos- 
 sible, free from draughts. We all know that cold air passing 
 through a chink, and then striking against some sensitive 
 nerve-point on the surface of the body, has a peculiar faculty 
 of abstracting heat, or giving what is known as '-a cold," 
 affecting the mucous membranes. Of course, the more deli- 
 cate or the younger the individual the more susceptible he 
 will be to such an impression. There are certain parts of the 
 body very susceptible to these currents of cold air ; these are 
 the face, neck, and feet; neuralgia, sore throats, and colds in 
 the head being the consequence. But it is to be observed 
 that these draughts are more apt to make themselves felt 
 when the parts on which they strike are in a state of relaxa- 
 tion ; naturally, should there be perspiration, its evaporation 
 would intensify the cold impression. When children, then, 
 after active play, and perspiring freely, sit in a room in a 
 draught, they will take cold, while, on the other hand, they 
 might continue their play in a colder. room and not feel it; 
 the action of their muscles, the excitement, giving them an 
 immunity which they would not have in a state of quiescence. 
 It should be our object, then, in the choice of a nursery, to 
 have a room, or two rooms communicating (when speaking 
 of these matters we specially refer to city houses), as far 
 removed as possible from the contaminations and filth of 
 the streets. The play-room should be large, should be situ- 
 ated in the second or third story, and should have the sun- 
 shine in it at least part of the day, A child's room should 
 
276 MOTHER AND CHILD. 
 
 have no communication whatever with a bath-room, water- 
 closet, or stationary wash-stands. Children are peculiarly sus- 
 ceptible to the effects of sewer-gas, or sewer-air contaminated 
 with germs, and many a case of diphtheria, or ^so-called mem- 
 branous croup, has succumbed to the subtle influence of the 
 poison of the disease) which has most insidiously been con- 
 veyed to the air of the room through traps that the plumber 
 has pronounced absolutely safe. We have witnessed such 
 distressing scenes in the houses — one might say palaces — of 
 the wealthy, have seen such frightful cases of malignant diph- 
 theria where money was no object in making the house perfect 
 in all respects, but where, unfortunately, ignorance or avarice ■ 
 on the plumber's part allowed a deadly leakage of non-odorless 
 sewer-air to go directly to a babe's room, that we feel we 
 cannot say too much by way of caution. 
 
 Of course, for a few weeks the new-born babe will sleep 
 with its mother; if it is a strong and vigorous child it may be 
 ]3ut in a crib or bassinet by her side. The great objection 
 to placing the child away from the mother is that, after the 
 nurse leaves, she will have to reach for it, and if her room is 
 cooler at night, as it should always be, there will be great 
 danger of her taking cold when she nurses the baby. On this 
 account, the child's crib should be j)laced as near as possible to 
 the mother's bed, or she should allow it to sleep in the bed 
 with her, but so placed that it will have a portion of the bed 
 entirely to itself. The child is, certainly, after a couple of 
 months, healthier when sleeping alone. 
 
 For the first month, at least, after birth, while the nurse is 
 still with the mother, she should take charge of the infant and 
 bring it in to nurse at the proper hour. The choice of a nur- 
 sery and sleeping-apartment is a matter of great importance. 
 The essentials are purity of atmosphere, uniformity of tem- 
 perature, and freedom from dust and gases which may arise 
 from methods of heating; especially is this the case with 
 faulty hot-air furnaces. There should be plenty of sunshine 
 when possible. At the present day. with our extended knowl- 
 
FRESH AIR, VENTILATION, OVT-DOOR EXERCISE. 277 
 
 edge of the causes of disease, impurity in the atmospliere lias 
 assumed great importance ; we are now able to recognize the 
 fact that certain diseases which were hitherto attributed to 
 cold, are in reality due to filth ; that certain other intestinal 
 disturbances which were attributed to heat, are in reality due 
 to decomposed or fermented food and to bad milk. These 
 facts are most important to bear in mind, not only to enable 
 us to cure disease, but also because, by a thorough recognition 
 of them, diseases or disorders which have been attributed 
 to climacteric disturbances, may, by the timely institution of 
 hygienic measures, be avoided. There is no reason why a 
 child that has a well-ventilated, clean, bright nursery, whose 
 milk is watched with zealous care and never allowed to become 
 tainted, one who is daily bathed, not overfed, neither debili- 
 tated by too heavy clothing nor subjected to daily fluctuations 
 in bodily temperature, should not pass through the summer 
 season in a city unharmed by the so much dreaded summer 
 weather. We mention this because, probably, many mothers 
 who read this book cannot afford to spend the summers out 
 of town. 
 
 A nursery should always have an open fireplace for ventila- 
 tion, and a counter-opening should be made over the window, 
 so as to allow the air to be changed with the least draught 
 possible ; this can be done by pulling down the top sash and 
 inserting a four-inch strip of board to keep it down ,• by this 
 means an indirect current will be made between the sashes. 
 Of all the methods of heating, probably the most used, but, 
 unfortunately, the one that can be most abused, is the hot-air 
 furnace. Parents should see that their nurseries are supplied 
 with air that is, first of all, pure : it must be taken at as great 
 a distance as possible from the ground, and not immediately 
 off gutters and damp yards, as is very frequently the case. 
 The air most charged with atmospheric impurities, whether 
 they be germs or gases, is that which is usually heated and 
 sent to the nursery ; the heating simply making it more poi- 
 sonous than before. The heated air should be passed over a 
 
 24 
 
278 MOTHER AND CHILD. 
 
 siu'face of pure water, by wliich means it will receive a cer- 
 tain amount of moisture, and should then be carried, as free 
 from dust as possible, directly to the nursery. Air which is 
 not passed over water, but simply dried, will undoubtedly pro- 
 duce various forms of irritation of the mucous membranes, 
 dryness of the throat and nose, languor, — symptoms which 
 we all recognize at once. Certainly nothing can be better 
 than an open grate, with a wood fire, even if it be only oc- 
 casionally used, to supplement the furnace, especially at 
 night ; but we much prefer a system of hot water and indi- 
 rect radiation for the heating of houses in our changeable 
 climate. 
 
 "We have always insisted that either an earthen water -vessel 
 which comes for the pui'pose be filled with water and placed 
 in front of the "register" in the nursery, or else a basin of 
 water with a towel dipped into it, the iipper corner of the towel 
 being pinned above the register. In a sick-room the water can 
 be medicated, if necessary. 
 
 The sleeping-room should be heated through the nursery, 
 if possible, and should be occupied only at night. Of course, 
 these matters are difficult to control, but at the same time, 
 if parents know what ought to be done and take an interest in 
 the matter, — think for themselves, — many arrangements can 
 be made to overcome temporary difficulties which at first seem 
 insurmountable, and thus render a dreary, unhealthy nursery 
 healthful and habitable. The nursery should always have a 
 thermometer, and the temperature should be kept at about 
 68° or 70° r. The heat should be always shut off at night, and 
 the bedclothing so arranged as to prevent its being thrown off 
 while the child is perspiring during the early morning hours, 
 when the system is most depressed, and at which time the 
 danger of catching cold is most imminent. For an infant, the 
 sleeping-room should be kept as much as possible at the same 
 temperature day and 'night. Avoid all sewerage arrangements 
 — pipes of every kind — in a nursery. The science of ventila- 
 tion and house-drainage gives us probably as perfect a system 
 
FRESH AIR, VENTILATION, OUT-DOOR EXERCISE. 279 
 
 as we shall ever have, but, unfortunately, the slightest fault 
 of construction will turn the otherwise harmless contrivance 
 for our comfort into one of the most deadly ; and there is no 
 means by which we can detect the presence of the sewer-air 
 that serves as a carrier of the poison of diphtheria or typhoid 
 fever, any more than there is evidence of the existence of their 
 germs in drinking-water. The most costly habitations of 
 the wealthy have these dreaded diseases carried into their 
 midst to a greater extent even than is found among the poor. 
 The classes of persons who suffer most from diphtheria are the 
 very wealthy and the very jDoor. Those of moderate wealth 
 guard their children carefully against cold, in the first place, 
 and their limited means prevent them from having those lux- 
 uries by means of which the deadly sewer-air is carried into 
 their bedrooms. Physicians believe that diphtheria most fre- 
 quently requires a cold, a catarrh in the throat, before the 
 poison is thoroughly absorbed, and probably this accounts for 
 the resistance which is observed in so many cases to an attack 
 in the summer. Just as soon as the child takes cold, becomes 
 a little run down, that dreaded disease will show itself. 
 
 The drinking-water should be pure ; when there is the 
 least doubt about its purity it should be boiled. We think 
 every household would be safer in having a Pasteur filter. " A 
 stitch in time saves nine;" a little expense and trouble may 
 save a loved one from death by typhoid or diphtheria. It 
 should also be remembered that ice is a great carrier of dis- 
 eased germs ; in fact, that the freezing process merely benumbs 
 them to render them as virulent as ever when thawed. If 
 possible, only artificiailj'-made ice should be used, and if it can- 
 not be obtained, the strictest care should be taken that natural 
 ice, from however pure a source, should not come in contact 
 with the infant's food. With the Pasteur filter comes a " cooler" 
 by which the water can be cooled. Iced water is not healthy 
 for children ; water should be cool, not cold. 
 
 We have laid great stress on the impoi'tance of thorough 
 ventilation and fresh air, but we wish it distinctly under- 
 
280 MOTHER AND CHILD. 
 
 stood that constancy in the purity of air, both day and night, 
 is not onl}^ requisite in the nursery, but also in the sick-room. 
 Cold air is not necessarily pure air, nor is air which is warmed 
 made impure by warming ; at the same time it should be 
 remembered that air filled with germs of disease, warmed by 
 a "heater," may become most deadly when carried to the 
 sleeping-chamber. A child's vitality is lowered at night, its 
 circulation is slower, its resistance to disease is less. A person 
 sleeping and chilled is much more liable to take cold than one 
 who is awake ; especially is this so in childhood and old age ; 
 but the temperature of the sleeping-room may be reduced 
 at night (the heat being turned off), with benefit, if the child 
 is covered — not enough to induce perspu^ation — and the cloth- 
 ing so arranged as not to be thrown off. Of course, a child, 
 up to at least six months, should be kept in a room which has 
 as nearly as possible the same temperature day and night, as 
 it sleeps most of the time, and when taken out of doors is so 
 warmly clad that the change of air cannot affect it. 
 
 To sum up, then, a nursery, or child's living-room and bed- 
 room, should be kept scrupulously clean, thoroughly aired, 
 and should be free from dust ; dust, independently of its irri- 
 tating character upon the mucous membrane, is the means of 
 conveying disease. The room should be swept with a patent 
 sweeper, and the dust which has accumulated should be care- 
 fully wiped off the places of its lodgement by means of a damp 
 cloth. The ideal nursery floor is one of hard wood, well laid 
 and polished, with rounded corners, and covered with a rug, 
 which should be shaken frequently. There are many days in 
 our treacherous climate when a child cannot be taken out of 
 doors ; indeed, there are many days when it had better remain 
 in its well-aired nursery. — days during which, if it went out of 
 doors in its perambulator, it would inhale the exhalations from 
 the foul masses that accumulate in our city streets. A child 
 in arms is far safer when carried out of doors for fresh air than 
 is one in a perambulator upon its first going out. 
 
 The day nursery should be supplied with plants. They are 
 
FRESH AIR, VENTILATION, OUT-DOOR EXERCISE. 281 
 
 undoubtedly beneficial to health when properly cared for, and 
 make the living-room bright and cheerful, and this reacts on 
 the disposition of the child. A bright, happy home makes a 
 bright, happy child, and what is freqently taken for temper, 
 perverseness, in many children is often sickness and unhapjDi- 
 ness. Happiness tends to health, and health is greatly depend- 
 ent on happiness. A child, from its infancy, that can take a 
 "no" from its parents as an ultimatum is far happier than 
 one who constantly frets for the purpose of having its whims 
 gratified. The parent who forbids the child five times and 
 then relents establishes a precedent that will invariably give 
 rise to trouble in the future. A command should always be 
 observed, a " no" should always be a " no," and such a bring- 
 ing up will help the doctor in case of illness — save life, perhaps 
 — and make the child a blessing in the house and a delight to 
 all who come in contact with it. An unhappy time indeed 
 has. the doctor who is called to attend a child in illness who 
 has been accustomed to say, "I won't" or "I will." Those 
 who are much thrown among children recognize this fact ; in- 
 deed, it is one which every grown person feels when he or she 
 looks back to childhood days. The energy and buoyancy which 
 comes with good health is in marked contrast to the depression 
 and u-ritability that is associated with illness, or, if not ex- 
 actly illness, with those sedentary pursuits that are in them- 
 selves unhealthful. 
 
 In an excellent article on "l^ursery Hygiene,"^ Dr. L. M. 
 Tale says, — 
 
 " In selecting a room for a nursery-, that should be chosen 
 which is the sunniest, best aired, and driest; and in deciding 
 between two or more houses in other respects equally eligible, 
 distinct preference should be given to that one admitting of 
 the best arrangements for nursery purposes. In houses where 
 no room is to be specifically set apart as a nursery, and chil- 
 dren are to occupy the general living-room by day and the 
 
 ^ Keating's Cyclopedia of the Diseases of Children, vol. i. 
 24-' 
 
282 MOTHER AND CHILD. 
 
 parents' bedroom by night, the same rules should govern the 
 selection of these rooms, the sanitary benefit in such case 
 accruing to adults and children alike. "When the nursery is 
 separate it is preferably to be placed above the ground-floor, 
 unless the latter be unusually well raised from the ground, 
 but it should not be immediately under a roof, on account of 
 the difficulty of regulating the temperature in such a situa- 
 tion. 
 
 '• The beneficial influence of sunlight needs no insisting upon ; 
 nevertheless it is constantly overlooked. The nursery should, 
 if possible, look to the south, or as nearly so as the situation 
 of the house permits, with a morning exposure in preference 
 to an afternoon sun, if but one can be had. The windows 
 should be ample in size, and more than one if possible, as they 
 not only serve for the admission of light, but in the ordinary 
 dwelling are the only avenues of ventilation. The sensibility 
 to the loss of sunlight seems to vary somewhat with adult in- 
 dividuals, but we believe that all children suffer from its ab- 
 sence; and the physician should insist upon the daily complete 
 sunning of the apartment. In summer, even, it is usually 
 better to have the sun and to mitigate its power at proper 
 times by means of a^vnings and blinds than to have a room 
 upon which it does not shine. There may be circumstances 
 of climate or of prevailing winds which will modify this rule, 
 but it holds in general. The room should be of ample size, 
 particularly if it serve, as is the rule in ordinary houses, the 
 double jDurpose of night and day nursery, The precise amount 
 of space required for each child will vary with the arrange- 
 ments for ventilation, but not less than fifteen hundred cubic 
 feet of air per hour should be allowed, and preferably double 
 that amount. 
 
 '• As only in the houses of the wealthy can a room be specially 
 set apart as a sick-bay or hospital, the nursery must ordinarily 
 serve that purpose whenever illness occurs. For this reason, 
 as well as for others, the furnishing of a nursery should be as 
 simple and as easy of cleansing as is consistent with comfort. 
 
FRESH AIR, VENTILATION, OUT-DOOR EXERCISE. 283 
 
 The floor should be of smooth, closely-joined boards, preferably 
 of hard, close-grained wood. The seams, if they open by 
 shrinkage, should be closed either by relaying or by calking 
 ■well done. Poor calking is worse than useless, and any calk- 
 ing is inconvenient in rooms the floors of which must be raised 
 to reach gas- or water-pipes, as is unfortunately often the case. 
 Carpets are necessary to comfort, but movable carpets or rugs 
 are far preferable, as permitting more frequent cleansing both 
 of the carpet and floor. At the present time even cheap grades 
 of carpets are made in rug form, or the desired pattern can be 
 made up with tasty borders without much expense. In case 
 of actual illness of a contagious nature the rugs may be taken 
 away at once, and their contamination be prevented, which in 
 view of the difficulty of subsequent disinfection is very desira- 
 ble. The same precaution against dangerous dirt leads to the 
 preferring of painted and varnished to papered walls for the 
 nursery, even at the loss of some beauty in the apartment. 
 If paper is strongly insisted on, it should be of a kind that can 
 be thoroughly varnished and will admit of being washed, and 
 ail old paper must be first removed before new is laid. The 
 furniture of the room should be as light as consistent with 
 serviceability, in order that the pieces may be easily moved 
 from place to place to admit of frequent cleansing; and for 
 the same reason, every bulky or heavy article should have 
 large and strong casters. It is further desirable that all furni- 
 ture should be as plain and simple as possible, carved wood and 
 thick upholstery stuffs being objectionable as receptacles for 
 dust. Taste may be gratified without violating this require- 
 ment. Further, all cupboards, closets, and similar places of 
 deposit should be as o^i^u to inspection as possible, in order 
 that offensive or untidy things may easily be detected and re- 
 moved. On account of this facility of examination and cleans- 
 ing, the writer usually jDrefers shelves with a removable curtain 
 in front to closed cupboards and deep drawers. The latter are 
 suitable enough for clean linen, but are temptations to careless 
 attendants to indulge in ' tuck-away neatness.' 
 
*284 MOTHER AND CHILD. 
 
 " Warming and ventilation can only be touched upon in this 
 article. If the nursery is in a house with a good system of 
 heating and ventilating, nothing in particular will be needed 
 except a grate or a stove for use in emergencies. Ordinarily, 
 however, even houses which have a fairly good furnace or 
 other heating-apparatus have no specific arrangements for 
 ventilation beyond what are afforded by the windows, chim- 
 neys, and imperfections of structure. The ordinary methods 
 of warming in use in this country are open fires, stoves, and 
 hot-air furnaces. The hot-air furnace, if properly constructed, 
 is quite satisfactory. Its commonest faults are the delivery 
 of too small a quantity of air at too high a temperature (a 
 larger quantity at a lower temperature being preferable), and 
 such an arrangement of its cold-air flue that the supply is 
 from an impure source. The former difficulty is overcome by 
 having the furnace considerably larger than necessary and by 
 keeping the fire moderate ; the latter, by using a tight metal 
 flue the outer end of which is free from unwholesome surround- 
 ing and preferably raised some feet from the ground, by which 
 means some of the foul air of dark city back-yards or of the 
 gutters is avoided. The same precaution is of use in many 
 country houses. The outer end must be protected by a wire 
 screen, to prevent mischief being done by children or small 
 animals. If the screen be fine-textured it will diminish the 
 amount of dust drawn into the house. For a nursery it is of 
 advantage to have the registers for warm air rather high, as 
 this arrangement m.akes a better general circulation of air, 
 diminishes the intensity of floor-draughts, and renders med- 
 dhng with the register by small children more difficult. 
 
 " The open fireplace has for advantages cheerfulness of aspect 
 and a fair amount of ventilating -power, for disadvantages 
 great wastefulness of fuel in proportion to its heating-j)Ower, 
 so that ordinarily, when this is the only source of heat, great 
 differences of temperature exist in different parts of the room ; 
 if the neighborhood of the fire is comfortable, the remoter 
 parts are cold. Further, it ventilates by the production of 
 
FRESH AIR, VENTILATION, OUT-DOOR EXERCISE. 285 
 
 draughts, particularly of floor-draughts, which are especially 
 dangerous in the nursery, where little children spend so much 
 of their time upon the floor. The wood fii'e is very beautiful 
 and useful when a short, quick heat is needed, but, aside from 
 its costliness, it is not so good for steady heating as a coal fire. 
 In the nursery any open fire must be carefully guarded by a 
 strong wire screen, to prevent accidents from sparks or from 
 the clothing of children taking fire. Stoves of the ordinary 
 close varieties, the 'air-tights,' are very economical of fuel, 
 but nearly useless as ventilators, and if used make especial 
 watchfulness as to ventilation necessary. The ventilating 
 stoves which are the offspring of the old ' Frankhn' make a 
 compromise by which all the ventilating value of the open 
 grate is preserved with far less waste of fuel, about three 
 times as much of the heat-value of a given amount of fuel 
 being utilized by these stoves as by the open fire. The jDrin- 
 ciple of construction in its simphcity is to surround the stove 
 and its smoke-flue for some distance with an air-chamber ; to 
 this chamber air is admitted, preferably from out of doors, 
 and as it is warmed it is poured into the room at a higher 
 point, — for instance, near the mantel. As regards all stoves, 
 it is perhaps safer to have no damper in the smoke-flue, or else 
 to fasten it so that it cannot be closed without difficulty, since 
 by so doing the danger of the gases of combustion being 
 forced into the room is removed. 
 
 " Yentilation, in a house which has been constructed with no 
 reference to it, usually must be accomplished by simple devices 
 or not at all; any radical improvements would be practical 
 reconstruction. The most natural thing to do to let in fresh 
 air and let out foul is to open a window ; but this of course in 
 cold weather involves dangerous draughts. We cannot, with 
 our fickle and often severe climate, even do as some English 
 writers suggest should be done, — fasten the upper sash so that 
 it cannot be quite closed. Window-ventilation, therefore, must 
 in winter be carried on by means of some contrivance which 
 will break the force of the current of air and direct it upward 
 
286 
 
 MOTHER AND CHILD. 
 
 Fig. 34. 
 
 ^ 
 
 so that it may be diffused about the room. The 'elbow-tube' 
 ventilator placed under the lower sash is well known ; so are 
 various wire screens, either vertical or ro- 
 tating like at ransom. A very useful one, and 
 the simplest and cheapest, is the common 
 window-board, which, fitting against the in- 
 side of the lower sash, allows the latter to be 
 raised and the current of air inward is sent 
 directly upward at the overlapping of the two 
 sashes. The board should be at least eight 
 inches high. The plan of a stout cloth nailed 
 across the lower part of the window allows, 
 when the sash is raised, two currents, one 
 above and one below. The writer thinks he 
 gets the same advantages by modifying the 
 window-board as in the figure. The strip B 
 runs the whole length of the board. If it is 
 desired to shut off the lower current, the sash 
 is left in contact with the strip ; if the 'lower 
 current is desired, it is left below the strip, 
 as at A. 
 
 "The stove with jacket used in barracks 
 seems to be well adapted for nursery use. 
 The stove is surrounded by a jacket of sheet 
 zinc or iron, with necessary doors, leaving 
 space between the stove and the jacket. This 
 should come to the floor, and the cold air be 
 brought from out of doors to within the 
 jacket by means of a small pipe ; the air es- 
 capes warmed at the top of the jacket. For 
 the nursery the jacket has the advantage of being a safeguard 
 against burns, at least against severe ones. 
 
 " The getting of foul air out is a rather more difficult problem, 
 especially with stove heat. An open window with the double 
 current described will do fairly well under favorable circum- 
 stances, but is rarely sufficient when an air-tight stove is used. 
 
 aTt\- 
 
FRESH AIR, VENTILATION, OUT-DOOR EXERCISE. 287 
 
 If in the construction of chimneys a ventilating-flue is in- 
 cluded, or if the smoke-flue is enclosed in a space which may- 
 serve as a ventilation-flue (as, for instance, a stove-pipe run- 
 ning up within a chimney which has a fireplace at the bottom), 
 it is easy to ventilate a room. If the chimneys are already 
 closed in, the cheapest and at the same time an efficient 
 method is to have an air-flue leading from near the floor into 
 the chimney higher up. The upward current of air in the 
 latter draws the air through the ventilating-shaft. It is more 
 efficient if placed near the stove, so that the air within it is 
 heated and its upward movement hastened. Its mouth is 
 placed low, to save unnecessary waste of warm air. 
 
 " It should be remembered that the artificial light of lamps 
 or gas in a room rapidly spoils air for breathing. Lighting- 
 capacity is usually measured in candles, and an average adult 
 produces rather less than twice as much carbonic acid as one 
 candle : as a consequence, a large kerosene lamp or gas-burner 
 often equals the production of five or six adults. It is very 
 desirable, therefore, if a night-light is necessary in the nui'sery, 
 that its carbonic acid be got rid of; and by the device, often 
 used for ventilating purposes, of putting the burner or lamp 
 within or beneath a tube or flue going to the roof or chimney, 
 the results of combustion are curried away and an outward 
 current of small power is also established. By having at the 
 bottom of the flue a box, with a door, to contain the light, the 
 latter may be shut off partly or wholly except when needed. 
 
 " As to the temperature of the nursery authorities are not 
 quite agreed ; but it is certain that in American cities it is usu- 
 ally too high, in common with that of the rest of the house. 
 Children and adults are often forced to endure in winter apparel 
 a temperature (70° F. and upward) which in summer is con- 
 sidered to demand much lighter dress. There are good reasons 
 why the standard of house-temperature is usually set high in 
 America, but it is carried too far. The discrepancy between 
 in-door and out-door temperature is made too great, the skin 
 and mucous membranes are made sensitive, and the multitudi- 
 
288 MOTHER AND CHILD. 
 
 nous forms of ' colds' favored. We believe that if a room 
 can be uniformly heated, 65° F. will be found, on the whole, 
 more comfortable and healthful than the usual 70° F., which 
 latter should not be exceeded. "Where intelligent supervision 
 of the temperature can be relied upon, we believe that a still 
 lower degree than 65° F. will be healthful to children old 
 enough to play about. At night the temperature should not 
 be allowed to fall too far below the day standard ; and especial 
 pains should be 'taken to guard against the uncovering of 
 children in bed. 
 
 " A word should be added concerning windows. As is well 
 known, the loss of heat from the cold glass is very great : Mr. 
 Hood puts it that by each square foot of glass more than ono 
 and one-quarter cubic feet of air (1.279 cu. ft.) will be lowered 
 each minute as many degrees as the difference between the 
 iuternal and extei*nal temperatures. If, for instance, the ther- 
 mometer outside showed no colder than freezing temperature, 
 32° F., and within no higher than 67° F., the discrepancy 
 would be still 35° F. A window three feet by six feet would 
 expose eighteen feet of glass surface, and according to this 
 rule it would cool each minute (18 X 35 X 1-279 =) 805 + 
 cubic feet one degree, or about two hundred cubic feet four 
 degrees. This makes a constant current of descending cold 
 air near a window very sensibly felt by any one obliged to 
 work in such a place in cold weather. It is important, then, 
 that children should not play immediately near a window in 
 cold weather, and a low article of furnitui-e may be often so 
 placed as to keep them away without the trouble of constant 
 oversight. The ingenuity of the attendant will similarly 
 devise means of keeping them from sitting on the floor if it 
 be draughty. 
 
 "Besides the admission of pure air and the discharge of foul 
 air, purity of atmosphere demands that no nursery nuisances 
 be allowed to exist. It is better that no plumbing of any sort 
 should be in the room itself. Bath and closet conveniences are 
 very necessary, but should be a little removed and well venti- 
 
FRESH AIR, VENTILATION, OUT-DOOR EXERCISE. 289 
 
 lated. In houses that are not plumbed, a place to which all 
 offensive or soiled articles can be directly removed should be 
 provided, which place should have free ventilation. In especial 
 all soiled napkins and vessels containing evacuations or urine 
 should be promptly removed, and in case of sickness a vessel 
 should be provided in which the napkins or stools can be 
 disinfected. 
 
 "Under otdinary circumstances, however, disinfectants, in 
 the usual sense of the word, have no place in the nursery nor 
 in hygiene generally. A place that cannot be made wholesome 
 by sunlight, air, and cleanliness should not be occupied. When- 
 ever emergencies demand their use, they should be of the 
 safest kinds consistent with efficiency, iind after a contagious 
 illness only the more costly contents of the nursery should be 
 disinfected ; the cheaper ones can be burnt with greater ulti- 
 mate economy. For this reason we always urge that toys be 
 of the cheapest description, particularly if of such a kind as 
 readily to conceal supposed sources of contagion. The paint- 
 ing of walls and ceilings and the closely-laid floor already 
 urged are of great assistance in promoting efficiency of disin- 
 fection. . . . 
 
 " The care of the hair consists in infancy chiefly in the care 
 of the scalp, which must be kept strictly clean. If the vernix 
 caseosa is as completely removed from the scalp at birth as 
 from other parts of the person, there is usually little difficulty 
 in preventing future accumulations. A soft brush should be 
 frequently used upon the hair, a comb only as a separator for 
 parting the locks and in emergency for disentangling. 
 
 " The teeth require the same care as in adult life, but brush- 
 ing should be of the gentlest sort, for fear of irritation of the 
 gums, which may cause their subsequent retraction. . In in- 
 fancy after each feeding or nursing the gums should be washed, 
 to prevent the formation of aphthous growths, and the teeth 
 treated likewise as they appear. When the child is old 
 enough to be quiet while the cleansing is done, a soft badger- 
 hair tooth-brush should be used. 
 
290 MOTHER AND CHILD. 
 
 ^- Dress. — The hygienic essentials of dress are — sufficient 
 warmth without burdensomeness, uniformity of protection as 
 far as consistent with activity, freedom, and, for children at 
 least, softness. The problem of warmth without undue weight 
 is best solved by the use of woollen garments. By reason of 
 the poor conducting power of wool, such garments retain the 
 bodily heat longer than those made of other materials. This 
 slowness of conduction is greater in loose-textured fabrics. 
 That is to say, a given weight of wool is warmer if loosely 
 than if tightly woven. Hence the warmth of knitted gar- 
 ments. The difference is due to the retention in the interstices 
 of a certain amount of air, which is a poor conductor. For 
 the same reason, two garments, two shirts for instance, are 
 warmer than one shirt of weight equal to the two, and loose- 
 fitting garments are warmer than tight ones. In hot weather, 
 however, tight garments are distressing for other reasons. 
 Linen stands at the other extreme of ordinary dress-materials, 
 being the best conductor of heat. It follows that woollen 
 garments give the best protection against change of temper- 
 ature and chilling, and in proper weight they make the safest 
 dress in all places where temperature may vary or for all 
 children who may become heated in play. Fashion or taste 
 usually calls for outer garments of linen, but the protective 
 garments should be beneath. The absorption of heat from 
 the sun varies very much according to the color of the gar- 
 ment, the material and texture beins: unchansred. white takino- 
 the least heat, or being the coolest, while black will absorb 
 about twice as much. Singularly enough, the ' cool-looking' 
 light blue is found by some experiments to be very nearly- as 
 hot as black. For very young children who are little exposed 
 to the sun's heat this question of color is of minor importance. 
 
 " Softness of material is essential for children on account of 
 the sensitiveness of their skins. To most infants fine soft 
 woollen shirts, either knitted or of ' baby flannel,' are seem- 
 ingly entirely comfortable. Some, however, manifest unusual 
 irritability of skin, and for such a shirt of fine linen should be 
 
FRESH AIR, VENTILATION, OUT-DOOR EXERCISE. 291 
 
 placed within the flannel. This precaution is more often 
 necessary in hot weather, when the flow of perspiration is 
 increased. 
 
 "The ordinary dress of very young children is objectionable 
 in several ways. It is ordinarily unnecessarily confining about 
 the body and limbs, although it has never in this country 
 reached the degree in this respect that seems to be usual in 
 some Continental countries. There is also an unnecessary 
 number of layers of fabric involved, as they are not required 
 for the child's warmth under ordinary circumstances. The 
 process of dressing or undressing is really an ordeal to the 
 infant, as it is alternately rolled upon its back and belly in 
 the nurse's lap, in order that one band after another shall be 
 fastened by pins or stitches. Yery much of this dressing 
 is unnecessary, if not harmful. First of all is the ' band,' a 
 girdle enveloping the trunk from about the nipples to the iliac 
 crest. Such an appliance may possibly be useful during the 
 healing of the navel; afterwards it is not of use if tight. 
 The abdomen needs no support in health, the compression 
 of the ribs is not advantageous, and so far as such a girdle 
 aflfects the question of hernia (which it is popularly supposed 
 to prevent) at all, it rather favors the jDroduction of the in- 
 guinal or femoral variety. A loose girdle worn to prevent 
 chilling is, however, often advisable in hot weather; and in 
 cold weather a flannel girdle, or binder, ' cut bias' to secure 
 elasticity, makes a useful envelope for the entire trunk of 
 very young children as a preventive of bronchitis. 
 
 " As a means of getting rid of the objectionable features of 
 the ordinary dress, the writer has for some years recommended 
 the following plan^ or some modification of it. There are 
 three garments (besides the napkins), all covering the neck 
 and shoulders and reaching ten or twelve inches below the 
 feet. The outer garment, as well as the middle one, is a httle 
 
 ^ " This plan was originally devised by Dr. Grosvenor, of Chicago, for 
 use in his own family, and subsequently published by him. 
 
292 MOTHER AND CHILD. 
 
 larger in every dimension than tliat beneath it, so that no 
 binding shall take place. They are all cut in the girdle-less 
 pattern called 'Princess.' The inner one has sleeves, and 
 may be made of cotton flannel or very soft wool flannel ; if 
 wool is used, care must be taken against shrinkage in washing. 
 The next garment has no sleeves, and no seams at the arm- 
 holes, to insure against pressure there ; the material is wool 
 flannel. The outer one is the usual dross, with high neck and 
 sleeves, the details of which may be modified to suit taste. 
 Thus, except the sleeves, the thickness is the same throughout. 
 At night a garment like the inner one ahove described and a 
 napkin only are worn. These three garments are placed one 
 within the other before the dressing commences, pains being 
 taken to avoid wrinkles and folds, and they are put upon the 
 child as one garment with very little trouble. They are 
 removed with equal ease. 
 
 "The napkins may be of any suitable kind, — i.e., soft and 
 absorbent material, easily washed. Linen has no real advan- 
 tage ordinarily over cotton, except aesthetically. Old linen 
 is soft, but likely to be thin. It is desirable to diminish the 
 bulk of the napkins as far as possible, to prevent uncomfortable 
 pressure: this is accomplished by having a small napkin 
 simply to cover the seat and genitals thick enough to retain 
 the urine or fteces, covered by another one not thick, but large 
 enough to envelop the hips. The age at which napkins may 
 be discontinued depends upon circumstances. Among English 
 families of the better classes, apparently, children are taught 
 to make their needs known earlier than is usual with us. 
 Much can be done by an attentive and intelHgent nurse who 
 holds the child over a vessel with suitable frequency. But 
 children vary greatly in this particular, and under no cir- 
 cumstances is any severity justified, or even scolding, as 
 nervousness or anxiety on the part of the child simply aggra- 
 vates the trouble. As soon as the child can regularly give 
 notice of its wants in this respect it is better to discontinue 
 the diaper, as its absence gives greater freedom to the limbs. 
 
FRESH AIR, VENTILATION, OUT-DOOR EXERCISE. 293 
 
 Of course at all times napkins should be changed as soon as 
 discovered to be damp or soiled. Eubber or other impervious 
 covers for diapers should not be used. Even the exigencies 
 of a railway-joiirney, with the conveniences usual in this 
 country, do not require their employment. They simply 
 convert a wet napkin into an unclean fomentation. 
 
 " When a child begins to use its limbs freely, the clothing 
 should be shortened. In fact, there is no real need of long 
 clothes at any time, except to save labor in keeping the in- 
 fant's feet covered. When it begins to creep, its manoeuvres 
 are facihtated by slipping over its skirts a loose baggy pair 
 of breeches of woollen which is tied around its waist and 
 buttoned about its knees. This keeps the skirts from im- 
 peding its progress, and protects it against floor-draughts 
 in a measure. 
 
 " The dress of older children should conform to the same 
 hygienic requirements as given above. The two most fre- 
 quently disregarded are freedom from constriction and uni- 
 formity of protection. The former is violated by the use of 
 tight girdles, or even by corsets, tight sleeves, garters, and 
 misshapen stockings and shoes. Their harmfulness is well 
 understood : the neglect is usually a wilful preference of fash- 
 ion to healthfulness. The same might perhaps be said of the 
 fashion of unevenly distributing the clothing over the person ; 
 but the injurious effects of this are less understood. Chilling 
 is resisted far better if the whole person is exposed to the 
 same temperature than if one part is exposed to a lower 
 temperature than another. It is a matter of universal experi- 
 ence that many persons who rejoice in out-door life even in 
 severe weather are directly injured by a draught and by 
 sitting near a window. Yet formerly more than now low- 
 necked dresses were used for children, the entire shoulders 
 being exposed, while the remainder of the trunk was burdened 
 with dress. At the present time fashion exposes the legs 
 more. Shoes and stockings arc often too thin, but in par- 
 ticular children are too often dressed with the lower limbs 
 
 25* 
 
294 MOTHER AND CHILD. 
 
 bare from, above the knee to a little way above the ankle, the 
 foot being covered by a sHpper. The difference is often aggra- 
 vated by too much clothing on the body and a sash over all. 
 The lower hmbs should, be thoroughly clad, — not cumbrously, 
 but warmly. The stocking of a child old enough to run about 
 should be long enough to meet or be overlapped by the next 
 article, napkin or drawers, as the case may be. Stocldngs of 
 wool, for the reasons already given, are to be preferred. 
 They should be soft. They should not be pointed at the 
 toes, but be wide enough to admit of ample play in every 
 dii-ection of the anterior part of the foot. Color is not indif- 
 ferent, as some dyes have been found to produce eruptions 
 on the skin. Public attention has, however, been so thor- 
 oughly drawn to this subject as to have led in some instances 
 to legislative enactments, and such dyes are probably less 
 frequently used than fonnerly. AniUne reds have been thought 
 to be especially irritating. 
 
 " Shoes of proper shape are not easy to get for children ; not 
 nearly so easy as for adults. This comes probably partly 
 from the supposed necessity of making them for a low price 
 and partly from a belief, often openly expressed, that 'a 
 baby's foot has no shape.' The real shape of the human foot 
 is followed in the true ' waukenphast' shoe, but this we have 
 never seen of proper sizes for infants or young children. It 
 is not enough that a shoe should be as wide or wider than the 
 foot, but it should have its width rightly disposed: space 
 where the foot does not demand it in no wise compensates for 
 pressure elsewhere. The result must inevitably be a distortion. 
 In choosing shoes for infants it is better that they should be 
 unduly long, if that be necessary to obtain the requisite width 
 in front, than that they should be narrow." 
 
 The following, taken from Miss A. M. Bacon's fascinating 
 book on " Japanese Girls and Women," will be of interest. 
 Writing of the Japanese baby, she says, " It is not jolted, rocked, 
 or tossed to sleep ; it is allowed to cry, if it chooses, without 
 anybody supposing that the world will come to an end because 
 
FRESH AIR, VENTILATION, OUT-DOOR EXERCISE. 295 
 
 of the crying ; and its dress is loose and easily put on, so that 
 very little time is spent in the tiresome process of dressing 
 and undressing, . . . and it is not subject to fits of hysterical 
 or passionate crying, brought on by much jolting or tossing, 
 or by the wearisome process of pinning, buttoning, tying of 
 strings, and thrusting of arms into tight sleeves. 
 
 " The Japanese baby's dress, though not as pretty as that 
 of our babies, is in many ways much more sensible. It con- 
 sists of as many wide-sleeved, straight, silk, cotton, or flannel 
 garments as the season of the year may require, — all cut after 
 exactly the same pattern, and that pattern the same in shape 
 as the grown-up kimono. These garments are fitted one 
 inside of the other before they are put on, then they are laid 
 down on the floor and the baby is laid into them ; a soft belt, 
 attached to the outer garment or dress, is tied around the 
 waist, and the baby is dressed without a shriek or a wail, as 
 simply and easily as possible. The baby's dresses, like those 
 of our babies, are made long enough to cover the little bare 
 feet, and the sleeves cover the hands as well, so preventing the 
 unmerciful scratching that most babies give the face, as well 
 as keeping the hands warm and dry." Would that some bold 
 and brave mothers would make fashionable such baby-dressing 
 in this country ! 
 
 By way of contrast we will quote the following : 
 Dr. W. Thornton Parker, writing of American Indian 
 women, says, "As soon as the Indian baby is born it is 
 placed in a cofiin-shaped receptacle, where it passes nearly 
 the whole of the first year of its existence, being taken out 
 only once or twice a day for washing or change of clothing. 
 This clothing is of the most primitive character, the baby 
 being simply swaddled in a dressed deerskin or piece of thick 
 cotton cloth, which envelops the whole body below the neck. 
 The outside of the cradle varies with the wealth or taste 
 of the mother, scarcely two being exactly alike. Some are 
 elaborately ornamented with furs, feathers, and bead-work, 
 others are perfectly plain. Whatever the outside, the cases 
 
296 MOTHER AND. CHILD. 
 
 themselves are nearly the same. A piece of dried buffalo hide 
 is cut into proj)er shape, then turned on itself, and the front 
 fastened to a board or, in the most approved cradles, to two 
 narrow pieces of board joined in the form of an X. 
 
 " It forms a real ' nest of comfort,' and, as the Indians are 
 not sticklers on the score of cleanliness, it is the very best 
 cradle that they could adopt. To the board or boards is 
 attached a strap, which, forced over the head, rests on the 
 mother's chest and shoulders, leaving the arms free. 
 
 " When about the lodge the mother stands the cradle in some 
 out-of-the-way corner, or in fine weather against a tree ; or if 
 the wind is blowing fresh it is hung to a branch, where it 
 fulfils all the promise of the nursery rhyme. When the baby 
 is ten months old it is released from its confinement and for a 
 year or two more of its life takes its short journej^s on its 
 mother's back in a simple way." 
 
 The question is often asked, at what age a child should go 
 out of doors, and whether it should go out every day, not- 
 withstanding the weather. It makes a very great difference 
 whether the parents live in the country or the city. Country 
 children, of course, are out most of the time, as they grow 
 older especially; whereas, in the city, tbe impossibility of 
 thus turning them loose and the necessity of a nurse to accom- 
 pany them are matters that have to be taken into consider- 
 ation. After a babe is about six weeks or two months old, 
 if the weather be at all moderate, the nurse can wrap the 
 child well and take it in her arms out for a walk. There is 
 less risk of young children taking cold than older ones, from 
 the fact that they are much easier wrapped and kept warm, 
 and the nurse is able to carry them. At the same time, if the. 
 house is well ventilated and warm and the weather cold and 
 changeable, — dirty streets, snow, and dampness rising from 
 the ground, — it is far better for the child to remain in the 
 house. As soon as a child arrives at the age when it is a drag 
 upon the nurse, is difficult to carry, and at the same time 
 cannot walk, and a perambulator is required, the time to exer- 
 
FRESH AIR, VENTILATION, OUT-DOOR EXERCISE. 297 
 
 cise the most judgment has come. Any mother can see this 
 for herself by going to one of our city j)arks and watching 
 the congregation of nurse-girls there assembled, noting the 
 position of the baby carriages and the condition of their occu- 
 pants. A child will be left facing the bleakest March wind, 
 or the midsummer sun fiercely attacking its unprotected 
 head, while the nurse is engaged in conversation with a 
 number of her friends. We have often been at a loss to under- 
 stand how mothers could, select these young, inexperienced 
 creatures to take care of their children, knowing full well 
 what would be the consequences, and then be surprised if the 
 child should be taken with a severe sore throat, earache, pneu- 
 monia, or inflammalion of the brain. It would be far better if 
 all children, until they are old enough to sit up by themselves, 
 were carried by their nurses on their every-day outing, and 
 that after a child is too big to carry, and too young to 
 walk, it should sit up in its carriage, well wrapped, then the 
 nurse take a long walk, with the distinct understanding that 
 under no circumstances is the carriage to be stopped ; when 
 she is tired she is to come home. We are very particular in 
 laying stress upon this matter, because, notwithstanding all that 
 has been written on the subject and the full knowledge that 
 mothers obtain from their family physicians, who are one and 
 all opposed to the present system and acknowledge that a 
 larger part of the diseases of children is due, undoubtedly, to 
 the carelessness, in one way or another, of their nurses, — these 
 girls, without any experience whatever, with no judgment, 
 certainly no affection for their charges, are hired and intrusted 
 with the care of an infant, and are allowed to take it out, going 
 where they will, to carry it into heated rooms, to leave its out- 
 door wraps on, to carry it out of doors while it is perspiring, 
 and to expose it to contagion of every kind, taking it into all 
 sorts of atmospheres ; and yet, after the child has been returned, 
 its fond mother will fondle and caress it, guard it against the 
 least exposure, treat it as the tenderest flower, and be struck 
 with wonder and surprise when it is taken ill. So important 
 
298 MOTHER AND CHILD. 
 
 do we deem it that a child's nurse should be selected with the 
 greatest possible care, that she should be a woiQan chosen on 
 account of her experience, conscientiousness, and truthfulness, 
 that we believe the mortality from contagious diseases, and 
 from those disorders due to direct exposure, would be dimin- 
 ished if mothers could be made to appreciate this matter. 
 
 CHAPTEE XXXIX. 
 
 BATHING. 
 
 The child should be gently washed in warm water with a soft 
 sponge, or soft linen, with Pears' non-scented or with Castile 
 soap, and care should be taken that every part of the body 
 be carefully washed, so as to free it from any impurities that 
 cause irritation to the tender skin ; the nostrils, the ej'es, the 
 mouth, the various crevices of the groin, the armpits, and 
 the genitals should be thoroughly cleansed. 
 
 There should be a thermometer in the nursery, and the 
 child's bath should be always regulated by it. The tempera- 
 ture of the water should be such as to give a sense of gentle 
 warmth to the hand, and as the child grows older and becomes 
 strong, the circulation well established, the temperature should 
 be gradually reduced until it is about 75° F., or cooler. It is 
 not at all necessary that a child should receive a full bath twice 
 a day; once a day is amply sufficient, — in the morning. A 
 child should always delight in its bath ; when it is old enough 
 to have its tub, the bathing should be made a pleasure to it. 
 Give it something to play with in the water ; make a frolic of 
 it. Should it at first dread the bath, be careful not to frighten 
 it ; place a blanket over the water and let the child gradually 
 become surrounded by water by immersing it with the blanket. 
 Always wet the head first, even with babes. At bedtime a 
 
BATHING. 299 
 
 sponging off will be enough, unless the child possesses one of 
 those excitable dispositions to which we have already alluded, 
 — is the child of intellectual parents, those who depend upon 
 their brains for a livelihood : these children always exhibit 
 a more or less nervous, irritable disposition, which renders 
 them at times restless and sleepless. For such, the sedative 
 effect of a bath at night is most marked ; indeed, for these it is 
 well to usually sponge off with cool water in the morning, and 
 leave the baih for the night, making the water about blood- 
 heat in order to get its full sedative influence. 
 
 It is a very great mistake to accustom a child to bromide, 
 valerianate of ammonia, brandy, or gin, to make it sleep ; 
 these should never be used without the consent of a physician; 
 but the sedative influence of a warm bath, or warm foot- 
 bath, can never be harmful. The usual time for giving the 
 morning bath is about nine or ten o'clock ; at this time diges- 
 tion is not going on, as a rule, and the child can be thoroughly 
 washed, the surface being brought to a glow either with the 
 hand or with a soft towel ; the child may then take its bottle 
 or breast, get its hour's sleep, and there will be still time for it 
 to spend the best part of the day out of doors. Of course in 
 summer, when the child should be out as much as possible, the 
 bath may be given at an earlier or later hour, to suit the cir- 
 cumstances. For a very young infant it is not absolutely 
 necessary to give a bath in the tub ; the room should be 
 warmed to a temperature of about 75° F., and guarded 
 against draughts. 
 
 The temperature of the bath, if the child is immersed, 
 should be about 90° F., but if it is delicate and young a thor- 
 ough sponging of the surface will be sufiicient, and it should 
 be gradually accustomed to the water until it will of its own 
 accord show a liking for the bath. When travelling, a port- 
 able bath, such as is figured in the plate preceding Part II., is 
 a useful companion, and in these days of electric lighting a 
 spirit lamp is a necessity, and should never be forgotten when 
 leaving home. 
 
300 MOTHER AND CHILD. 
 
 The question often arises, How long a time sliould elapse 
 after feeding before the child has its bath ? Certainly not less 
 than an hour, better if two hours should elapse after a heavy 
 meal. Of course this refers entirely to a bath by immersion, 
 but for a young infant that is simply sponged and nursed with 
 breast-milk, an hour will be sufficient. 
 
 It is often necessary to bring about a glow on the surface 
 of the bodies of children who are delicate, when, for some 
 reason or other, the bath cannot be given ; the body should be 
 gently rubbed with either spirits of wine or washing whiskey, 
 to which a little salt may be added to make it more stimulating ; 
 or, if the child is very delicate, cod-liver oil may be used, to- 
 gether with rubbing. About a tablespoonful of a solution of 
 Castile soap (scraped) dissolved in alcohol, to a basin of water, 
 is frequently an excellent addition to the sponge-bath. This 
 can be made up by the pint and kept for that purpose. 
 
 The child should not be permitted to go out immediately 
 after its bath, nor indeed for an hour or so, if the weather be 
 cold ; but as the day's sleep is taken immediately after the 
 bath, scarcely any mother would be tempted to take her child 
 out. Mothers ought to make it a rule never to take a child 
 out of doors on an empty stomach ; not only will a child that 
 has been given food before going out be better able to resist 
 cold, but there will also be less chance of it becoming infected 
 by contagious diseases. In most places children and delicate 
 people should be in-doors at sundown ; the sudden chilling of 
 the air renders it harmful, and at this time germs of malaria 
 that have been carried upward by the warm day air are 
 precipitated. 
 
 If a child objects very seriously to its bath, it is far better 
 to gradually accustom it to being immersed, and this can be 
 readily accomplished as it grows older by teaching it to play 
 in its tub, which should be gradually filled with water ; or over 
 the tub can be thrown a light blanket, and the child slowly 
 immersed, gently lowered into the water. 
 
 The question as to when a salt bath should be used is often 
 
BATHING. 301 
 
 asked. This, of course, is a matter which, as a rule, should 
 be left to the family physician to decide. Salt water is more 
 stimulating than plain water ; it also has the advantage of 
 being especially valuable in cases of chronic enlargements of 
 the glands and tonsils, — a tendency to scrofula. Children who 
 lack muscular strength, are troubled with loss of appetite, or 
 who sleep badl}^, are especially benefited by salt baths. It is 
 not necessary to obtain what is known as sea-salt, though this 
 is usually sold for that purpose. A tablespoonful of ordinary 
 salt to the gallon is about the strength of sea water. 
 
 As children gi-ow older the question arises as to the s^ea- 
 shore and its advantages, especially sea-bathing. All children 
 who are delicate, those that are scrofulous, those that are 
 threatened with spinal curvature, or who have a tendency to 
 become bandy-legged or pigeon-breasted, improve wonderfully 
 at the sea- shore. As far as the bathing is concerned, surf- 
 bathing or cold sea-water should not be used for children under 
 three years of age ; until that time the sea-water can be given 
 in the ordinary tub, to which has been added sufficient hot 
 water to give it a temperature of at least 80° F. Any one who 
 has spent summers at the sea-shore has certainly seen a great 
 deal of the cruel practice of carrying a screaming, struggling 
 infant in the arms and plunging it into the sea-water. We can- 
 not imagine a more barbarous proceeding. The sudden shock 
 from the use of cold water, the fright, is enough to bring on 
 convulsions. A child at the age of two years may have its 
 bathing-suit ]mt on in the middle of the day, run in its bare 
 feet in the sands, bask in the sunshine, get its feet wet in the 
 cool sea-water, and receive very much more benefit than it 
 would from a plunge into the ocean, even if that could be done 
 without the struggle which usually accompanies this proced 
 ure. Even for infants of a year old, sponging the neck with 
 cold Avater and dipping the feet in the same, followed by brisk 
 rubbing,' will prevent in many cases the taking of cold. We call 
 the attention of mothers to this point. It will be a very valu- 
 able procedure, especially in our changeable winter climate, if 
 
 26 
 
302 MOTHER AND CHILD. 
 
 adopted every night before retiring, to prevent the many at- 
 tacks of cold that are so annoying and prevalent. 
 
 Sea-bathing is to be interdicted for rheumatic children, for 
 those with asihma, skin-diseases, and fevers. Kidney-disease, 
 irritable lungs, a tendency to bronchitis, and some chronic 
 eruptions come under the same category. In the case of heart- 
 disease, the stimulating atmosphere excites this organ to too 
 rapid action and aggravates the disorder. Weak eyes are to 
 be kept from the shore, where the air, impregnated with salt 
 and fine sand, and the glare keep up a constant irritation. The 
 same applies to ear affections, but with exceptions, which, how- 
 ever, should be made only under the advice of a competent 
 physician. Little consumptives do better in the interior, as 
 the coast air is too damp for their weak lungs. 
 
 Children with tubercular tendencies and those with chronic 
 joint diseases should be sent for residence to such places as 
 Colorado, ^ew Mexico, or parts of Texas. The establishment 
 of children's sanitaria and boarding-schools in these localities 
 should receive attention. 
 
 The action of the skin is so essential to good health, that 
 when a child is really ill, a simple sponging of the surface of 
 its skin may not do any harm ; of course the water should be 
 tepid, the room carefully guarded against draughts, and the 
 child, afier being thoroughly dried, should not be allowed to 
 run out in the cold entries until the skin has entirely re- 
 acted. The mother will often say, "Doctor, my child has a 
 cold ; shall I wash it '?" We may answer that when these 
 precautions are taken, the sponging of the chest and throat, 
 with subsequent friction, is the best thing she can do for the 
 cold. 
 
 In regard to the use of cold water in nursery bathing, it is 
 a great mistake to believe that a child should be sponged with 
 cold water, notwithstanding its dread of it and the shock which 
 it gives to its nervous system. A child should be made to love 
 its bath, to look forward to it with delight ; it should have a 
 big sponge to play with, and in a very short time, as it grows 
 
BATHING. 303 
 
 older, it will gladly sit in the tub of water, splash around to its 
 heart's content, and get sufficient exercise to avoid any chances 
 of taking cold. 
 
 In using soap, great care should be taken that it be pure, 
 with no free alkali, such as the ordinary common cheaj) 
 soaps. That which is non-scented is to bo preferred. After 
 the child has been dried, in summer-time, its body shouLI be 
 powdered with a little starch or talc powder, which has a 
 soothing effect upon the skin ; or in winter-time its chest and 
 back, and the folds of the skin in the groin and axilla, can be 
 greased with a little vaseline, just enough to make the skin 
 soft and pliable, and also to protect it from cold. 
 
 There is one caution which we think is in place here : a bath 
 in tepid or cool water for a short time is invigorating ; a pro- 
 longed soaking in warm water has precisely the opposite eifect. 
 
 If the child is debilitated during hot weather by the pro- 
 longed heat, and a more stimulating bath than the ordinary 
 cool one is. required, a teacupful or two of cider vinegar may 
 be added to the bath, with or without the addition of salt. In 
 children who have delicate skins, the red spots or blotchy 
 eruption which appears shortly after birth is usually due 
 to too active use of soap and water immediately following 
 their birth. This can be obviated by following the directions 
 given when speaking of the washing of the new-born babe ; 
 but very frequently a child's skin becomes dry, rough to the 
 touch, and needs constant attention to prevent eruptions, 
 especially the much-dreaded eczema of childrei). Such children 
 should not have salt baths, except when advised by the physi- 
 cian ; they need fresh air, plain food, and probably cod-liver oil. 
 
304 MOTHER AND CHILD. 
 
 CHAPTER XL. 
 
 TEETHING. 
 
 The first lower incisors — that is, the two lower front teeth 
 — are usually cut when the child is from six to seven months 
 old. For some time previous it has probably been noticed that 
 the child has been restless and uneasy, that its sleep has either 
 been disturbed or it has been wakeful. Before this time the 
 child's secretions have been pretty well established. The tears, 
 the saliva, will probably flow readily ; indeed, such children 
 usually cut their teeth with but little trouble. It is doubtful 
 whether all the troubles that are associated with teething are 
 really due to that condition. There is no question but that 
 the pressure upon the delicate nerve-pulp beneath a tooth 
 that is bound down by a thick capsule, and probably on top 
 of that a congested gum, may give rise to serious trouble, 
 amounting to convulsions or intestinal disturbance at times; 
 or the irritation which is produced may inflame the gum, and 
 thus starting as a sore mouth, the dryness of the mucous mem- 
 brane extends to the stomach, and is the starting-point of a 
 severe catarrh or earache. 
 
 As a rule, children suffer comparatively little with their 
 early teeth ; possibly because, while these are being cut, ihey 
 are still nursing in many cases, or they have not yet had a 
 large amount of farinaceous food added to their diet. Then, 
 also, the large back teeth and the eye-teeth cause far more 
 pressure on the delicate nerve-pulp, more disturbance in the 
 jaw, and therefore are followed by a greater degree of sympa- 
 thetic derangement. This sympathetic dex'angement" may 
 show itself in excitement of the nervous system, especially at 
 night, and be one of the most active causes of sleeplessness ; 
 also in its action upon the glands that secrete the fluids used in 
 digestion ; and it is on this account that the second summer is to 
 
TEETHING. 
 
 Fig. 35. 
 
 305 
 
 Appearance of mouth at about seventh month. 
 
 Appearance of mouth at about tenth month. 
 
 Appearance of mouth at about fifteenth month. 
 
 Appearance of mouth at about twenty-fourth month. 
 
 Appearance of mouth at about thirtieth month. 
 26* 
 
306 MOTHER AND CHILD. 
 
 most mothers a dreaded time, as then a baby is usually weaned, 
 and the slightest neglect in the preparation of its bottle 
 will permit of the fermentation of the starchy material that 
 faulty secretion prevents from turning into grape sugar. 
 
 Nature's plan is to keep the gum softened by being soaked in 
 saliva ; it also uses the bowels as a sort of safety-valve to relieve 
 the congested nervous system. A large watery movement of 
 the bowels will cause a shrinkage in the gums, by depriving 
 them of water, and will often take the place of the lancet. 
 Congestion may be present in the delicate nerve-pulp beneath 
 the teeth, and give rise to annoyance, irritation, pain, and at 
 the same time the gum above give no evidence whatever, by 
 its appearance, of what is going on beneath. A child suffering 
 in this way from its teeth will crave something to bite upon, 
 but as soon as it takes the nipple of its bottle, its fingers, or 
 even its thumb in its mouth, and bites upon it, it will suddenly 
 throw it aside, and show evidences of pain. The relief that 
 comes from the soaking of the gums is very great; it is said 
 that children who suck their thumbs seldom have trouble, and 
 yet thumb-sucking should be discouraged, as it certainly de- 
 forms the mouth and renders the upper teeth prominent. 
 
 By the time a child reaches two and a half years, it should 
 have cut its entire twenty teeth. They are usually cut in 
 pairs: first the lower two incisors, then the upper two, then 
 the outside two above, then below, next to those first cut ; then 
 skipping a space for the eye- and stomach-teeth, the others 
 will come in turn. From the sixteenth to the twentieth month 
 the eye- and stomach-teeth will be cut. By referring to the 
 diagram (Fig. 35) this will appear plain. 
 
 The cutting of the teeth by no means always follows in this 
 order, nor indeed do we always find the first appearance of the 
 lower incisors as early as the sixth or seventh month. Sir 
 William Jenner has stated that if a child does not cut its first 
 tooth within a year, it is an undoubted sign of rickets. 
 
 We think it well here to make a few remarks on the sub- 
 ject of rickets, that the mother may fully understand what is 
 
TEETHING. 307 
 
 meant by the term. To some people no greater insult can be 
 offered than to suggest that their children are rickety ; to their 
 mind, the word seems to imply some constitutional taint to be 
 ashamed of. This is a great mistake. So large a proportion 
 of children have rickets to a more or less marked extent that 
 physicians feel the necessity of impressing upon the community 
 the great importance of attention to the very subjects to which 
 this book is devoted. Eickets is a condition, the result of 
 faulty nutrition ; it is found among the rich as well as the 
 poor. It is the result, in the latter, of exposure, starvation, 
 neglect ; in the former, the direct consequence of high pressure, 
 nervous exhaustion, improper feeding, — in other words, negli- 
 gence or ignorance. The mother who fails to nurse her babe, 
 and turns it over to the tender mercies of an ignorant nurse 
 and a bottle, should not be surprised if her child suffers in 
 consequence. ]^o more, indeed, should one ignorant of the 
 fact that starchy food wnll ferment and be productive of harm, 
 be surprised to see her child develop spine-disease or become 
 bow-legged. 
 
 By rickets we mean a disease of the nutrition of the body, 
 whereby its natural growth and development are arrested, the 
 formation of bone is retarded, and the pressure exerted by the 
 muscles and the weight of the body causes deformities which 
 later in the disease become permanent. This want of bone- 
 deposit delays the formation of teeth ; the interference with 
 nutrition causes wasting of the muscles, produces disorders of 
 digestion, and also shows itself in affections of the lymphatic 
 glands, the liver, the sj)leen, and the brain. Its causes are bad 
 feeding, want of sunshine, dampness, want of cleanliness ; and 
 yet so gradual and slow is the process by w^hich this faulty 
 nutrition shows itself, that many children who are seemingly 
 strong and hearty will manifest signs of rickets towards the 
 end of their early dentition. 
 
 Eickets is in nearly all cases developed after birth, usually 
 about the fifth or sixth month. 
 
 As regards the normal growth of the child during the first 
 
308 MOTHER AND CHILD. 
 
 year of its life, the average growth is about eight inches ; 
 during the second year about four inches, and at this time it is 
 supposed to have attained half of its full adult height. As 
 regards weight, at the end of the first year it has gained about 
 three times its weight at birth, but during the second year it 
 has only increased this by about one-third. 
 
 We have endeavored to impress upon mothers the great 
 importance during pregnancy of leading the sort of life that 
 will give them good digestion, — plenty of fresh air and exer- 
 cise, — and of a diet that will supply all the demands of nature. 
 Otherwise, at this time they are the ones who will suffer ; 
 nature will draw from them the material to supply bone to 
 their infant. The nursing mother should also be most careful 
 in her mode of life, knowing that the nutrition of two indi- 
 viduals depends ui)on herself. Should the supply fail, one or 
 the other will suffer. Infants deprived of the materials that 
 go to the formation of bone (lime-salts) will develop rickets 
 though they may be fat ; becattse excessive storage of fat is 
 no evidence of health, but, on the contrary, is often evidence 
 of faulty nutrition. The failure of the diamond-shajDed open- 
 ing on the top of a child's head to close before the end of the 
 first year; the delay in cutting its first tooth until the expira- 
 tion of this period ; the tendency to enlargements of the 
 glands, especially the tonsils ; disturbances of the bowels, 
 especially that form where bile does not seem to be properly 
 secreted ; the tendency to perspire at night about the head or 
 neck, notwithstanding the fact that the child seems fat and 
 well nourished, are all, particularly when found associated in 
 the same case, evidences of rickets, and a child presenting 
 these symptoms should at once have a change of air and diet, 
 and be placed under medical treatment. 
 
 These symptoms may occur in a child that is nursed by a 
 seemingly healthy mother ; in fact, we often find that the 
 healthiest looking woman may be the one whose milk is least 
 nutritious. They are apt to occur in a child that has followed 
 ra|)id successive pregnancies, are almost certain to take place 
 
TEETHING. 309 
 
 should the mother while prescnant attempt to nurse a child, 
 and will very frequently be noticed exclusively in children 
 who have been nursed too long. Too early weaning, especially 
 if the bottle be made up of starchy food improperly cooked 
 or given in too large quantities, will be a cause of rickets. 
 Such children will develop, besides the other evidences above 
 noted, large bellies distended with wind, vomiting occasionally 
 sour matter, alternating diarrhoea and constipation, and the 
 stools will most frequently be found either chalky or putty- 
 like, and containing quantities of mucus. If a child is late in 
 cutting its first teeth, though rickets may not be present, 
 there is something faulty in its condition. By late, we mean if 
 it has not cut its front tooth by the tenth month. Such a child 
 should be carefully watched, and its diet freely supplied with 
 bone-forming material ; it should be given Mellin's food with 
 its bottle, or (Trommer's) extract of malt, without hops (a 
 teaspoonful to the bottle). It should have a salt bath daily, 
 its muscles should be exercised by daily gentle rubbing or 
 massage, and under no circumstances should such a child be 
 allowed to stand on its feet until it has demonstrated its ability 
 to do so after the gradual strengthening of its bones and 
 muscles by creeping. 
 
 A great mistake is often made by permitting a child to 
 creep in one position. These children also should be watched 
 with care, that they receive no sudden shock, or blow, or fall. 
 Spinal curvature may be the result ; distortion of their hip- 
 bone or pelvis, — a serious matter if thej^ are girls. Diseases 
 of the lungs should be guarded against, as bronchitis, pneu- 
 monia, etc., as the difficulty in breathing will press the weak 
 ribs out of position and keep them so, making the child 
 pigeon-breasted. 
 
 We have dwelt at length upon this matter in order to show 
 that what is usually attributed to difficult dentition — the head- 
 sweating, digestive disturbances, sleeplessness — in many cases 
 may have nothing whatever to do with dentition, the difficult 
 dentition being simply a symptom in the course of the disease. 
 
310 MOTHER AND CHILD. 
 
 Malnutrition is tbe true cause. There are certain disturbances 
 (mechanical ones), that are caused by the pressure of the teeth 
 upon the nerve-pulps beneath, that are especially noticeable in 
 children of highly-nervous organization, those whose parents 
 are brain-workers, and in these cases we are apt to have dis- 
 orders of digestion, malnutrition, brain-excitement, resulting 
 in sleeplessness and possibly convulsions. Especially do these 
 conditions manifest themselves during the cutting of the 
 back teeth, as the molars ; also the eye-teeth and stomach-teeth ; 
 the eye-teeth, so called because their cutting is usually accom- 
 panied by more or less disturbance in the circulation of the 
 brain and the upper parts of the face, giving rise to excite- 
 ment, to sleeplessness, or to catarrh in the nose or in the 
 eyes ; and the stomach-teeth because their cutting is usually 
 accompanied by disorders of digestion. 
 
 Sleeplessness and irritability seem a constant accompani- 
 ment of the teething process. A new-born infant sleeps from 
 fifteen to eighteen hours out of the twenty-four ; a child of 
 two years should sleep with little interruption at least ten or 
 eleven hours at night, and from one to two hours in the middle 
 of the day. But sleeplessness is not alwaj'S an evidence that 
 the child is suffering ; habit has much to do with this condi- 
 tion. A child should be prepared for sleep ; its hours should 
 be as regular as clock-work, and under no circumsianees should 
 it be allowed to pass its sleep-time. Especially is this rule 
 important during the time of teething. The reasons for the 
 sleeplessness of many children are, first of all, our city children 
 are of an excitable temperament; they do not get sufficient 
 fresh air or exercise, and in consequence the fatigue which 
 should naturally invite profound and peaceful sleep is accom- 
 panied by a degree of excitement that prevents this. 
 
 Sleeplessness from this cause can be remedied by attention 
 to these matters. It is produced by exciting a child just 
 before its sleep-time, especially after it has taken its bottle ; 
 its bottle or bowl of food should be given the very last thing. 
 The drowsiness which follows this meal, if once disturbed, will 
 
TEETHING. 311 
 
 cause a wakeful night. Among the poor, the father comes 
 home tired from overwork, and the family retire together at 
 an early hour ; with the well-to-do, the lights are all lighted, 
 the older children have their romp, or the baby, if it be the 
 first, has to have its half-hour of play with the father, and 
 possibly the excitement of its brain may cause a restless first 
 sleep and wakefulness for the greater part of the night. This 
 is altogether wrong, and is undoubtedly the cause of many 
 brain disorders. For cases of wakefulness from no apparent 
 cause, a hot foot-bath will have a most soothing effect, or, if 
 they still resist, the morning bath can be postponed until 
 evening, giving a warm bath at this time, and a sponging in 
 the morning instead. In these cases, a bottle of food as warm 
 as the child can take it, consisting of Mellin's food and water, 
 the proportions being a tablespoonful of the food and water to 
 fill the bottle, which will put the child to sleep. If the wake- 
 fulness is due simj)ly to excitement, the child seeming perfectly 
 well otherwise during the daytime, medicine should be avoided 
 unless specially ordered by a physician. The habit of giving 
 bromide, for no other reason than simply wakefulness, is a 
 mistake. 
 
 Another cause of sleeplessness is insufficient nourishment ; 
 we sometimes see such cases, where the mother is gradually 
 losing her milk , its bulk remains probably the same, but it is 
 losing its richness or quality. Children fed on condensed milk 
 alone are sometimes underfed, from the fact that the milk is 
 given too highly diluted. One part to twelve of water should 
 be the strength up to the second or third month ; after that, 
 about one part to ten or eight, as the child grows older, or, 
 better still, increasing the quantity of cream, and from a pint 
 and a half to a quart of the mixtm'e in the twenty-four hours ; 
 but if the child seems hungry after each bottle, give it more 
 until it is satisfied. But we fear that among those who will be 
 readers of this book the greater cause will come from over- 
 feeding. A restless infant, and especially a child about a year 
 old, who tosses in its sleep, cries out, mutters, dreams, is one 
 
312 MOTHER AND CHILD. 
 
 who in all probability is receiving food in excess, or is certainly 
 not getting rid of the surplus in a proper way. If the mother 
 notices that a sleepless, restless child, at whatever age it be, 
 has a furred tongue, that its breath is foul, that its urine is 
 scanty, high-colored, or that it passes water very frequently, 
 probably wets its bed at night, is constipated, and the move- 
 ments are light and pasty, she will know that the child needs 
 a laxative, to be followed by a change in its diet, — a dose of 
 Husband's magnesia, about a quarter of a teaspoonful, or, 
 probably better than all, a dose of castor oil, followed next 
 day by a limited amount of milk, substituting chicken-broth 
 and avoiding oatmeal or beef-juice until the bowels become 
 more normal. Castor oil can be given in warm water in which 
 has been dissolved a peppermint drop, or a tablespoonful of 
 liquid soda mint, a preparation now so well known that it can 
 be obtained at any drug-store. The " soda mint" compressed 
 tablets should be kept in every house, as they are frequently 
 useful for " hiccups" or slight indigestion, thou^ for infants 
 the liquid is better. This form of sleeplessness is most apt to 
 be noted at about the end of the first year. With some chil- 
 dren the constant diet of oatmeal without any variation, the 
 daily use of the expressed juice of beef, and at the same time 
 large quantities of milk, which at this period is not often much 
 diluted, will bring about the form of digestive disturbance just 
 mentioned, and a degree of nervous excitability that is often 
 referred to the teething -process alone. On that account 
 barley is preferable to oatmeal. 
 
 We often hear of children who are said to be suffering when 
 cutting their back teeth, and upon investigation find that they 
 are taking about a quart of milk a day, with a tablespoonful 
 of Mellin's food in each bottle, an ounce or two of the 
 expressed beef, possibly a bowl of oatmeal food, and in addi- 
 tion are constipated, get no fresh air, — in fact, are city chil- 
 dren, surrounded by all the disadvantages that our changeable 
 and treacherous climate affords ; viz., overheated houses and 
 impure air. A child of this sort, if given chicken-broth instead 
 
TEETHING. 313 
 
 of beef-juice, less Mellin's food, thin bread and milk instead of 
 oatmeal, allowed to drink freely of water, and given an occa- 
 sional laxative, will soon cease to suffer with its teeth. Ovei"- 
 feeding — stuffing, oven with good, wholesome food — is the 
 cause of much of the disorder and febrile attacks of children, 
 to say nothing of the " sweets" that are permitted between 
 meals. 
 
 Sleeplessness may arise from pain ; especially is this the 
 case in bottle-fed children, who suffer from neuralgia, muscular 
 soreness, possibly vague rheumatic pains, supposed by many 
 to be caused by the fermentation of the sugar or starches 
 which they are unable to digest. A child that is fed upon too 
 much sugar will develop acidity ; the same with starch : this 
 leads possibly to rheumatism, or rheumatic neuralgia, called 
 growing pain, and eventually to rickets, restlessness, sleepless- 
 ness, or sudden starting, soreness to the touch, no desire for 
 '* exercise, peevishness, or possibly extreme pain upon move- 
 ment. When, the child is lifted suddenly, or is handled while 
 dressing, it will cry, — all important symptoms of this con- 
 dition. 
 
 An extra-sensitive nervous system will probably cause 
 neuralgia through the jaw and head, earache, in some chil- 
 dren, from tooth-pressure ; this cause is recognized from the 
 fact that these children will avoid anything placed in the 
 mouth, even the nipple of their nursing-bottle. The gums 
 may be slightly swollen, but not inflamed or in themselves 
 tender, but the least pressure upon them with the finger will 
 cause intense suffering. In a case of this kind, if severe, — the 
 child restless, starts in its sleep,refuses food, — the gum should 
 be lanced. A cross-cut that will open the capsule of the tooth 
 will in a moment relieve the pressure. If this is impossible, a 
 hot bath or hot foot-bath should be given, also an enema of 
 warm water, and if the child still suffer, and the mother is 
 away from the doctor, she may give two grains of bromide 
 of potassium, or five drops of the elixir of the valerianate of 
 ammonia, the latter to be repeated in the course of an hour, if 
 o '27 
 
314 MOTHER AND CHILD. 
 
 necessary. These are the cases in which the bromide of potas- 
 sium, if given judiciously, is of the greatest value ; they 
 present the purely nervous type, and the nervous system 
 should be soothed by precisely the same mode of treatment 
 that one would adopt for a severe neuralgic headache. The 
 bromide may be given with a teaspoonful of syrup of lactu- 
 carium, or a teaspoonful of orange-flower water. If the 
 excitement is great, the child of a year old should take about 
 four grains of bromide ; should a convulsion threaten or occur, 
 the proper treatment is warmth and counter-irritation to the 
 legs, and an enema of two ounces of water, at about the tem- 
 peratui'e of 100° F., containing one teaspoonful of the tincture 
 of assafoetida. After the foot-bath the child's legs should be 
 thoroughly wrapped in a blanket, and the only food given it 
 for a time should consist of the blandest kind, such as barley- 
 water, wine- whey, or chicken-tea. 
 
 Dr. A. Jacobi, on the treatment of convulsions, writes as fol- 
 lows: 
 
 " Eemove the injurious substances from the stomach. If 
 vomiting have not occurred or not sufficiently, it should be 
 provoked by tickling the fauces, and friction of the precordial 
 [heart] region. These, as a rule, will suffice, but if they do not, 
 quantities of warm water or mustard waier will answer a good 
 purpose. The syrup of ipecac is a doubtful and unreliable 
 preparation. Purgatives should not be given in the begin- 
 ning ; large enemata will act more favorably, as warm water, 
 or warm water with antispasmodics, such as assafoetida, or 
 local stimulants, such as turpentine. 
 
 " Fever, unless it be high, requires no special treatment. As 
 a rule, cold applications to the head will act well when there 
 is a tendency to convulsions. Cold applications to the heart 
 will reduce the temperature of the whole body. A warm bath 
 will frequently do good. I do not adoise bathing or handling 
 the child much ivhile the convulsion is on. When thirst is very 
 great, small quantities of ice-water should be given often, or 
 Seltzer water, or Yichy or Apollinaris. 
 
TEETHING. 315 
 
 " Solid food must not be given." 
 
 A teaspoonful of the tincture of assafoetida in a teacup of 
 water is the proper strength for an injection. 
 
 Mothers should not give their children ipecac in this condi- 
 tion, it being very irritating, and the strain produced by 
 vomiting may be productive of harm. Ten drops of the 
 aromatic spirits of ammonia, or ten drops of brandy, whiskey, 
 or gin, in two tablespoonfuls of warm water, are lar better, 
 when given to the child as soon as it can swallow ; if there is 
 any oflt'ending matter in the stomach, it will act sometimes as 
 an emetic. 
 
 There is another cause of restlessness and sleeplessness from 
 teething, that due to the congestion of the gum and inflamma- 
 tion of the mucous membrane of the mouth. We more fre- 
 quently find this condition when the back teeth are being cut, 
 and in children who secrete but little saliva. The gum is 
 found swollen, red ; the mouth is dry ; tlie child will turn away 
 from more solid food, and will eagerly drink water to allay 
 the irritation in its mouth. Frequently, during the second 
 summer, it will be accompanied by diarrhoea, from the fact 
 that the mucous membrane extends to the stomach and bowel 
 Very often small ulcers (aphthae) form in the fold of the 
 cheek or the surface of the gum, become coated with secretion, 
 and are exceedingly painful. If there is disturbance in diges- 
 tion, liitle round vesicles, which burst and form ulcers with a 
 grayish coating, will form on the inside of the cheek or the 
 lips, and on, or beneath, the tongue. These aphthae will 
 annoy the child extremely, and produce sleeplessness ; they 
 are the result of indigestion, not of teething, though fre- 
 quently associated with it. The physician will probably give 
 a little calomel and soda to correct the digestive disturbance, 
 or the mother can give some magnesia, or from ten to twenty 
 drops of spiced syrup of rhubarb with a teaspoonful or two 
 of soda mint, given once a day until the bowels become reg- 
 ulated ; at the same time the child can have its mouth washed 
 gently with a soft piece of linen, with a solution composed of 
 
316 MOTHER AND CHILD. 
 
 a pinch of borax, a teaspoonful of glycerin, and a tablespoon- 
 ful of rose-water. 
 
 The congestion of the gum of which we' have been speaking 
 causes the child to crave salty food ; indeed, this is an effort 
 of nature to relieve this condition by inducing a flow of saliva. 
 Lancing the gums will often be of great service, by the relief 
 it gives to congestion ; the incision should be deep enough to 
 cut through the capsule of the tooth ; instead of this the child 
 should be given something to bite upon, and it will probably 
 obtain relief in that way. The small bone of a well-boiled 
 ham is salt, and the child will eagerly suck it and frequently 
 bite it. A chicken-bone, slightly salted, is also useful, or the 
 child may be allowed to bite on a piece of rare roast beef, aod 
 possibly the eagerness with which it will seize upon it may 
 cut the gum from below with the sharp points of its tooth. 
 Children who sufi'er thus from their gums often get relief from 
 Mellin's food, tied in a rag to suck or bite upon. 
 
 To sum up, the object to be secured is the free flow of saliva ; 
 it will relieve congestion and soften the gum. It is a mistake 
 to rub a gum under such circumstances by hard, dry friction, 
 but if the little one suffers so as to disturb its sleep, the 
 mother's finger, dipped in the syrup of lactucai'lum, or even in 
 paregoric and glycerin, ten drops to the teaspoonful, can be 
 gently carried over the tender and inflamed gum, and, by 
 gentle pressure, soothe instead of irritate ; and now and then 
 a little firmer pressure may allow the point of a tooth to force 
 its way through. Some children will eagerly suck a piece of 
 ice wrapped in linen, and it will relieve the congestion of the 
 gum. 
 
 In these cases a hot foot-bath again has its advantages, by 
 relieving the congestion of the head and mouth ; or, if the child 
 is constipated, the operation of a laxative will be followed by 
 relief to its congested gum. The latter will shrink, and a 
 point of the tooth emerge from its captivity. 
 
DIET AFTER EARLY DENTITION. 317 
 
 CHAPTEE XL I. 
 
 DIET AFTER EARLY DENTITION. 
 
 After a child hcas cat its twelve teeth, it is well to give it 
 more solid food than that which it has been accustomed to take. 
 The milk diet has been continued, or the bread and milk, up 
 to this period, in addition to the mutton-broth, chicken-broth, 
 or beef-soup, and our endeavor now should be to encourage 
 the digestion of more solid food by gradually adding it to the 
 diet to which the child has been accustomed. In almost every 
 house is kept on hand what is known as stock ; this forms a 
 very valuable addition to a child's dietary, as it is nutritious, 
 palatable, and can be flavored so as to make a change. A 
 child about two j-ears old may have a more solid mid-day 
 meal, composed of a piece of rare tenderloin or juicy mutton- 
 chop, with some well-boiled rice or a thoroughly-roasted, dry, 
 mealy potato, well minced, in addition to its soup, or the white 
 meat of a tender fowl, or sweetbread finely chopped, first 
 heated, though not fried. For its breakfast, instead of the 
 bottle, a child of this age may take about a tablespoonful 
 of cracked wheat (which must be thoroughly boiled or steamed), 
 or oatmeal, or yellow corn-meal, or white grits of moderate 
 consistency (thorouuhly boiled), and milk. A little salt should 
 be added to these while boiling; this is preferable to flavoring 
 with sugar. We think, indeed, it is better than using salt and 
 butter ; butter used in that way will certainly upset a child's 
 digestion. The sanitary foods (cereals) prepared at Battle 
 Creek, Michigan, are useful in this connection. 
 
 A soft-boiled Qgg, with bread and butter and a tumbler of 
 milk ("cambric tea"), is about the best breakfast a child can 
 have at this age. If it sits at the table and is taught to eat 
 slowly, it will not become dyspetic. Between times, if the 
 child is thirsty, a drink of milk is admirable. With its dinner, 
 
 27* 
 
318 MOTHER AND CHILD. 
 
 water is probably better; we have certainly found it so in 
 children who are of a bilious habit. It is a great mistake to 
 give a child sweet things hefore its meal; after dinner it may 
 be allowed to have some mild dessert, light custard or pudding, 
 sponge-cake, a baked apple, or, indeed (after it has cut its 
 twelve teeth), a piece of ripe, raw apple or peach will have 
 a good effect on its bowels. The great advantage of bring- 
 ing a child to the table to eat with its parents is that it is 
 taught to eat properly, to masticate its food thoroughly, 
 which is the only way of avoiding dyspepsia ; and also, that 
 the child can thus be trained to see but not ask for things 
 that it knows it should not have. It is a great mistake to so 
 spoil a child that it will refuse when at the table the proper 
 sort of food, and cry constantly for that which is forbidden. 
 A taste of this or that at the table may not result, for the 
 time being, in an attack of indigestion, but the parents are sure 
 to suffer for it in the future. We so often make the mistake 
 of believing that children are rendered strong and healthy by 
 inattention to these matters of diet and clothing, that care- 
 lessness makes the child hardy, that the child who is strictly 
 brought up is usually a sickly one. We acknowledge that at 
 times great mistakes have been made by over-carefulness, that 
 the scientifically-brought-up child is not always the most 
 healthy. This carefulness may be carried to extremes, as may 
 everything else. It is always well to make your list for the 
 child's bill of fare as large as possible, and give it its choice ; 
 but always adhere to the lines of digestibility, and avoid those 
 articles that every one knows are absolutely indigestible or at 
 least harmful and irritating, such as veal, pastry, unripe fruit, 
 sweets in quantity ; and do not imagine that, because children 
 sometimes escape the dangers which indulgent parents bring 
 upon them, the words of advice only come from those who 
 are too highly scientific in their ideas. 
 
 The highly-educated classes and those who live by their 
 brains alone are notoriously dyspeptic, and the children of 
 these undoubtedly inherit the weak digestions of their parents 
 
DIET AFTER EARLY DENTITION. 319 
 
 us they do their more highly organized brains and possibly 
 larger heads. They are more subject to acute brain-troubles 
 from this cause, and the}' are certainly more subject to all 
 the influences which produce intestinal disorders, and cannot 
 possibly digest the same food that will agree with a child of 
 the same age, the offspring of the less intellectual and the 
 laboring classes. This is a matter which every mother 
 should thoroughly understand; it explains to her why one 
 child will thrive on food that would be ]ioison to another; 
 it will prove to her beforehand, without the necessity of an 
 experiment, that her child would not be made more hearty by 
 feeding on the boiled potatoes, soggy bread, corn-starch, or 
 apple-dumpling that has failed to kill her washerwoman's child. 
 Nature has so constituted food that it is not all concentrated 
 nourishment ; in grain, in fruit, in meat, the easily digested 
 portions are associated with certain materials that are harder 
 to digest; in a mixed diet the various substances have dif- 
 ferent degrees of digestibility, and in this way the digestive 
 juices come more closely in com act with the food, owing to 
 its bulk, and the muscular contraction of the stomach and 
 intestines is promoted by the mass of material which passes 
 through them. It would be, then, a mistake to feed a healthy 
 p<T8on entirely on concentrated nourishment ; the intestinal 
 digestive jtiices would fail to be secreted, the liver would 
 become congested and diseased, the bowels would be coated 
 with mucus and would fail to act, and the refuse from thvi 
 destruction of tissue, which is normally carried off by them, 
 would remain behind and poison the system. But during 
 illness, when digestion is checked, and when it is neces- 
 sary to supply in small amounts the most concentrated 
 nourishment to sustain the system of the patient, then the 
 well-known preparations of peptonized foods, of concentrated 
 meat-extracts, are not onh^ most valuable but often absolutely 
 indispensable. 
 
 After it has cut its twelve teeth, the child will naturally 
 desire a greater variety of food, and within bounds this de- 
 
320 MOTHER AND CHILD. 
 
 sire may be satisfied. Its bill of fare should include articles that 
 are easy of digestion, — mutton, beef, sweetbread, fowl of various 
 kinds, soft-boiled Qgg^^ scrambled eggs, or light omelet ; vege- 
 tables, as carrots, spinach, young beans, young beets, asparagus, 
 old potatoes, — the latter well boiled and mashed, or roasted ; 
 by all means avoid parsnips, cabbage, turnips, etc. For fruits, 
 baked apples, raw apples scraped, oranges (of course only the 
 juice), grapes (avoiding the skins and seeds), peaches (pro- 
 vided they are not picked green and then ripened) ; and avoid 
 berries of every kind, also pineapples, green apples, etc. Figs, 
 dates, and raisins are all bad for children at this tender age. 
 
 The seeds of raw berries, also cherry-stones and chestnuts, 
 are apt to lodge in a certain portion of the intestine and 
 become impacted, thus giving rise to a serious disease that 
 will require surgical interference. 
 
 Dr. S. S. Adams, of Washington, has given us an interesting 
 resume of the subject, and we will quote at length from his 
 valuable paper :^ 
 
 " For convenience it is necessary to assume that the child 
 has been deprived of the breast-milk at the twelfth month, 
 and to formulate a dietary accordingly. The eruption of the 
 lower central incisors, during the seventh or eighth month, 
 seems to be the indication to mothers to begin supplemental 
 feeding. Yery few infants pass far beyond this physiological 
 epoch without it. . . . 
 
 " The object being to prescribe a suitable dietary for the 
 child, in health and disease, from weaning to puberty, it will 
 be best attained by making divisions to conform to the recog- 
 nized anatomical and physiological changes in the organism. 
 The following divisions seem, therefore, to meet all the require- 
 ments: 1, twelfth to eighteenth month; 2, eighteenth to thirty- 
 sixth month ; 3, third to fifth year ; 4, fifth to eighth year ; 5, 
 eighth year to puberty. 
 
 " While most mothers will appreciate the value of milk as 
 the chief food for infants during the first year, very few will 
 
 1 Keating's Cj^clopEedia of the Diseases of Children, vol. i. p. 337. 
 
DIET AFTER EARLY DENTITION. 321 
 
 be convinced of its value as such after weaning. Several 
 months before the child is weaned, in many instances, it has 
 had some of the farinacese, and also, probably, meat-broths. 
 If weaning takes place before the eruption of the molars, the 
 diet should be milk. If it is weaned during the summer 
 months, milk should be its only food, although the molars and, 
 perhaps, the canines have appeared. If, however, the child 
 does not seem to derive sufficient nourishment from the milk, 
 it may be given some additional food, provided the weather be 
 cool, but always remembering that its chief constituent must 
 be milk. If it seems to thrive on milk alone, it will be advisa- 
 ble to limit it to it until the eighteenth month. It is the ex- 
 ception, however, when a child will be satisfied with milk until 
 this late period. It is generally necessary to supplement its 
 food by adding some farinaceous aliment. If there is a ten- 
 dency to loose bowels, barley-water is preferable. It is made 
 by grinding a tablespoonful of the grain barley and adding to 
 it six ounces of water : this should be boiled for fifteen or 
 twenty minutes, salt added to suit the taste, and the mixture 
 strained. This decoction should be made fresh twice a day 
 and kept cool. It should be added to the milk in the propor- 
 tion of one to three or one to two. The prepared barley may 
 be used in the same manner, bat it is not so reliable. If con- 
 stipation is the rule, oatmeal may be used by preparing a de- 
 coction similar to that of the barky. Arrow-root should not be 
 used, on account of the large proportion of starch it contains. 
 
 "Bread jelly has been highly recommended by Churchill and 
 others as an excellent food for children just after weaning. 
 It is made by taking a quantity of the soft part of stale bread, 
 breaking it into small pieces, covering it with boiling water, 
 and allowing it to soak for some time. The water is then 
 strained off, and fresh water added. This should now be boiled 
 until it becomes soft; the water is then pressed out, and the 
 bread on cooling will form a jelly. A portion of this should 
 be mixed with sweetened milk. 
 
 " In some cases beef-tea will be well borne. That made in a 
 
322 MOTHER AND CHILD. 
 
 bottle swimming in a water-bath does not contain soluble albii- 
 minoids. It contains large quantities of salts, and should not 
 be given when there is a tendency to diarrhoea. Excellent 
 beef-tea is made by mincing one pound of lean beef and add- 
 ing a pint of cold water and ten drops of dilute hj-drochloric 
 acid. This should stand for two or three hours, with occasional 
 stirring. It should then be left to simmer for fifteen or twenty 
 minutes, when it will be ready for use. 
 
 " Beef-broth is not very nutritious, and is not recommended. 
 Mutton-, veal-, and chicken -broths are nutritious, and are appli- 
 cable in many cases. It must be borne in mind, however, that 
 mutton causes constipation, and veal diarrhoea. . . . 
 
 " With the sixteen teeth the child should be allowed a more 
 liberal diet. Its digestive apparatus is now capable of digest- 
 ing food which has been masticated. It may be allowable to 
 give it stale, well cooked bread, and butter, or crackers. It 
 may also be given a little mashed white potato, with gravy. 
 A sandwich of scraped lean beef and bread, seasoned with 
 salt or sugar, will be relished, and is very nutritious. It may 
 have a piece of rare beef or a chicken-bone to suck, care being 
 taken that it does not swallow the pulp or bone. 
 
 " Peptonized beef preparations have been recommended by 
 the recognized authorities. 
 
 " In regulating the regimen of a healthy infant during this 
 period, very little change is required in its food. It should be 
 fed fiive or six times, at the same hours, every day, but should 
 not be awakened for the purpose. If it desire its food before 
 its accustomed time, it should have it. 
 
 " First meal, 6 a.m. — A cup of milk, with cream biscuit or a 
 slice of buttered bread. 
 
 "Second meal, 8 a.m. — Stale bread, broken and soaked in a 
 tumblerful of rich milk. 
 
 " Third meal, 12 m. — A slice of buttered bread, with about 
 half a pint of weak beef- tea or mutton- or chicken-broth. 
 
 " Fourth meal, 4 p.m. — A tumblerful of milk, with crackers 
 or a slice of buttered bread. 
 
DIET AFTER EARLY DENTITION. 323 
 
 "Pifth meal, 8 p.m. — A tumblerful of milk, with bread or 
 crackers. 
 
 " Towards the latter part of this period, when the child has 
 sixteen teeth, it may be desirable to substitute the following : 
 
 " First meal, 6 a.m. — Bread or crackers, with a half-pint of 
 milk. 
 
 " Second meal, 8 a.m. — A tablespoonful of oatmeal, cracked 
 wheat, or corn-meal mush, with milk, and a couple of shoes of 
 buttered bread. 
 . " Third meal, 12 m. — Bread-and-butter, milk, and a soft-boiled 
 
 " Fourth meal, 4 p.m. — A piece of rare roast beef to suck ; 
 mashed boiled potatoes, moistened with dish-gravy ; bread and 
 milk ; and a small portion of rice, bread jelly, or farina. 
 
 " Fifth meal, 8 p.m. — Milk and bread or crackers.^ 
 
 " This is a modification of the diet laid down by L. Stair ; 
 but the writer usually insists that the infant should be eon- 
 fined to milk, milk and barley-water, or milk and oatmeal- 
 water, during this entire period. When his advice has been fol- 
 lowed, the perils of the ' second summer' have been avoided. 
 
 " Fruits and berries of aU kinds should be interdicted. 
 
 " Every case of infant-feeding must be regulated by its own 
 indicated requirements. There is no uniform rule applicable 
 to all. Each must be studied carefully, and that mode of 
 feeding must be adopted which proves best suited to it. 
 
 " The child should not be permitted to sit at the family table. 
 It may have a separate table, where it can have its frugal 
 meal without being tempted by unwholesome dishes. 
 
 " The diet in sickness during the first period must be regu- 
 lated by the nature of the case. It is impossible to prescribe 
 a regimen suitable to all sick children. 
 
 "Yomiting is unquestionably the most frequent symptom 
 to be controlled. It may be due to overfeeding, or to some 
 
 ^ Often it would be preferable to give the fourth meal at three p.m., and 
 the fifth meal at six p.m., especially in winter, so that the child can be put 
 to bed by seven o'clock. — K. 
 
324 MOTHER AND CHILD. 
 
 fault in the quality of the food. AYhen it is caused by over- 
 feeding, a diminution in the quantity of food, as well as a 
 longer interval between meals, will usually correct it. If it 
 should be caused by a defect in the quality, this should be 
 discovered and remedied. If the ejected matter is sour- 
 smelling, the alkali must be increased. Frequently, forced 
 abstinence will correct it ; and in many cases small quantities 
 of food given every fifteen, twenty, or thirty minutes will 
 have a salutary effect. 
 
 " Diarrhoea is often the result of improper feeding. The food 
 may be too concentrated, or its quality may be poor. When 
 it is due to too .much solid food, the indicated treatment is to 
 confine the patient to a liquid diet. If the quality of the food 
 is not good, it should be improved. In many cases the addi- 
 tion of barley-water to the milk will prove effectual in check- 
 ing the diarrhoea. 
 
 " Constipation may often be corrected by adding oatmeal to 
 the second meal, or oatmeal-water to the milk. 
 
 "It should be the invariable rule to confine children to a 
 liquid diet as soon as any impairment of digestion or assimi- 
 lation is noticeable or they become ill. Milk should always 
 have the preference. It may be given pure, diluted, boiled, 
 or, perhaps, predigested. In rare instances milk will not be 
 retained by the stomach, or will be passed from the bowels' 
 only partially digested. In such cases a mixture of equal 
 parts of milk and lime-water, given in teaspoonful doses every 
 ten or fifteen minutes, will not infrequently be retained and 
 digested. In some cases where milk cannot be retained, 
 barley- or rice-water may be temporarily substituted. In 
 other cases beef tea, beef-essence, or beef-juice may be admin- 
 istered in small quantities, frequently repeated, with marked 
 benefit. Tea and coffee should not be allowed. 
 
 " In weakly children the following may be given : ^ 
 
 1 The following are very good recipes, recommended on high authority : 
 For beef-essence take one pound of beef free from skin and fat, chop as 
 
DIET AFTER EARLY DENTITION. 325 
 
 " Chicken Jelly. — Clean a fowl that is about a year old, and 
 remove the skin and fat. Chop it, bones and flesh, and put it 
 in a pan with two quarts of water. Heat slowly, and. skim 
 often and carefully. Let it simmer for five or six hours ; then 
 add salt and mace or parsley to taste, and strain. Set away 
 to cool. When cold, skim oif the fat. The jelly is usually 
 relished cold, but may be heated. G-ive this in small quan- 
 tities, very often. 
 
 " Wine- Whey. — Boil three wineglasses of milk, and add a 
 wineglass of sherry or port wine. Strain, and add a wineglass 
 of warm water. A wineglassful of this may be given once 
 or twice a day. 
 
 " White Wine- Whey. — To half a pint of boiling milk add a 
 wineglassful of sherry; strain through a fine muslin cloth, 
 and sweeten. A tablespoonful of this may be given every 
 two or three hours. 
 
 " Eighteenth to Thirty-sixth Month. — It is quite as important 
 to regulate the diet of the second period as that of the first, 
 but much more difficult. At this period the child is walking, 
 and often helps itself to indigestible substances. It now has 
 all its milk-teeth, and is capable of mastication. Its mind is 
 
 fine as mince-meat and pound in a mortar witli two tablespoonfuls of 
 water. Put into an earthen jar with a little salt, cementing the edges of 
 the cover with pudding paste ; then put the jar in an oven or tie tightly in 
 a cloth and keep in a pot of hoiling water for three hours. Strain through 
 a coarse sieve. Give two or more teaspoonfuls. 
 
 For chicken-broth take half a chicken, one quart of water, a small 
 bunch of sweet herbs, one blade of mace, and salt to taste. Put into a 
 saucepan and allow to simmer gently for one and a half hours, carefully 
 skimming in the mean time. Then strain and cool. When cool remove 
 all fat from the surface. This may be warmed as needed. 
 
 Mutton-broth is made by taking one pound of the scrag end of the neck 
 of mutton, a small bunch of sweet herbs, half a turnip, and a little salt. 
 Put into a stewpan and pour over it three pints of cold water. When it 
 boils, skim carefully, cover closely, and allow it to simmer gently for an 
 hour ; then strain, cool, and take off all fat. This may be warmed as re- 
 quired. Pearl barley or rice may be added, but must be boiled thoroughly. 
 
 28 
 
326 MOTHER AND CHILD. 
 
 generally sufficiently active to be taught what edible articles 
 it should have. Its power of masticating, its flow of saliva, 
 its good digestion and assimilation, and its increasing bodily 
 growth demand a greater variety of food. If it reach its 
 second period during the summer, and have the appearance 
 of health, and seem satisfied with its milk and simple food, it 
 will be prudent to wait until cool weather to change its diet 
 to a more substantial kind. 
 
 '= It is now admissible to allow it to eat at the family table, 
 because the opportunity to begin its training early should not 
 be overlooked. It can be taught to eat slowly, that certain 
 articles are not suitable for it, and that it can have enough of 
 the proper kind of food. Wlien a child frets for different 
 articles of food on the table it is generally because some impru- 
 dent pei'son has allowed it to taste them. If it is not tempted 
 by tasting other, it will be contented with its simple food. It 
 should be fed at least four times daily, and occasionally will 
 require a few crackers or a slice of bread-and-butter between 
 meals. 
 
 "First meal, 8 a.m. — A portion of well-cooked oatmeal, 
 wheaten grits, or corn-meal mush, with a liberal supply of 
 milk ; cold bread-and-butter ; and a jDiece of finely-cut, tender 
 beefsteak, or a soft-boiled Qgg. 
 
 " Second meal, 12 m. — A bowl of chicken or 03'ster soup, or 
 weak beef-tea ; milk, with bread or crackers, and butter. 
 
 " Third meal, 4 p.m. — Eoast beef, mutton, chicken, or turkey ; 
 fresh white fish ; mashed white potato, moistened with gravy ; 
 bread-and-butter ; and rice and milk, 
 
 " Poui'th meal, 8 p.m. — Milk, with bread or crackers. 
 " It may be necessary to give a glass of milk and a piece of 
 bread-and-butter between the first and second meals ; and if 
 the child is particularly hearty the same may be occasionally 
 required in the early morning. Towards the latter part of 
 this period fresh ripe fruits are admissible, provided due care 
 is taken to prevent the ingestion of seeds and rinds. A pop- 
 ular fruit is the banana; but the writer's experience has been 
 
DIET AFTER EARLY DENTITION. 327 
 
 such that he considers it more productive of eclampsia than 
 any other fruit, and consequently he cannot recommend it.^ 
 
 " The meal-hours vary in diiferent communities, so that those 
 for children will be governed by the local customs. It may 
 be necessary to give the principal meal earlier than four p.m. 
 It must be remembered, however, that most children sleep the 
 greater part of the afternoon, so that if they eat dinner at two 
 o'clock they will be asleep during the digestion of the bulk 
 of the day's solid food ; on the other hand, if the meal be at 
 four o'clocki there will be active exercise after it to aid di- 
 gestion and assimilation. 
 
 " It will need constant watching to prevent it from obtaining 
 unsuitable food. 
 
 " Frequently the neuroses, as eclampsia, ' night-terrors,' petit 
 mal, and the numerous symptoms attributable to 'worms,' 
 may be directly traceable to the presence of indigestible food 
 in the alimentary tract. A brisk purgative seldom finds the 
 ' worms,' but generally allays the excessive exaltation of the 
 nervous system by removing the offending material. 
 
 "When the child is suffering from an acute disease, its diet 
 should be limited to milk and beef-tea. In chronic ailments, 
 or in protracted convalescence from acute disease, each case 
 must be treated by its individual requirements, while good 
 judgment will render valuable assistance in the selection of 
 those foods which are easily digested and which possess the 
 maximum quantity of nutritious matter to the quantity in- 
 gested. In sickness, tea and toast are favorite articles, but 
 only load the alimentary tract with innutritions matter. • 
 
 " During the third period— /rom the third to the fifth year — the 
 difficulty of regulating the child's diet will be great. It has 
 now reached the aa-e when its friends will humor it with 
 
 ^ The plantain, or banana, is brought to this country green, and on that 
 account is indigestible. When picked ripe in its native land it is most 
 digestible. It is said that a pound of ripe bananas is equal in nourishment 
 to a pound of bread or a pound of steak. — K. 
 
328 MOTHER AND CHILD. 
 
 knick-knacks and table-food of difficult digestion. It has 
 twenty teeth, and its friends cannot understand why it should 
 not have such food as a healthy adult can digest. A devoted 
 mother, or usually grandmother, will argue that all her chil- 
 dren, at this age, were fed from the table and were not injured. 
 Such children lived in spite of mismanagement. Granting 
 that its diet must be more liberal at this age, it must still 
 be restricted, for even now the presence of indigestible or 
 undigested food in the alimentary tract may be productive 
 of reflex nervous disturbances. 
 
 " Its activity and waste and repair demand an increase in the 
 quantity of nutritious food. Three substantial meals a day 
 will usually suffice, but occasionally a snack between meals 
 will be required. While it is well to apply the rule of regu- 
 larity, it is not always prudent to enforce it, especially if 
 the child is hungry. The practice of children running to 
 the pantry and helping themselves should be discoiiraged. 
 In such cases children do not eat enough at the regular 
 meals. 
 
 "It is impossible to lay down 'a bill of fare' for this period, 
 but a frugal meal can be selected from the followins: : 
 
 " BREAKFAST. 
 
 " Corn-meal mush ; oatmeal ; wheaten grits ; hominy ; with 
 plenty of cream. 
 
 " Potatoes, baked and stewed. 
 
 " Eggs, poached, soft-boiled, and omelet. 
 
 "Fish, fresh, broiled. 
 
 " Meats. — Beef hash ; broiled steak ; stewed liver and kidney ; 
 lamb-chops ; chicken fricassee. 
 
 " Tomatoes, sliced (occasionally). 
 
 "Bread. — Cold, light ; Graham ; entire wheat ; corn ; muflSns, 
 plain and Graham (occasionally) ; corn- and rice-cakes. 
 
 " Fresh ripe fruit may be given in moderate quantity. 
 
 " Highly-seasoned food must be avoided. 
 
DIET AFTER EARLY DENTITION. 329 
 
 " LUNCHEON. 
 
 " Soups. — Oyster ; bean ; chicken ; consomme. 
 
 " Vegetables. — Potatoes, baked and stewed ; sliced tomatoes. 
 
 " Meats. — Beefsteak ; lamb-chops ; cold lamb or mutton. 
 
 " Bread. — Cold rolls and soda-crackers. 
 
 " Fi-uits in season. 
 
 " Eice and milk. 
 
 "dinner. 
 
 " Soups. — Consomme ; noodle ; oyster ; cream of barley ; 
 potato ; chicken ; and chicken stew. 
 
 " Fish. — Fresh, baked, broiled, and boiled. 
 
 " Meats. — Beef, chicken, lamb, and mutton. 
 
 " Yegetables. — Potatoes, rice, cauliflower, macaroni, peas, 
 tomatoes, beans. 
 
 " Bread. — Well-cooked wheaten. 
 
 " Desserts. — Eice and milk ; light puddings ; ice-cream occa- 
 sionally. 
 
 " Fruits and berries in season (fresh and sound). 
 
 " The regimen of the sick during this period does not differ 
 very materially from that of the preceding, except that, gen- 
 erally, a more generous diet may be allowed. If the illness be 
 of a nature demanding liquid food, the principles already set 
 forth will be applicable. In all cases of illness the food should 
 be reduced in quantity and changed in character, although the 
 patient may not be confined to liquids. As soon as the appe- 
 tite becomes impaired, the child should be put upon a simple 
 diet. Frequently, in children of this age, too much or dete- 
 riorated fruit will cause digestive disturbances. Withholding 
 the fruit for a few days will usually effect a cure. The child 
 should always have its fruit selected for it. When sick, knick- 
 knacks, jellies, and fancy dishes should be forbidden. If the 
 illness be protracted, and the food be digested and assimilated, 
 it should have the most nutritious aliment. This rule is 
 especially applicable to scrofulous, syphilitic, rachitic, and 
 tuberculous children. We need not wait for the manifestation 
 
 28* 
 
330 MOTHER AND CHILD. 
 
 of these diatheses. Ef there is good reason for suspecting 
 their presence, the sooner the select diet is begun the better j 
 and, even if they are not latent in these children, the care in 
 feeding will prove beneficial. 
 
 " New troubles seem to arise during the fourth period which 
 require close vigilance over the child's dietary. At this time 
 the milk-teeth begin to decay, and the first of the permanent 
 teeth make their appearance. The child has frequent attacks 
 of toothache, the dread of which prevents him from properly 
 masticating his food. Consequently, indigestion and diarrhoea, 
 from bolting food, are of frequent occurrence. 
 
 " Again, the child is old enough to be indulged by its parents 
 with everything they eat : hence the impossibility of restrict- 
 ing the diet as long as it is healthy. . . . 
 
 " In sickness the general rule of restricting the diet according 
 to the nature of each individual case is also applicable. 
 
 " The physiological changes which take place during the fifth 
 period would seem to warrant the statement that extraordinary 
 care should be exercised in regulating the child's regimen be- 
 tween the eighth year and puberty. . . . 
 
 " The rules governing the dietary during sickness are similai 
 to those for adults. 
 
 " The use of wines and beers should be prohibited, and that 
 of tea and coffee discountenanced- 
 
 " In discussing the diet for children in the preceding pages 
 the writer has not lost sight of the fact that some regard 
 should be paid to the important factor of the circumstances 
 of life. It is well in prescribing a regimen which has stood 
 the tests of the laboratory to remember that such advice is 
 given to a large number who are not able to incur the necessary 
 expense of typical feeding. To prescribe such food as that 
 hereinbefore recommended for the child of the laborer, whose 
 wages are scarcely adequate to support his large familj^, would 
 entail hardships on those whose affections are strongest for 
 the weak and aflSicted. The expense necessary to obtain cream, 
 milk, and milk-sugar will not be considered by people of even 
 
DIET AFTER EARLY DENTITION. 331 
 
 moderate circumstances, but will be difficult for the mechanic 
 and impossible for the laborer. Therefore it is important in 
 selecting a food for children, either well or ill, in the lower 
 walks of life, to recommend that which will be healthful and 
 of reasonable cost." 
 
 As thorough digestion and nutrition require fresh air, 
 mothers should bear in mind the importance of letting those 
 children that eat heartily keep out of doors as much as possi- 
 ble. The overfeeding, even with nutritious food, in our hot 
 American houses during winter-time, is undoubtedly one of 
 the great causes of those disturbances of the liver which are so 
 frequently met with. It is the same process almost that is used 
 in the making of the pdUs de foies gras. The Strasburg geese 
 are overfed and overheated. Constipation, which is so com- 
 mon in these bilious children, cannot be overcome by laxatives 
 or purgatives, and mothers should avoid their use or their 
 abuse. Let a bilious child be allowed to drink water freely, to 
 have a good run in the open air with its clothes sensibly loose, 
 ride on its tricycle, play with its hoop, jump rope, and restrict 
 its diet; the biliousness will then rapidly diminish and the 
 bowels become regular. 
 
 " After the eruption of the temporary teeth, the most impor- 
 tant particular is their preservation. They should be pre- 
 served (if possible) until they are replaced by the permanent 
 set. If the temporary set are preserved, in due time absorp- 
 tion of their roots takes place, the little crowns become loose 
 and fall out, or can be easily extracted. Premature removal 
 of the temporary teeth often causes irregularity of the per- 
 manent teeth in this way. It is not that their removal 
 shortens the maxillary bone, but when they do not occupy 
 their respective place, the bone does not grow as it should, con- 
 sequently when the permanent teeth are ready to be erupted, 
 there is not sufficient room between the teeth for proper de- 
 velopment, and they are forced out of their regular positions 
 
 "It is a well-known fact that the structure of the deciduous 
 teeth is more delicate than that of the permanent set, and 
 
332 MOTHER AND CHILD. 
 
 they are almost invariably subject to decay, and the deposit 
 of a calcareous salt, commonly called ' tartar.' This salt, or 
 tartar, is a precipitate from the saliva ; it is often found firmly 
 attached to the teeth near the gum margins. There are several 
 varieties of tartar, but we will only speak of the kind most 
 destructive to the deciduous teeth ; this is called ' green stain,' 
 and is very deleterious to teeth-structure. When once allowed 
 to deposit on the teeth, it gradually encroaches beneath the 
 gums, causing irritation, inflammation, and finally suppuration ; 
 periosteal trouble ensues, and other serious comphcations are 
 liable to follow. In addition to this the green stain, as seen on the 
 deciduous teeth, has the effect of chemical abrasion, which 
 softens their structure, causing the teeth to waste away. "When 
 it is found to exist, it should be cai'efully cleansed off, and a 
 suitable wash prescribed to prevent its recurring. 
 
 "Lastly, we will call attention to the first permanent tooth, 
 which is erupted when the child is in its fifth or sixth year, 
 and is called the ' sixth-year molar.' This is the largest of 
 all the teeth of the permanent set, and gives pi"ominence to 
 the cheeks. This tooth is often mistaken for a temporary 
 tooth, and as such allowed to decay ; in fact, we are often 
 called on by the parents of the little sufferers to extract this 
 tooth, and when we protest, they say, ' Why, is not that tooth 
 soon to be shed?' Indeed, they seem to be greatly surprised 
 when told that it is a permanent tooth, and very important 
 to preserve the regular features of the face. When it is found 
 that the teeth are decaying, they should receive the earliest 
 possible attention. It is a common error to suppose that, be- 
 cause these teeth are temporary, they do not require attention ; 
 or if any anxiety is felt about them, it is that they are not 
 allowed to remain too long in the mouth. When the child 
 finds that by the act of mastication the food is forced in upon 
 the nerve through the decayed cavity, and suffers violent pain 
 from it, he will not try it again. They will swallow their food 
 whole, causing indigestion and its attendant evils. Acidity 
 of the saliva is the common cause of caries of children's teeth. 
 
DIET AFTER EARLY DENTITION. 333 
 
 This may be determined by the test paper and corrected by 
 proper treatment.'" ^ 
 
 Dr. B. T. Darby, of Philadelphia,^ whose large experience in 
 dentistry entitles his recommendations to earnest consideration, 
 writes, — 
 
 "the care of the teeth. 
 
 " The care of the teeth should begin in infancy. As soon as 
 the temporary teeth begin to make their appearance, they 
 should receive the attention of the mother or nurse, while the 
 child is still young; they may be cleansed daily with a soft 
 linen or muslin rag, but as soon as the teeth are all present in 
 the mouth a small soft tooth-brush should be used upon them 
 once or twice daily. The child can early be taught the use of 
 the brush, and not infrequently a child two or three years of 
 age will become so habituated to its use that it will not feel 
 comfortable until its teeth have been properly cleansed. Stains 
 upon the teeth are not only unsightly even in the mouth of a 
 child, but they may be of such a character as to be injurious 
 to the teeth. The green or brown stains which are sometimes 
 seen upon the labial surfaces of the teeth are usually the result 
 of an abnormal condition of the oral secretions, and a micro- 
 scopic examination will often show them to be of fungous 
 origin. These stains when present should be polished off, 
 either with a fine powder of precipitated carbonate of lime or 
 with a pine stick dipped in fine pumice-stone. 
 
 " Salivary calculus — or tartar, as it is commonly called — is 
 found upon the teeth of all persons, although not to the same 
 extent. It may be of various colors, either white, yellow, or 
 brown or almost black. It is a calcareous deposit from the 
 saliva, and, where mixed with mucus and other substances found 
 in the mouth, precipitates upon the teeth in greater or less quan- 
 tities. While salivary calculus does not injure the teeth them- 
 selves, it has a very destructive action upon the gums, causing 
 
 ^ Texas Sanitarian, November, 1891. 
 
 ^ Keating's Cyclopedia of the Diseases of Children, vol. ii. p. 932. 
 
334 MOTHER AND CHILD. 
 
 them to become congested and inflamed and to recede from 
 around the necks of the teeth, and the teeth themselves to loosen 
 and fall out. Whenever it is found in the smallest quantities, it 
 should be promptly removed, and the surface of the tooth to 
 which it was attached thoroughly smoothed. The importance 
 of thoroughly brushing all surfaces of the teeth cannot be 
 overestimated. Comparatively few adults, much less children, 
 perform this part of their toilet with anything approaching 
 thoroughness : they simply cleanse with the brush the labial sur- 
 faces of the teeth, leaving those surfaces which are more difficult 
 to reach almost or quite untouched, and it is in these hidden 
 places that deposits are found and that caries occurs. The 
 young child should be taught the importance of picking the 
 teeth with a quill pick after each meal, to insure the removal of 
 all particles of food which may have lodged in the interstices be- 
 tween the teeth, where, if allowed to remain, fermentation ensues 
 and decaj^ is almost sure to follow. The use of floss silk nicely 
 waxed and passed between the teeth after each meal and always 
 before retiring at night cannot be too highly recommended.- 
 
 ^'■Dentifrices composed of precipitated carbonate of lime, pul- 
 verized orris-root, pulverized myrrh, and cinchona bark, with 
 the addition of a little pure. Castile soap, may be used once or 
 twice daily, with the best results. Nothing adds more to the 
 appearance of a child's face than a row of pearly-white teeth, 
 and nothing detracts more than a mouth full of diseased, dis- 
 colored ones. To attain the former a little care only is neces- 
 sary in early infancy, because when the habit of caring for 
 the teeth is once acquired it continues throughout life.-^ 
 
 " The temporary set of teeth are frequently the seat of caries : 
 hence the importance of early dental treatment. The child 
 of two years should be taken to the dentist, that its teeth may 
 
 ^ We wish to impress upon mothers the great importance of washing the 
 child's mouth with clean water at least once a day. A soft tooth-brush 
 can he used, or a clean linen rag, and we know of nothing hetter than 
 listerine to use with it. 
 
DIET AFTER EARLY DENTITION. 335 
 
 be carefully examined, and if decay has begun on any of the 
 teeth they should be treated as indicated elsewhere. Periodi- 
 cal visits at intervals of six months should be made to the 
 dentist, to insure freedom from pain and the retention of the 
 temporary teeth until they are displaced by the advent of the 
 permanent set. 
 
 " At the sixth year of age the first teeth of the permanent 
 set make their appearance in the jaw. These are the first 
 four molars, and their position is posterior to the molars of 
 the temporary set. Great ignorance, even among people of 
 more than ordinary intelligence, exists in regard to these teeth. 
 The belief is general that all teeth erupted in childhood belong 
 to the temporary set, and it is not uncommon for these molars 
 of the permanent set to be allowed to decay until all hope of 
 saving them is doubtful or impossible before the dentist is 
 consulted. They are the largest teeth of the dental series, and 
 are situated where they perform the most important part of 
 the masticating function, and their preservation throughout 
 life is of paramount importance. Every mother and every 
 person who has the guardianship of children should bear in 
 mind, when the number of teeth in the mouth of a child, ex- 
 ceeds twenty (ten in each jaw), that all in excess of this num- 
 ber are teeth belonging to the permanent series and should be 
 watched with the greatest care. The loss of a single perma- 
 nent tooth in early life may not necessarily be attended with 
 inconvenience or injury, but more frequently than otherwise 
 such a loss impairs mastication, mars the harmony of facial 
 expression, and destroys the symmetry of the whole face." 
 
 An excellent mouth-wash is the following : 
 
 Thymol, three grains ; 
 Benzoic acid, forty grains ; 
 Tincture of eucalyptus, three drachms ; 
 Essence of peppermint, twenty drops; 
 Alcohol, three ounces. 
 Pour enough in a glass of water to render it turbid, and use as a mouth- 
 wash. 
 
336 MOTHER AND CHILD. 
 
 CHAPTEE XLII. 
 
 THE BOWELS. 
 
 It is very important that a mother should know what con- 
 stitutes a normal condition of the bowels of her children. At 
 birth, the intestines contain an accumulation which is car- 
 ried off by the first milk, this milk being laxative in character. 
 The first movements are dark in color and viscid. The pas- 
 sages will then assume a yellow color, and in about two or 
 three weeks will begin to get gradually solid, in part. The 
 passages should have little odor, should not be sticky nor con- 
 tain mucus, and should be liquid. According to Ellis, "the 
 healthy motions of an infant vary from a light orange yellow 
 to a greenish yellow, from yolk-of-egg color to that of a mess 
 of mustard. The smell should never be oifensive, but resem- 
 bling that of sour milk." 
 
 Up to three or four months there should be two or three 
 or even four or five movements in the twenty-four hours ; 
 though many children are perfectly healthy who have but one 
 movement in the twenty-four hours, even at this tender age. 
 As soon as a child has had a movement from its bowels it 
 ought to be changed, and it is well to thoroughly anoint the 
 parts with vaseline ; anything that causes irritation of the 
 skin — undue acidity of the passages, or too frequent passages 
 from the bowels — will rapidly cause soreness, unless the parts 
 be washed and then thoroughly greased. It is a very great 
 mistake for mothers to use rubber or oil-cloth with the diapers, 
 as it will draw or keep the parts in constant perspiration. In 
 washing diapers soda should not be used. Grease is far better 
 than powder to use on a child's skin. A little white vaseline, 
 as before recommended, tallow, simple cerate^ or lanolin, will 
 make the best ointment. 
 
CONSTIPATION. 337 
 
 As the child grows older the movements become less fre- 
 quent ; by the time that it is six months old it will have about 
 two passages in a day. These passages, of course, are not' 
 always exactly the same in a nursing child ; indiscretion on the 
 part of the mother, the use of purgatives, or of certain articles 
 of diet, will so affect her milk as either to cause vomiting or 
 purging in her infant. The child's movements may vary in 
 color, becoming greenish or variegated, or they may become 
 dark or thin (watery), or again they may be very much con- 
 stipated, hard, round, surrounded by mucus, or the passages 
 maybe white, looking like cheese. Constipation may be evi- 
 dent from the very earliest movements of a child's life, and 
 be extremely difficult to overcome. 
 
 "We will study the two conditions, — constipation and diar- 
 rhoea, — and endeavor to point out the cause and remedy in each 
 case. 
 
 CHAPTEE XLIII. 
 
 CONSTIPATION. 
 
 Owing to the smallness of the bowel and to its position in 
 the infant, there is not that accumulation in the lower bowel 
 which takes place in the adult, and which acts as a reflex, or 
 sympathetic, irritant, causing the muscle to contract in order 
 to have a movement. This reflex irritation, or desire to have 
 a movement of the bowel, has a marked tendency to return at 
 certain hours, — that is to say, to become a habit, — and when 
 properly regulated at that period of a child's existence when 
 the habit can be established, — when the child is a year old, for 
 instance, — the tendency to constipation which may have ex- 
 isted previously will rapidly disappear, especially as from this 
 time forward the child's bowel gradually changes its position, 
 which allows a greater distention to take place. The cause of 
 ■B w 29 
 
338 MOTHER AND CHILD. 
 
 constipation in an infant at the breast is, indeed, one of the 
 most difficult problems to solve that we know of; at times it 
 seems to be a hereditary condition, a lethargy of the intestinal 
 nervous system, which fails to respond to irritation. The con- 
 tents of the bowel are composed of many materials which 
 have escaped digestion : curds, mucus, the secretions which have 
 been thrown into the bowel to lubricate it or to help digestion ; 
 the secretions from the liver especially, which are intended, 
 first, to help digestion by aiding the absorption of fats ; second, 
 to prevent decomposition, as bile is a great antiputrefacient; 
 third, the bile contains the refuse, the ashes, that have been 
 thrown off by the liver from the use and destruction of tissue. 
 These materials, if not thrown off by the liver, are poisonous, 
 and give rise to the symptoms known as biliousness, l^ow, 
 mothers must not make the mistake which is so prevalent at 
 the present day, of imagining that constipation always means 
 faulty action of the liver. If the child be constipated, the j)as- 
 sages white or chalky, if there be much flatulence or colic, if 
 the tongue be coated, and the urine stains the diaper with a 
 reddish hue, then there is a decided want of action of the liver, 
 and the constipation has probably a cause which can be re- 
 moved by appropriate treatment ; but frequently the liver 
 itself may be working perfectly well, while a catarrh of the 
 bowel, the result of cold or indigestion, may be seated at that 
 -part where the bile flows from the liver into the intestine, and 
 the flow of bile be checked. 
 
 The symptoms are very much the same in these two cases, 
 although it is obvious that the cause is different, and the mother 
 who recognizes the condition, but fails to comprehend the dif- 
 ference, and who doses her child without the advice of her 
 physician, may do an immense amount of harm. 
 
 For these reasons we have throughout this work insisted 
 upon the submitting of all such matters to the family physician. 
 We are. opposed to household works on medical treatment, 
 except so far as they give general information and are part of 
 a liberal education. Every physician knows that with an edu- 
 
CONSTIPATION. 339 
 
 cated mother, who is thoroughly in accord with the doctor in 
 his endeavors to understand the child's condition and treat it 
 properly, the chances of success are greater than when the 
 parent is ignorant of the many details which works of this 
 sort impart. 
 
 Constipation may be due to the character of the food, to the 
 want of secretions in the intestines, or to the failure of the in- 
 testines to contract and propel the material towards their out- 
 let, — what is known, technically, as peristaltic action. An 
 infant at the breast, or bottle especially, may be constipated, 
 and every endeavor fail to give it regularity ; yet as soon as it 
 begins to take solid food the bowels will immediately become 
 normal. A mother should recognize these different conditions 
 in order to be able to counteract them. If the constipation 
 depends on the character of the food, its indigestibility, or the 
 rapidity with which the water is absorbed, leaving an excess 
 of solids or curds behind, the movements will be of a cheesy 
 character, putty-like, the masses hard, lumpy ; possibly not dif- 
 fering very much in color from what they ought to be, but sur- 
 rounded by mucus, — in fact, very much resembling putty. The 
 movements may be infrequent, or there may be quite a num- 
 ber of very small movements, showing an irritability of the 
 rectum, and this may be accompanied by what is known as 
 the diarrhoea of constipation. This form of bowel-trouble is 
 found especially in children who are weaned from the breast 
 and who are on bottle-food, and its treatment consists in giving 
 freely some of the broths, such as chicken, or beef, a cupful or 
 two during the day ; in avoiding a heavy meat diet, or one 
 composed exclusively of milk ; and in giving the child its bowl 
 or bottle of thin boiled bread and milk, using stale baker's 
 bread and straining, and making it thin enough to pass 
 through the nipple of the bottle, which should be larger 
 than that ordinarily used. The child should have some prep- 
 aration of malt or pepsin to aid its digestion : a teasj^oonful 
 of wine of pepsin in a claret glass of water immediately after 
 eating or just before, if the appetite is failing; and if the 
 
340 MOTHER AND CHILD. 
 
 masses of matter passed still show indigestion, the child should 
 take about ten drops of the aromatic sj-rup of rhubarb with 
 five drops of the wine of ipecac, every night, in a claret glass 
 of water, until the passages show, by their healthier color, that 
 the bile is being secreted. 
 
 For those children who have been weaned from the bottle 
 and are taking thicker foods, — that is, solid diet, — it is a mis- 
 take to give water too freely with their meals. The water 
 should be given between meals, as in that way it not only sup- 
 plies a need of the system, but it cleanses the stomach and 
 bowel of undigested matter and mucus, aids, by its mechan- 
 ical action, the passage of materials which should be dis- 
 charged, and relieves constipation. For these reasons a glass 
 of water the first thing upon rising in the morning is recog- 
 nized as a laxative. If the child have much straining, it 
 will be noted that the passages are streaked with blood ; this 
 is caused by congestion of the mucous membrane, and can be 
 avoided by the use of some soothing enema. A small hard- 
 rubber syringe holding about one ounce may be filled with the 
 
 following : 
 
 Sweet oil, a tablespoonful ; 
 
 Warm water (100° F.), a tablespoonful; 
 
 Pinch of salt. 
 
 Mix thoroughly. 
 
 This, given to the child at the time when its bowels should' be 
 opened, will supply something for the muscle to contract upon, 
 and thus clear the mucus out of the lower bowel. If the 
 mucus and streaks of blood still remain, thin starch-water, 
 boiled, should be used in the same way. 
 
 Another form of constipation is that which is simply due to 
 want of propelling power in the bowel. In these cases a child 
 will go for several days without a movement, although appar- 
 ently in good health ; when moved, the passages are to all 
 appearances perfectly normal, large, well formed. It is aston- 
 ishing how much can accumulate in the bowel. Indeed, it is 
 probable that most of the overfed, fat children of the well-to- 
 
CONSTIPATION. 341 
 
 do in our large cities, who take but little exercise, consisting 
 only of a daily parade with the nurse, and so dressed that it 
 is impossible for them to get the amount required, have their 
 bowels much distended with matters that finally undergo de- 
 composition and are the causes of the blood-poisoning which 
 foul breath, furred tongue, loss of appetite, languor, and drowsi- 
 ness indicate, — all grouped under the synonyme of bilious- 
 ness. A child needs exercise as well as fresh air. After its 
 bath, if the room is warm and comfortable, it should be allowed 
 to have a romp with its mother or nurse and not be cramped 
 by clothing. Throw a blanket on the floor and let it kick to its 
 heart's content, toss and roll, exercise its arms and back and 
 chest; let nature have full play, and such a babe will grow 
 strong and sleep and eat well. Flabby children are consti- 
 pated simply through want of propelling power in the bowel 
 or in the muscles of the abdomen. For these the treatment is 
 generally divided as follows : the external, the dietetic, and the 
 use of medicines. The external treatment consists in manipu- 
 lating or kneading the abdominal wall. As this condition ex- 
 ists in individuals from infants at the breast, we might say, until 
 old age, — for it is almost as common with the parent as with 
 the child, — the treatment, more or less modified, is useful for 
 all. After its bath, the child should be placed on a blanket, on 
 its back, on the mother's lap, and the abdomen gently rubbed, 
 beginning by placing the palm of the hand upon the navel and 
 rubbing with a circular motion gently but firmly until the 
 surface is in a glow, at each movement increasing the size of 
 the circle, like the rings in a pond after a stone has been 
 thrown into the water. Soap liniment can be used, or cod- 
 liver oil, or sweet oil, or even castor oil, externally, if constipation 
 be marked. As the contents of the bowel descend on the left 
 side, the movement should be from left to right. One good 
 rubbing a day will frequently be followed by a movement of 
 the bowels. This may be still further facilitated by placing the 
 hand in the same way and shaking the abdomen. Of course, 
 exercise will be of great service in this form of constipation. 
 
 29* 
 
342 MOTHER AND CHILD. 
 
 For an infant this can be secured by gentle manipulation ; for 
 an older child, by passive exercise and the encouragement of 
 out-door sport. 
 
 The next form of constipation will include that which is due 
 to derangements of digestion, probably induced by too highly 
 stimulating food, or food which has a tendency to ferment and 
 produce gases. Mucus will be secreted in the bowel when the 
 intestine is irritated by food or cold, and instead of producing 
 diarrhoea, which would have been the result had the intestines 
 been inflamed, may cause attacks of vomiting, colic from flatu- 
 lence, and the expulsion of gases which have an extremely 
 offensive odor. The child's abdomen is swollen with wind, and 
 the passages are usually qffensive, possibly fluid, or they may 
 be hard, dark-colored, and infrequent, accompanied also by a 
 coating of mucus. Children that are fed largely upon eggs 
 frequently suffer in this way, or those who receive a large 
 amount of starchy food, not sufiiciently boiled, which remains 
 undigested in the bowel. The children lose their appetites, 
 become peevish, restless, suffer from inordinate distention of 
 the abdomen, and, finally, if the cause is allowed to continue, 
 catarrK of the stomach and intestine and obstinate diarrhoea 
 will follow. Of course, the treatment in cases of this kind is 
 obvious : the diet should be regulated, and such harmless laxa- 
 tives used as will relieve the child of the offending elements 
 and re-establish its digestion. Stop all solid food for a day or 
 two, also milk and starches ; put the child on broths, and give 
 it a dose of castor oil, a teaspoonfufor two. A tablespoonful of 
 liquid soda mint should be made quite warm, castor oil mixed 
 with this, and when the oil floats to the surface it can be readily 
 skimmed off and given to the child by the spoon. Sweet oil 
 may be used in this way for an infant, instead of castor oil, if 
 preferred. If there is much vomiting in these cases, and food, 
 such as broths or barley-water, is not tolerated, the nourish- 
 ment ma}^ be given in small quantities, using fresh beef-juice, 
 Wyeth's or Valentine's extract. Five or ten drops of whiskey 
 or gin in warm water should be given every fifteen or twenty 
 
CONSTIPATION. 343 
 
 minutes, or two or three drops of aromatic spirits of ammonia, 
 or gum-arabic water and lime-water may be used for a time 
 until the vomiting is relieved. Dr. Walker, of Brooklyn, 
 recommends the following : 
 
 Creosote, two drops ; 
 Glycerin, two teaspoonfuls ; 
 Water, a small tumblerful. 
 A tablespoonful of this every hour. 
 
 And if there is much colic he advises, — 
 
 No. 1. 
 
 Aromatic catnip tea, two tablespoonfuls ; 
 
 Tincture of assafoetida, ten drops ; 
 
 Syrup (simple), two tablespoonfuls. 
 Or No. 2. 
 
 Aromatic spirits of ammonia, fifteen drops ; 
 
 Essence of peppermint, ten drops ; 
 
 Glycerin, a dessertspoonful ; 
 
 Aniseed-water, two tablespoonfuls. 
 A quarter to half a teaspoonful of one of these, in water, every fifteen to 
 thirty minutes, if necessary, until relieved. 
 
 Use hot foot-baths (mustard and water), and apply mus- 
 tard poultices, consisting of half- mustard and half meal, to the 
 abdomen, or, if the pain should still continue, an enema of warm 
 water, about half a pint or less, or one of hop tea. When 
 colic and constipation exist, the mother should never give a 
 purgative without consulting her physician, as twisting or 
 constriction of the bowel may be the cause, but recourse should 
 be had to ihe above-mentioned treatment, which can never be 
 harmful, or to an enema. As regards constipation, we may 
 also mention the fact that when it is obviously due to a want 
 of expulsive power in the child, the use of suppositories is 
 often of value, and when cautiously given they can be used 
 for some months until the child has gotten into the habit of 
 having the bowels moved daily at the same hour. These sup- 
 positories may be made either of Castile soap, or coca butter 
 
34-i MOTHER AND CHILD. 
 
 with glycerin ; or the gluten suppository made by the Health 
 Pood Company is often very useful. It is a mistake to give a 
 child laxatives and purgatives as a routine practice. Yary the 
 diet; change its bottle-food from one thing to another; en- 
 courage it to phiy; give it outdoor exercise. These will 
 often in themselves be sufficient. For older children hran^ as 
 crackers, is often laxative, or it can be made into bread for a 
 change. 
 
 Dr. C. A. Earle, writing on the subject, says, — 
 
 "If an evacuation of the bowels does not occur within 
 twenty-four or thirty-six hours after birth, a careful examina- 
 tion of the anal opening should be made ; indeed, in some of 
 the large lying-in hospitals a very small enema is given as 
 part of the baby toilet at the first dressing. This demonstrates 
 at once the perviousness of the canal. Next let the mother be 
 examined for a cause of constipation, and, by changing her 
 diet, seek to correct her baby's habit. It may be necessary 
 to administer a mild laxative to the mother, for, as a rule, 
 simple constipation in the child should be overcome without 
 giving it medicines or injections. 
 
 " If the child has been provided with a wet-nurse, and is con- 
 stipated, the question will arise as to the propriety of changing 
 to a wet-nurse with younger milk, in order to furnish more 
 colostrum and less casein. Of course everything of a consti- 
 pating nature, including starchy foods, is to be excluded from 
 the diet of mothers or wet-nurses whose children are consti- 
 pated. 
 
 " If, notwithstanding these directions, the habit persists, and 
 the child has but a single dry passage each day, and this is at- 
 tended with straining, some exceedingly simple remedy should 
 be administered to the child. As the- simplest of laxatives, I 
 strongly recommend a little molasses or simple syrup in water, 
 and when the passages are very dry and the child is known to 
 perspire freely, we should suspect an insufficiency of water in 
 its system, and to ovei'come this there is nothing better than 
 pure water internally. If the measures already suggested do 
 
CONSTIPATION. 345 
 
 not give relief, of course other treatment must be ado]3ted, and 
 we come to consider local stimulants which may be introduced 
 into the anal opening or into the rectum. Among them I notice 
 the soap-and-gluten suppository (Health Food Company), mo- 
 lasses boiled and moulded into little masses'and inti-oduced. and 
 the nozzle of a syringe oiled and inserted and injections of very 
 small quantities of glycerin or water or both combined. Bohn 
 recommends as preferable to any of the foregoing injections 
 of cold water three times if needed in each day, then twice 
 a day, and finally once daily until the cure is assured. Other 
 authorities advise cold water as an injection, to which may be 
 added a small amount of common salt. If enemata are neces- 
 sary, either warm or cold, use small quantities, one or two fluid- 
 drachms, of water or from ten to twenty drops of glycerin, to 
 which may be added a little water. Large injections of any 
 fluid should be avoided. 
 
 " By massage or gentle kneading of the abdomen over the 
 colon (that is, along the outer edge of the abdomen and the 
 motion from right to left) muscular action is stimulated and 
 the desired results are frequently brought about. This process 
 should be repeated two or three times a day." 
 
 Dr. A. Jacobi writes, — • 
 
 " Constipation depending on lack of sugar is very often 
 speedily relieved by increasing the quantity of sugar in the 
 food. This is the case, not only in artificial feeding, but also 
 when the children are fed normally on breast-milk. Such 
 mother's milk as is white and dense, and contains a large 
 amount of casein, is made more digestible, and will produce 
 better evacuations when a piece of loaf sugar dissolved in 
 tepid water is given immediately before nursing. 
 
 " Yery little medicine should be given in all these forms of 
 constipation, in infants or children. The best, after all, may be 
 magnesia, as there is frequently too much acid in the intestinal 
 tract of the young. It will at the same time neutralize the 
 acid and relieve the bowels. Whenever an addition is neces- 
 sary, rhubai-b will suffice. In most cases an enema will be 
 
346 MOTHER AND CHILD. 
 
 sufficient to relieve constipation. It should be given every day 
 for a long time. There is a prejudice against rectal injections 
 which is unfounded. They should not be given too hot, not too 
 cold. They may contain a small quantity of salt, so as to make ~ 
 a two-thirds of one per cent, solution. 
 
 " In those cases where constipation is very obstinate, the 
 enema should be given through a tube from four to six to eight 
 inches in length. Beyond that it is usually impossible to intro- 
 duce a tube." 
 
 Water plays such an important role in overcoming the con- 
 stipation of bottle-fed babes that we will quote the following 
 from Dr. Jacobi : 
 
 " The free dilution of children's nourishment with water is 
 demanded ujDon the following additional facts. Only to a 
 certain limit will pepsin be furnished for digestive purposes. 
 Probably a portion of this is not entirely utilized. A great 
 quantity of water is necessary to assist in pepsin digestion. In 
 artificial digestion albumin often remains unchanged until large 
 quantities of acidula-ted water are supplied. Without doubt 
 many disturbances of digestion are to be explained by a de- 
 ficiency of water, certainly many more than are due to an 
 excess of it, as it is so quickly absorbed. 
 
 " For the reasons given, I advocate under all conditions a 
 plentiful addition of water to children's food. In this connec- 
 tion I would lay stress upon the fact that, as a rule, small 
 children receive water only as they get it in their milk. Alike 
 in summer and in winter, it is probable that the fact seldom 
 occurs to a mother or a nurse that a child can be thirsty with- 
 out being hungry at the same time. Certainly many a dis- 
 comfort and even sickness in a child is conditioned upon the 
 fact that it has been compelled to eat in order to get its thirst 
 satisfied, and often has to suffer thirst because the over-stimu- 
 lated and injured stomach will take no more nourishment at 
 irregular and too short intervals. There are also normal prod- 
 ucts of digestion capable of producing disturbances in the di- 
 gestive process, chief among which is peptone itself. I have, 
 
CONSTIPATION. 347 
 
 therefore, considered it necessary in preparing rules for the 
 feeding of children, which the New York Board of Health has 
 annually published and distributed since 1872, to insist upon 
 giving infants, who cannot ask in so many words for it, an oc- 
 casional drink of water, at least during hot weather. When 
 there is the least ground for the supposition that the drinking- 
 water is contaminated with germs of disease, or where it is 
 unusually hard, it should be boiled before its admixture with 
 children's food, whether the diet be of milk or a mixed one. 
 In general it will give greater satisfaction to use the boiled 
 water systematically even where there is no apparent urgency 
 for it, for very young infants." 
 
 There are times, however, when none of the simple remedies 
 seem effectual; stewed fruit loses its power; enemata do not 
 seem to reach the spot, and indeed they should not be forcibly 
 given nor too frequently. In such cases we have found glycerin 
 suppositories very effectual. They can be obtained usiially at 
 any drug-store, or can be prepared from the following formula : 
 
 R Lanolin, 
 
 Glycerin, aa gr. xxx ; 
 Olei theobromse, 
 Cerat. alb., aa gr. xv. M. 
 Ft. supp. No. 1. 
 
 When it becomes necessary to use medicines as laxatives, 
 we have several articles that are simple yet valuable. Prob- 
 ably the simplest remedy is a teaspoonful of glycerin. A small 
 piece of manna, the size of a postage-stamp, dissolved in milk, 
 is an old-time but often excellent laxative, as are also the syrup 
 of rhubarb, the compound sjTup of sarsaparilla, the syrup of 
 senna, — though the latter is at times apt to give pain, — the 
 elixir eascara sagrada, and the compound liquorice powder. 
 Friedrichshall water and Eubinat-Condal water we have found 
 very useful, though the taste is sometimes objectionable to 
 children, but, strange to say, not nearly as much so as to adults. 
 As a purgative nothing excels castor oil; a teaspoonful of 
 aromatic syrup of rhubarb adds to its efficiency. 
 
348 MOTHER AND CHILD. 
 
 For older children — those from six years upward — we have 
 found the effervescent table-waters very useful at the mid-day 
 meal (all children should have a mid-day dinner, and avoid a 
 heavy meal at six or seven with their parents). When these 
 waters, such as ApolUnaris, Manitou, etc., are given, we believe 
 the excess of carbonic acid gas should be allowed to pass off, 
 as it only distends the stomach. 
 
 It should be remembered that pure water is the best laxative 
 of all. 
 
 These suggestions are only made for those who cannot get 
 medical advice ; this is frequently the case in the country or 
 in the far West on ranches, and persons intending to live in 
 such places should possess a medicine-chest containing such 
 simple remedies as they may need. 
 
 CHAPTEE XLIY. 
 
 DIARRH(EA. 
 
 This is one of the most important subjects for our consid- 
 eration. The complaint varies from simple frequency in the 
 natural movement to that most violent form which occurs in 
 summer-time ; but as the one leads to the other, mothers should 
 be instructed how to treat the earliest sj^mptoms, so as to 
 check them before there is any necessity for medical treat- 
 ment. 
 
 Indigestion is the one great common cause, and, as we have 
 before noticed, indigestion is produced by improper food and over- 
 feeding^ or by those depressing conditions which surround the 
 child and prevent the digestion of its food, allowing it to ferment 
 and act as an irritant. All these causes may act equally as well 
 
DIARRHCEA. 349 
 
 in winter as in summer, at the sea-shore or mountains as in the 
 crowded cities with unhealthy surroundings, in older children 
 as well as in infants ; but, as a rule, they are very much more 
 active in the overheated atmosphere of our densely-populated 
 city during the summer, and infants that are obliged to stay 
 in town are much more depressed, have less vitality, and their 
 food is more apt to be tainted by the germs. 
 
 Overfeeding is so constantly a cause of diarrhoea that it 
 deserves a few words of caution. Many young mothers believe 
 that if an infant cries it is always an evidence of hunger ; this 
 is by no means the case ; it may simply be thirsty. If it is 
 nursed at the proper time and has received its usual amount, a 
 few spoonfuls of water will often quiet it instead of having 
 recourse to the breast or bottle. We cannot lay too much stress 
 on the importance of water, especially in the summer-time; 
 when given judiciously and frequently it may often save the 
 child an attack of summer-complaint. Give cool water; do 
 not give iced water, but let it be pure, filtered always, and if 
 there is the least suspicion of its purity have it boiled. Do 
 not put sugar in it. 
 
 Mothers should watch carefully the urine of their children ; 
 if the child cries suddenly, in a rather shrill voice, which is 
 characteristic, it has probably wet itself and should be imme- 
 diately changed, and the parts thoroughly dried and slightly 
 greased to prevent irritation. If there should be a reddish 
 deposit on the diaper, it is an evidence of indigestion or 
 want of water to dissolve these crystals of uric acid. In 
 such cases the urine is usually scanty. It will be found that a 
 teaspoonful of soda-mint solution in a small teacup of water, 
 or lithia-water, which the child should drink freely or take 
 from a spoon, will, if kept up for two or three days, correct this 
 condition. 
 
 The child will cry if its position becomes irksome, if it feels 
 
 the cold, if its clothing irritates it, or if the bands of its clothes 
 
 are too tight, owing to flatulence extending the abdomen. 
 
 Frequently it will cry from irritation of the skin, due to what 
 
 30 
 
350 MOTHER AND CHILD. 
 
 is tnown as prickly heat. In such a case a little vaseline 
 rubbed on will sooihe it; or if the cry be sudden and sharp, it 
 will be noted to be one of jDain. This is frequently caused by 
 the passage of its water, and the doctor's attention should be 
 called to the parts. All these matters should be taken into con- 
 sideration and carefully investigated before the child receives 
 more food than its regular nursing every two or three hours. 
 
 Overfeeding is generally recognized by evidences of the 
 insufficient digestion in the passages, or by the frequency of 
 the movements, although they may not deviate from the nor- 
 mal condition; or the stomach may become overloaded, and 
 the uneasiness of the child following the taking of food, its 
 restlessness during sleep, with possibly nausea or vomiting, will 
 be the consequences. It is a fortunate thing that a child 
 vomits very readily, as in this way food that disagrees with it, 
 fermenting in its stomach, can be gotten rid of without passing 
 through the intestines, which are so easily irritated by such 
 material. If the symptoms just noted are present, the child's 
 breath be heavy or sour, and especially if it is a bottle-fed 
 baby, it will be well for the mother to encourage vomiting. 
 The simplest means of so doing is to give the child a glass of 
 water, and then tickle the fauces (throat) with a feather or 
 with the finger, making the child gag, or follow this by giving 
 a half-teaspoonful of syrup of ipecac every fifteen minutes until 
 vomiting is produced. 
 
 The next form of diarrhoea for its to study is that produced 
 by the food. It is a well-known fact that the nursing mother, 
 living on certain articles of diet, can so alter her milk as to 
 make it a potent cause of indigestion. It is also known that 
 emotions — passion, fright — will so change the character of the 
 milk as to produce the same effect. Also any irritation of the 
 nipple producing in the child a sore mouth will be the starting- 
 point of a cataiTh of the stomach and bowel ; this can be 
 readily obviated by cleanliness, the use of borax, glycerin, and 
 rose-water as a wash, and vaseline to the nipple to prevent 
 cracking. "We have frequently observed the fact that a mother 
 
DIARRHCEA. 351 
 
 can depart from this rule of careful dieting, on many occasions, 
 without altering her milk in a way that would affect her own 
 child ; whereas the same milk given to another child, should 
 she act as a wet-nurse, would be followed by harmful results. 
 The close sympathy between mother and child is thus kept up 
 after its birth. All physicians know of cases of infants at the 
 breast tiiat have suffered from violent attaclcs of diarrhoea 
 and convulsions, the result of extreme emotion (fright or pas- 
 sion) on the part of the wet-nurse. It is this, together with 
 the high living to which they are unaccustomed, the sedentary 
 occupation which encourages biliousness, carelessness in diet, 
 and the inability to watch them in every particular as to their 
 functional health, morals, and personal cleanliness, that renders 
 wet-nursing so unreliable. 
 
 Certain substances have a peculiar effect upon the milk. 
 Castor oil taken by the nursing woman will purge the child ; 
 mercurials will sometimes have the same effect ; onions and 
 garlic will be noticeable in the milk and cause indigestion. 
 Alcohol will find its way to the milk ; this fact has been taken 
 advantage of by giving the mother malt extract, which not 
 only aids her own digestion, but the alcohol which is in it in 
 small quantities, and also the diastase or nutritive qualities of 
 the grain, possibly stimulate th-e digestion of the child. 
 
 The one potent cause of intestinal disturbance in children, 
 in summer, is stale cow's milk; and by the word stale we mean 
 any milk that has stood some time after milking, unless it has 
 been boiled or subjected to sufficient heat and guai'ded against 
 atmospheric impurities. Our own experience is that milk 
 fresh from the cow — one that is healthy and clean and has 
 been carefully fed — may be given to a child from a bottle 
 without any manipulation, except slight dilution, and will be 
 digested ; whereas the same kind of milk after standing several 
 hours might cause intestinal disorder. It is the atmosphere 
 which does this ; it contains germs of putrefaction which are 
 very much more potent in the summer, and which abound in 
 our large cities. It is almost impossible to distinguish this 
 
352 MOTHER AND CHILD. 
 
 tainted milk from, that which is £i"esh and pure, the changes 
 being so insidious. 
 
 "We have said that the diarrhoea of infancy and childhood 
 included every form, from simple looseness of the bowel to 
 cholera infantum. The healthy passages should have little 
 odor, no mucus, no curds ; they should have the consistency and 
 appearance. of prepared mustard. Occasionally, from cold or 
 slight indigestion, one or two passages may change in appear- 
 ance ; they may become greenish, variegated in color, or they 
 may become more frequent and contain a few curds. If such 
 be the case, and the child is nursed, a teaspoonful of sweet oil 
 and one of solution of soda mint will often be sufficient to 
 restore the passages to their normal condition. If the mother 
 or wet-nurse show signs of biliousness, a dose of castor oil given 
 to her will probably have a good efifect upon the child. If the 
 child is bottle-fed, and curds still appear in the passages, it 
 is getting food too full of curd, or its digestion is weakened. 
 In such a case the bottle should be omitted for one feeding, 
 and some barley-water or weak chicken tea substituted, and 
 the child's digestion should be stimulated by giving five or ten 
 drops of the wine of pepsin or a grain of a reliable pepsin in a 
 tablespoonful of water, with five drops of whiskey, before the 
 next feeding ; or as much of a powder containing equal parts 
 of lacto-peptine and subnitrate of bismuth as will cover (not 
 heaped) a dime. 
 
 If the chM does not seem desirous of food, under no circum- 
 stances press it; should it crave water, allow it to drink, but 
 not iced water ;. if there is the least irritability of the stomach, 
 give it a tablespoonful of lime-water or a teaspoonful of soda- 
 mint solution every fifteen minutes or half-hour, until the 
 stomach is settled and the child quiet. 
 
 The evidences of catarrh of the stomach and bowel are pain, 
 restlessness, heat of body and head, with unnatural coldness 
 of the extremities, or there may be fever. The character of 
 the pain is peculiar ; the child will cry out at intervals and 
 draw up its knees ] the abdomen is tense, the muscles firm and 
 
DIARRHCEA. 353 
 
 rigid, and distended by gag. The passages, in such a case, 
 are usually liquid and contain curds, are lighter in color than 
 normal, and have mixed with them large quantities of slime' 
 (mucus). The tongue is coated ; the child will probably crave 
 water, if there is much heat or dryness of skin. ISTow, this con- 
 dition can be brought about at any time of year from exposure 
 to cold or from irritating food, but it is usually found in the 
 summer in bottle-fed babies. Should it be allowed to continue 
 for any length of time and the cause not be renaoved, — by this 
 we mean should the child continue to be subjected to the intense 
 city heat and the same bottle-food, — diarrhoea will soon become 
 excessive, evidences of inflammation will appear, — vomiting, 
 intense thirst, and an extremely watery diarrhoea, tinged with 
 green and containing minute specks of greenish matter ; result- 
 ing finally in entire loss of control over the bowels : the child 
 will gradually lose consciousness and die of exhaustion. 
 
 True cholera infantum is not a very common -disease, and 
 what is ordinarily known as cholera infantum, such as we have 
 described, is simply the aggravation of an ordinary simple 
 diarrhoea which has been improperly treated at the commence- 
 ment, either through ignorance or the force of circumstances. 
 It is impossible for one to fully guard a child against the many 
 causes that conspire to produce catarrhal affections; change 
 of pasture of the cow, change of milk, overheated rooms, and 
 the effects of sudden changes of weather are often beyond 
 control. But as soon as the first symptoms appear, the indi- 
 cations for treatment are absolute. If the symptoms of 
 digestive derangement are very mild, simply consisting of a 
 furred tongue, eructation of sour milk, or the appearance of 
 curds or slime in the stool without any actual diarrhoea, weaken- 
 ing the bottle with a little more water, taking out the farina- 
 ceous material that has probably been added to it, giving a 
 tablespoonful of Murray's fluid magnesia, and allowing the child 
 to drink, if it is thirsty, weak gum-arabic water or toast- water, 
 will probably be all-sufficient; but if the child has pain in 
 addition to these symptoms, the treatment is different. In 
 X 30* 
 
354 MOTHER AND CHILD. 
 
 such cases stop the bottle-food at once, aad when food is re- 
 quired give the child a mixture consisting of a tablespoonful 
 of cream, a tablespoonful of fresh milk, and two tablespoonfuls of 
 lime-water. Be careful not to overload its stomach ; feed it at 
 frequent intervals, very little at a time. If it is thirsty, allow 
 it to drink of the gum-arabic water or toast-water. If the 
 child is a year old or more, and especially if it be summer- 
 time, when the thirst is very great milk should be omitted alto- 
 gether from the diet, and barley-water — made by adding an 
 ounce of barley, crushed, to a quart of water, boiled for twenty 
 minutes and then strained — may be given with condensed 
 mi]k, one part to twelve ; or to this can be added two table- 
 spoonfuls of lime-water when the bottle is made up, and the 
 child given, every two or three hours, as a drink, ten drops of 
 whiskey in one ounce of water and One ounce of lime-water. 
 The white of an egg dissolved in a tumblerful of warm water, 
 to which is added a teaspoonful of glycerin and a dessert- 
 spoonful of orange-flower water, should be kept in a cool place 
 and given occasionally, as a drink, if the child is thirsty. To 
 this may be added ten grains of lacto-peptine. 
 
 In the cases just described the medicinal treatment would be 
 to clear the bowel at once of the accumulated curds and mucus 
 and relieve the congestion, and for this purpose a dose of 
 castor oil may be given as follows : a teaspoonful of castor oil, 
 ten drops of aromatic syrup of rhubarb, and a dessertspoonful 
 of warm soda mint (solution). A warm foot-bath should be 
 given, and over the child's abdomen should be placed either a 
 mustard poultice (half flour), a spice poultice, or flannels wrung 
 out in hot water, over which should be sprinkled some essence 
 of ginger. After the oil has operated once, and a large mass 
 of curds and mucus has been expelled from the bowels, the 
 subsequent passages will be of a more natural color, but very 
 cautiously indeed should the mother return to the ordinary 
 bottle-food. If the weather is very warm, the child should 
 be taken daily to some shady spot in the suburbs, where 
 the air is purer and fresher than it is in the city. If pos- 
 
DIARRHOEA. 355 
 
 sible, it should for several hours a day be permitted to breathe 
 air that comes off the water. There is no city charity that 
 should receive more encouragement than that which gives river 
 or country excursions to poor children, A few moments' 
 ride in a ferry-boat will often revive a child that is almost 
 exhausted by the heat and is succumbing to summer-com- 
 plaint. The nervous system has given out, it has lost its 
 control over the blood-vessels, and the serum or watery por- 
 tion of the blood, that contains all the nourishment, leaks into 
 the bowel and is drained away. The little sufferer dies abso- 
 lutely of hemorrhage, — white hemorrhage. That is why these 
 teething city babies so rapidly emaciate ; that is why they 
 crave water to supply that which is lost. A child, then, should 
 be treated in such a way that its nervous system will be 
 strengthened and once more given control. It should have 
 fresh, pure air, — either the air from the country, or, better, 
 the air from the water, or, better still, the air from the sea. 
 Its tissues should be braced by stimulating, cooling applica- 
 tions ; it should be sponged with vinegar and water, or alcohol 
 and water; its feet should be soaked in water containing a 
 little mustard, to stimulate its circulation ; the room should be 
 kept as cool as possible, thoroughly aired, free from all con- 
 tamination by sewer-air or putrefying matters, and the food 
 given should be absolutely pure and untainted. 
 
 In all these cases, if in the city, avoid raw milk, also 
 starches of all kinds, even should they be thoroughly cooked. 
 After a child has taken a dose of oil, it can be fed on con- 
 densed or evaporated milk, and wine-whey may be given to it 
 as a drink, a wineglassful every three or four hours, should 
 it exhibit any symptoms of exhaustion. After the bowels 
 have returned to their normal condition, the food can be 
 changed to either Pasteurized milk prepared for the bottle, 
 or some of the other prej^arations mentioned in the chaj)ter 
 on that subject. In these cases peptonized milk is often 
 very valuable, and when a milk diet is returned to, it should 
 consist of Pasteurized peptonized milk^ — that is, milk steriHzed 
 
356 MOTHER AND CHILD. 
 
 at 155° F., and containing the necessary amount of Fairchild's 
 "peptogenic milk powder." 
 
 It is well for a mother to recognize the fact that her child 
 should abstain entirely from food in these earlier stages of 
 diarrhoea, especially in summer, certainly until her physician 
 has seen the case. She should make it a rule to allow the 
 child to drink freely, if it wishes it, of gum-arabic or toast- 
 water; give small pieces of cracked ice, wine-wtie'y, Valentine's 
 beef-extract or the fresh expressed beef-juice, or some chicken- 
 broth; indeed, the beef-juice and chicken-broth, given with 
 gum-arabic water, make a nutritious and harmless diet in all 
 of these eases. This hygienic treatment alone, in the earlier 
 stages of a dian-hoea, will be of very great advantage, and 
 will materially aid the doctor by paving the way for that 
 medical treatment which he may find necessary in order to 
 bring about a normal condition. 
 
 Of course, a diarrhoea may come on very suddenly, with 
 great intensity, and may prove fatal within a few hours. These 
 cases are called cholera infantum. Their suddenness is appall- 
 ing ; their treatment should be immediate. Such cases seem to 
 be caused b}^ a union of all those conditions one of which alone 
 is sufficient to produce diarrhoea ; it is a blood-poisoning, origi- 
 nating, possibly, in the absorption of some germ, and aggravated 
 by improper diet, lowered vitality on the part of the child, im- 
 pure air, and intense heat, continuing unabated day and night. 
 Cases may originate in this way, coming suddenly upon chil- 
 dren who have been previously in good health, or this condi- 
 tion may be the result of a protracted and neglected simple 
 diarrhoea. The mother's duty in these cases is always to 
 attend to the hygiene, and by hygiene we mean proper food, 
 judicious bathing, and the placing of her child where it can, 
 for at least a part of the day, breathe pure air. 
 
 But the doctor's duties are equally important. Our object is 
 not to instruct the mother how to take the doctor's place, — his 
 duties are distinct from hers ; but it is simply to give her an 
 intelligent understanding of what the doctor means when he 
 
NURSING OF SICK CHILDREN. 357 
 
 lays down certain rules which ai'e to be carried out in the 
 nursing and management of her child, and without attention 
 to which the medical treatment would be absolutely of no avail. 
 It would be ridiculous for the doctor to give a child morphine 
 and sulphuric acid for a severe case of cholera infantum, or 
 salic3dic acid or bismuth and pepsin, while at the same time 
 the baby is kept in a close, ill-smelling room, and attempts are 
 made to quench its thirst by the free administration of tainted 
 cow's milk given through a dirty nursing-bottle ; and yet how 
 often, even in families that should know better, do we find 
 appalling ignorance in regard to these most important matters ! 
 If the child vomits much, food by the mouth should be 
 avoided and nutritious injections given instead, such as a raw 
 egg beaten with warm water and five or ten drops of brandy 
 or peptonized milk, about one ounce every two hours. 
 
 CHAPTEE XLV. 
 
 NURSING OF SICK CHILDREN. 
 
 • It is proposed in this section of our work to give to mothers 
 and nurses a plain statement of the causes and method of nurs- 
 ing of the more important disorders and diseases of children. 
 By disorders we mean simply functional disturbances ; by dis- 
 eases we mean those disturbances that are accompanied by some 
 structural changes. 
 
 It is not necessary to dwell at length upon the appearance 
 of a sick child. We have endeavored to form a picture of a 
 child in the enjoyment of perfect health, — an infant with all 
 its functions working in perfect accord, whose sleep is soft and 
 gentle, who awakes bright and cheerful, who eats with an evi- 
 dent relish for food, and who becomes drowsy as digestion be- 
 gins : one whose eyes are clear and bright, its skin soft, its 
 flesh firm, bears evidences of health. But when the child be- 
 
358 MOTHER AND CHILD. 
 
 comes peevish, restless, or drooping, uneasy after eating, start- 
 ing in its sleep, when the eyes lose their brilliancy and beconae 
 encircled with dark rings, its skin is hot and dry, and possibly 
 the hands and feet cold, its flesh flabby and soft, and the 
 rotundity of its form marked by a tendency to angularity, 
 showing a loss of the cushions of fat, it does not require much 
 experience to recognize such as a sick child. "Whether or not 
 this deviation from health is simply functional, or due to dis- 
 ease, is not the question we have to deal with ; that rests with 
 the doctor; but as he depends on the mother for a true recital 
 of those symptoms upon which he bases his conclusion, a 
 habit of accuracy in observation, one of thoroughness in in- 
 vestigation, should be cultivated by her. This and the thorough 
 carrying out of all the details of treatment, not as a mere 
 machine, but as an intelligent being, one who is capable of 
 exercising judgment, form the essentials of a good nurse, and 
 this every mother should seek lo be. 
 
 "Within the past ten years excellent training-schools for 
 nurses have been instituted in most of our large cities, and 
 the graduates are doing noble work. In most cases of serious 
 illness in families who are able to bear the expense, a trained 
 nurse is the doctor's most efficient adjutant, but in many, indeed 
 by far the most, cases some member of the family has to be 
 impressed for such a duty, and some knowledge of the subject 
 of this chapter becomes a valuable aid. 
 
 Miss Catherine Wood, of London, has written much upon 
 this subject, and we will here quote at length from one of her 
 valuable articles.' 
 
 " The .sad experience of every doctor who has had to treat a 
 spoiled child at home will confirm this : the child refuses to 
 take its medicine or food, and the united efforts of the parents 
 and household are useless ; it remains master of the situation^ 
 a hardened little sinner. Or some particular posture must be 
 maintained to allow an inflamed joint to recover itself; it 
 
 ' Keating's Cyclopaedia of the Diseases of Children, vol. i. p. 347. 
 
NURSING OF SICK CHILDREN. 359 
 
 screams and kicks at all efforts to place it aright, it frets if 
 fastened down, and refuses its food, until at last it is allowed 
 to lie as it likes, and valuable time is wasted. Place that same 
 little one in a children's hospital, in the hands of doctors and 
 nurses accustomed to children, and it at once becomes tracta- 
 ble ; all friction and contests are avoided ; it follows the ex- 
 ,ample of the next cot, and swallows medicine and food quietly ; 
 it submits to be laid down, for it seems the fashion of this 
 nursery and so must be right. Then the atmosphere of play 
 and merriment carries it over the tedious hours of a chronic 
 illness almost unnoticed. Dr. West, who was certainly the 
 pioneer in initiating a specialty in the treatment of sick chil- 
 dren, says in his opening lecture to students, ' Children will 
 form at least one-third of all your patients ; so serious are 
 their diseases that one child in five dies within a year after 
 birth, and one in three before the comjDletion of the fifth year. 
 These facts, indeed, afi'ord conclusive arguments for enforcing 
 on you the importance of closely watching every attack of 
 illness that may invade the body while it is so frail.' . . . She 
 [the nurse] must also learn how to combine firmness with 
 gentleness, how to insist without coercion, how to win obedi- 
 ence without friction, how to take her patient along with her ; 
 and all this can be accomplished only by love and truthfulness. 
 Once win the child's trust, and then it will yield itself a willing 
 slave. The most fearless truthfulness should be insisted on 
 ft'om all those who have to tend the sick child, even when it 
 wrings the loving heart to speak the truth. The pain the child 
 will feel will be far less than upon finding itself deceived, 
 especially when among strangers. . . . 
 
 " The poor mothers in their own homes make quite a toil of 
 their children ; they will hardly put them out of their arms, 
 and they certainly will not believe that the child can be thriv- 
 ing unless they are dandling it on their knees ; both are quite 
 wearied, mother and child. But this is all mistaken kindness. 
 A sick child will thrive best if laid quietly in its own cot, so 
 that the fresh air may play around it, and that it may rest. 
 
360 MOTHER AND CHILD. 
 
 Its little face will soon lose the worried look that is so often 
 marked on the faces of the children of the poor, and a look 
 of happiness and content will take its place. It is not difficult 
 to accustom the children to lie quiet; at first they will be 
 restless and fret at not being taken up, but when they see 
 that their frettings are of no avail, with the ready adaptability 
 of childhood they make the best of it, and soon find how much 
 the best it is. 
 
 " It is most essential in the cai'e of sick children that they 
 should be supplied with plenty of light and fresh air, in neither 
 case pouring in directly on them, but flooding them all round 
 in generous profusion. They by no means appreciate the 
 darkened room and hushed voice: like the plants in the 
 garden, they expand under the rays of light ; and there can 
 be no doubt that the light has a physiological influence on 
 their growth and development, especially so in the case of 
 illness. Therefore in arranging the sick-room, let it have as 
 much of the light as possible, a southern or western aspect, 
 and a free circulation of air through it, by maintaining an in- 
 terchange with the outer air without making a draught ; and 
 this should be kept up by night as well as by day, especially 
 in crowded cities. Of course in certain fever cases, in acute 
 diseases of the brain or diseases of the eye, a darkened room 
 may be required. 
 
 " The sympathetic nature of the child is at once afi'ected by 
 any deviation from the standard of health ; its organism is 
 like a delicate machine, disturbed by the presence of a minute 
 grain of sand ; it at once gives token that there is some morbific 
 influence at work. The severe onset of an illness, its rapid 
 course, and its speedy termination either in recovery or death, 
 are always matters of surprise to those accustomed to sick 
 children ; and so it requires that the attendants should be 
 fully on the alert to catch each new symptom, give it its value, 
 and be prepared with appropriate treatment. It is hardly a 
 safe course for the mother to wait until her child's illness has 
 declared itself before she takes action ; and even then, as a 
 
NURSING OF SICK CHILDREN. 361 
 
 mild domestic ailment and an acute disease may alike assume 
 the same symptoms, she would act more wisely to seek some 
 skilled assistance, for, however experienced a mother may be, 
 she can hardly read symptoms aright. Or it may be that one 
 of the infantile infectious complaints is declaring itself; and 
 then for the sake of the other children some system of isola- 
 tion is necessary. 
 
 " Illness at fii-st shows itself in a child by listlessness and loss 
 of appetite; the eyes look heavy; the child may be fretful, 
 especially if disturbed, or it may be drowsy ; it will feel hot, 
 and if the temperature be taken the thermometer will gener- 
 ally show an elevation above the normal; but this in itself 
 must not be regarded with disquiet, as a very little suffices to 
 disturb the normal heat of the body; in nearly all cases there 
 will be vomiting and some bowel-disturbance, and then special 
 symptoms will declare themselves. In the older child, one 
 able to give some account of itself, the symptoms generally 
 set in in the same sequence, and they must be taken as a warn- 
 ing that something is amiss. The best treatment is to wait 
 and see what is coming, at the same time placing the child in 
 favorable circumstances, — that is, keeping it quiet and away 
 from its fellows, giving it light food, of easy digestion, seeing 
 that the bowels are not overloaded, and then waiting for the 
 diagnosis of the medical attendant. 
 
 " Age has much influence upon the diseases of children, and 
 if it is borne in mind that before the age of seven the body is 
 being built up rapidly, and this means a great expenditure of 
 vital force, it is more easily understood that a small disturbing 
 cause will seriously upset the equilibrium of its powers. It is 
 of more importance to keep a child in health than to restore 
 it from illness to its normal condition; and very much may be 
 done by regularity in all its habits. Appropriate food at 
 regular intervals will drill the digestive apparatus into strong, 
 healthy ways; regular hours of rest and exercise will soothe 
 and strengthen the nerve-centres ; the muscular powers will 
 be developed by use, and the mental faculties develop them- 
 Q 3] 
 
362 MOTHER AND CHILD. 
 
 selves in harmony "vnth the animal vigor. There are certain 
 crises in the child's life that must always be reckoned with as 
 causes of disturbance, — notably, the period of teething. This 
 is a sea of troubled waves, over which the little bark must be 
 sensibly steered and it will voyage in safety ; but then it is a 
 natural process, for which provision .has been made in the 
 child's constituiion, and if its surroundings and habits are 
 healthful it will pass over the storm with but little danger. 
 Of more serious moment are the hereditary defects that are 
 ever-present dangers to the child life and will break out into 
 flame with the least spark and will modify acute disease by 
 their influence. If the mother has a good knowledge of her 
 child's constitution, she may do much to defend the weak point 
 by engendering a wholesome habit of living. This much is 
 quite certain, that no two children are alike, and that they 
 will thrive the best who receive the most individual thought. 
 
 " Of secondary importance, but by no means to be forgotten, 
 is the child's nursery: here three-fourths of its day will be 
 spent, and its aspect and traditions wOl never die out of the 
 child's life. It is of paramount importance that it should be 
 bright, cheerful, clean, and wholesome, that its presiding genius 
 should be a lovable, common-sense woman, and that order and 
 method should rule its habits. The little ones will then look 
 back upon their nursery days as some of the brightest in their 
 life. 
 
 " It may become the sad necessity to turn this bright room 
 into a sick-ward. In such case, tui^n all the unnecessary articles 
 of furniture out of the room, take up the carpet, remove the 
 hangings, if there are any, and have at hand everything that 
 is likely to be wanted, extra basins, jugs, cups, and feeders, 
 small pans for the linen, a plentiful supply of water and 
 liberal means of making it hot, baths, and a ready supply of 
 linen. Keep all these appliances handy, but outside the room, 
 and also outside have vessels for receiving the slops, so that 
 nothing off'ensive may be about the patient. Provide a good 
 supply of some disinfectant in a concentrated form, to be 
 
NURSING OF SICK CHILDREN. 363 
 
 readily weakened, and let this be freely used on the floor, in 
 the vessels, and for soaking the linen from the patient. Last, 
 but of no less importance, is the choice of the sick child's 
 nurse. It does not follow that either the mother or the nurse 
 is the most fitting ; the one may be too nervous and excitable, 
 the other too indulgent or ignorant : what is wanted is a 
 steady, reliable woman, who can manage the patient with 
 kindness and firmness, who can. be trusted to carry out orders 
 and yet have a discretion of her own, cheerful and even-tenl- 
 pered, physically strong in the face of an extra demand on 
 her powers, cool and self-possessed in an emergency, and, above 
 all, with a love for her work and her patient. If added to 
 these qualifications there is hospital training, then the right 
 attendant is found. It is very essential that as far as possible 
 the management of the sick-room should be kept in the hands 
 of one person, so that there may be a unity of treatment and 
 that methodical harmony which is of more importance in sick- 
 ness than in health ; and then, if the assistants are obedient, 
 good work may be done. There are few things more harmful 
 than the fidgety nursing that one so often sees in the family. 
 The nurse, if she shows herself to be a woman of tact and 
 sympathy, will soon infuse her spirit into the members of the 
 family, and they will readily work under her guidance. 
 
 " There are many little niceties of method and order that 
 form part of the training of a nurse in the hospital wards, 
 that will add to the comfort of the patient. A child with any 
 form of joint- disease or fever is easily washed in the recum- 
 bent position ou a blanket, being rolled gently from side to 
 side, and in the case of an injured limb it must be steadied 
 with one hand or by a second person, and then there is very 
 little pain or displacement. It -is a great husbanding of the 
 strength in fever, especially typhoid, to keep the patient 
 always lying down, and the whole of the person can be prop- 
 erly washed in this way. This is the sovereign preventive of 
 bed-sore, especially in cases of paralysis, where the evacuations 
 are not retained, and enables the nurse to see at once any 
 
364 MOTHER AND CHILD. 
 
 weakness of the skin. Complete drying of the skin must be 
 insisted on, and the liberal use of dusting-powder, and then a 
 child may lie for months on its back without any ill effects. 
 An important part of the nurse's work is to prepare her 
 patient for a physical examination, and to do this quickly and 
 readily without undue exposure is a sign of good training. 
 It is very irritating to a doctor to watch a nurse fumbling at 
 buttons and strings, and it wearies the child. Before the time 
 of the doctor's visit she should have all the clothing loosened, 
 and a blanket warming at the stove to wrap the child in if it 
 is to be taken out of bed. If the child is to be examined in 
 bed, the night-gown and vest are drawn over the head and 
 placed on the stove to keep warm : this is a little detail, but it 
 is important for a dehcate child to be saved the chill of cold 
 garments when exhausted by the examination. A loose wrap 
 will serve to cover the parts not under observation ; and if the 
 doctor uses the towel whilst examining the chest, be sure that 
 it is one well aired. If the patient is removed from the bed, 
 the nurse will take the child in the wanned blanket on her 
 lap and be ready to adjust it to the doctor's needs. Some 
 little gentleness and coaxing are required to prevent the child 
 from being frightened, and a few moments of time must be 
 spent in winning the patient's confidence and allaying its 
 fears; and if this is successfully accomplished, the patient 
 will probably look upon the whole as a game for its amuse- 
 ment. Should some operation be necessary without an anaes- 
 thetic, it is far better to tell the child that it will be hurt a 
 little bit, and if the instrument be kept out of sight the fright 
 will be very momentary. It is marvellous how patiently 
 children submit to painful remedies if only they are treated 
 with candor. In patting on hot applications it must be borne 
 in mind that the child's skin is more sensitive and tender than 
 an adult's, and that the test of the nurse's hand is not sufficient ; 
 the child's sensations must be the guide. It is a cruel thing 
 to put on a fomentation or poultice too hot, and it does no 
 good if it excites the child. If a blister is or-dered, it can be 
 
NURSING OF SICK CHILDREN. 365 
 
 put on more efficiently with blistering fluid, care being taken 
 that it does not run, and if put on at night the child will gen- 
 erally sleep through it ; the after-treatment will be according 
 to the instructions of the medical attendant. Children arje very 
 tolerant of blisters, and in wise hands they are useful reme- 
 dies.' The application of leeches is more complicated: the 
 sight of them must frighten the child, so they should be dealt 
 with quickly and decidedly. The easiest way is to turn the 
 box on to the part, which should be first well washed, and 
 then wait until they have all taken ; or take them up in cot- 
 ton-wool in the mass and hold them on ; in either way the 
 child does not see them moving about, and if the cotton- wool 
 is left on they will not be very evident. They must be left 
 until they drop off, and then the part washed, pads of lint or 
 absorbent wool put on, and the whole bandaged up. The 
 nurse must be on the watch for after-bleeding and report to 
 the doctor. 
 
 " Leeches should not be placed on the prominence over a 
 bone, nor on a vein, nor on any part that receives pressure. 
 The pain is not severe, and the fright is caused more by the 
 sight of them than by their bite. If possible, the child should 
 be kept quiet after the application, or the bleeding may be- 
 come troublesome. 
 
 " A very frequent remedy ordered is an enema, either as a 
 medicine in diarrhoea or constipation, or as a means of giving 
 food. Its nature and quantity will be prescribed by the doc- 
 tor, but its administration will be in the hands of the nurse. 
 Supposing it is to check diarrhoea, it will probably consist of 
 starch and opium, and should be made as small in bulk as pos- 
 sible, — not more than two or four teaspoonfuls of mucilage 
 with the quantity of opium prescribed ; if to deal with con- 
 stipation, it will be large in quantity, such as a pint of soapy 
 water warm, or gruel and castor oil, or soap and castor oil ; 
 and after the injection has been given leave the patient quiet 
 until there is a desire to return it. The tube should be well 
 oiled and passed up the rectum gently as far as it will go. In 
 
 31* 
 
366 MOTHER AND CHILD. 
 
 giving nutrient enemata, the food must be made as concentrated 
 as possible, and be a little thickened with, starch po^rder or 
 arrow-root. Four ounces is as much as the bowel will retain 
 with advantage. 
 
 " A nurse who knows her work will know that she has to put 
 out the urine for testing b}' the doctor : it should be a smaU 
 quantity taken from the first passed in the morning, and let 
 it be put aside in a clean vessel and covered over. 
 
 " It may be that she is instructed to measure and record the 
 amount of ui'ine passed in the twenty-four hours : in such 
 case she must have a suitable vessel, such as a marked jug or 
 glass, provided for her, and then should begin her observations 
 thus. Let her fijs on an hour, say nine a.m., at which to take 
 the observation : on the first morning let the child pass water 
 at that hour, and then throw it away : all the water passed 
 subsequently is to be saved, and at nine a.m. the next morning 
 the child is to be invited to pass water, and then the whole 
 quantity is measured, recorded, and thrown away. If the 
 specific gravity is to be taken, the nurse must be shown how 
 to use the httle instrument that weighs it, and how to record it. 
 
 " It is also part of the nurse's duty to examine the evacuations 
 and report on them, and in any case of doubt to save them for 
 inspection. On this point there is a great deal of ignorance 
 and diversity of o]Dinion : one nurse will call that diarrhoea 
 which another nurse wiU name only * a little looseness,' and 
 so on. The presence of shme and blood in the evacuations 
 should be at once reported, and the stool saved for insjDection ; 
 also the presence of undigested food. The frequency of the 
 action and the quantity must likewise be observed, and intelK- 
 gent answers given to the doctor's questions. 
 
 '•' The diseases of young children are so frequently induced 
 by bad management that the medical attendant will rely very 
 much for the success of his remedies upon the intelligence and 
 good management of the nurse. He may lay down theoreti- 
 cal rules for feeding and rest which may be entirely upset by 
 the wilftdness of his patient. What is to be done with a child 
 
NURSING OF SICK CHILDREN. 367 
 
 who will not take milk, where that is the special diet indicated 
 by its complaint ? What is to be done with a child who will 
 sleep by day and feed by night ? Or with one who refuses all 
 food ? In diarrhoea and vomiting, the ad-ministration of food 
 has much to do with the recovery : first of all it must be 
 suitable, then it must be given in such quantities as will suit 
 the digestion, then it must be given regularly and with 
 patience, and it must be freshly prepared. All the vessels 
 used for it should be scrupulously clean, for the least trace of 
 decomposition will upset the stomach. 
 
 " The popular feeding-bottle with the india-rubber tube is a 
 great oifender : it is almost impossible to prevent particles of 
 food from cHnging to its inner surface, and as these decompose 
 they will taint the most carefully prepared food. The bottle 
 and nipple need careful scalding and rinsing, and should be 
 kept in cold water betweentimes. If an infant hand-fed is 
 troubled with diarrhoea and vomiting, look to the bottle first. 
 As a subsidiary measure, and one of some importance, .see that 
 the loins and the abdomen are quite warmly clothed. In feed- 
 ing a child who has a dehcate or irritable stomach it is of 
 great importance to give the food in smaU quantities and as 
 frequently as the digestion will bear. 
 
 " In all diseases of the respiratory organs the child requires a 
 warm, even temperature, not made stuffy or poisonous by 
 want of efiicient ventilation, but a constant temperature kept 
 up with a free interchange of fresh air. This requires a little 
 management, but it can be done. "What is essential is that 
 the external air, which is the freshest, should be admitted 
 steadily, and the temperature kept from falling below 60° F. 
 The means by which this is to be brought about must be left 
 to the nurse's ingenuity, but she must remember that letting 
 in the used-up air off the staircase and passages is not venti- 
 lating with fresh air. 
 
 " At times it is a great rehef to the patient to moisten the 
 air with steam ; this is best done by surrounding the bed with 
 some light curtains or screen and then letting the steam come 
 
368 MOTHER AND CHILD. 
 
 into the bed from some suitable apparatus, care being taken 
 that there is an escape from the top of the bed, or the curtains 
 will become damp. This is an essential in the treatment of 
 laryngitis and diphtheria after the operation of tracheotomy, 
 it being advisable to moisten and warm the air before it enters 
 immediately into the lungs through the tube. 
 
 " It will not be necessary in an article of this nature to give 
 instructions for dealing with diphtheria or laryngitis, as these 
 cases require incessant care on the part of both medical attend- 
 ant and nurse. Still, a few hints of arrangement may be of 
 use. There are few cases that demand more skilled nursing 
 than diphtheria, and the attendance on such cases should be 
 always put into the hands of old, experienced nurses, especially 
 after the operation of tracheotomy, as careful feeding and 
 watching by an experienced nurse are essential to recovery. 
 One small precaution may prevent the nurse from taking a 
 disease which is propagated by the breath, and that is to keep 
 her mouth closed whilst standing over the patient, and to use 
 a disinfectant for washing the hands before taking her meals. 
 A basin of weak carbohc solution should be put near the cot 
 for washing the sponges, etc., used about the patient, and all 
 feeding-cups, spoons, and glasses must be kept apart. Linen 
 over a piece of waterproof to make a bib and pinned over the 
 neck of the child's night-dress is a clean way of keeping the 
 neck dry and wholesome ; for it must be remembered that the 
 diphtheritic discharges are most irritating to the skin. To 
 sum up, a nurse in dealing with these cases must be prepared 
 for a work that will tax all her skill, patience, and vigilance : 
 her patient will require incessant watching, and will make 
 endless demands on her ingenuity. Instead of pocket-hand- 
 kerchiefs, some rags that can be burnt at once are advisable. 
 
 " When infectious diseases are in the house, very much may 
 be done by way of precaution in the use of disinfectants for 
 the linen and the discharges before they are taken out of the 
 room, as it is in these that the germs of disease are conveyed. 
 A sheet kept moistened with some disinfectant, and hung over 
 
NURSING OF SICK CHILDREN. 369 
 
 the outside of the door of the sick-room, is very effective. 
 Then, of course, there should be no intercourse between the 
 inhabitants of the sick-room and the rest of the household,, 
 and the nurse and friends should change their garments before 
 going out. The floor of the sick-room should be swept with 
 saw-dust moistened in the disinfectant, and all dust and refuse 
 should, if possible, be burnt. In scarlet fever in the desqua- 
 mating stage, it is the practice of some doctors to have the 
 patient rubbed over with an ointment; but, whatever treat- 
 ment is adopted, it is essential that the skin be kept clean by 
 frequent sponging with warm water, and by baths, and that 
 the patient be kept warm in bed until the process is over. 
 Every precaution should be taken to hinder the dust from the 
 bed or room from being scattered about. 
 
 . " Measles is a much more unruly disease to deal with ; it 
 starts infection in the early stage, before the eruption has de- 
 clared itself, and so spreads among a household almost un- 
 checked. The same rules of disinfection will apply to this; it 
 is of importance to keep the patient in a warm room, in bed, 
 until the eruption has quite disappeared, and longer still if 
 there is any tendency to lung-disease, as shown by a continued 
 high temperature and the state of the breathing. 
 
 " In this and in all other eruptive diseases the diet should 
 be light and nourishing and with but little animal broth or 
 tea in it, as this is apt to be over-stimulating, except when 
 contra-indicated by great prostration. Careful observation of 
 the temperature is of great assistance to the nurse. It begins 
 to fall about the third day; but if it persists high or rises 
 above 103°, then the nurse must be on the alert for some com- 
 plications and look out for all symptoms that may aid the 
 doctor in detecting the mischief, and for her part she must 
 keep her patient warm, lying down, pay attention to the evac- 
 uations, and support the strength with careful systematic 
 feeding. 
 
 " Whatever may be the nature of the illness, one great essen- 
 tial in its nursing is scrupulous cleanliness in the person of the 
 y 
 
370 MOTHER AND CHILD. 
 
 patient and in all its surroundings. A sick child should be 
 washed all over every day, and sometimes twice a day; every 
 part of its body should be examined, that the first sign of a 
 sore maybe detected, or any change in its condition, such as a 
 swelling, discoloration, or enlargement about a joint, and such 
 information should be handed over to the doctor at the earliest 
 opportunity. In the case of young babies, their skin requires 
 washing and drying each time the napkin is changed ; a nui'se 
 who knows her work well will be able to keep her charges 
 clean and their wants anticipated without giving in to these 
 lazy ways. If the patient is to be clean, so must also the bed, 
 and all soiled linen at once be taken away, not pushed under 
 the bed out of sight, nor one wet end of the sheet tucked 
 under the mattress, but absolutely put in its proper receptacle, 
 where it will do no harm. The hospital draw-sheet is very 
 useful on the sick-bed ; it can be quickly drawn away without 
 much disturbance to the patient, and another substituted. A 
 draw-sheet is a narrow, long sheet, about one and one-half 
 yards long by three-fourths of a yard wide, of a coarser mate- 
 rial than the linen, and is placed under the body of the patient, 
 sometimes with a square of mackintosh under it ; it tucks in 
 well and keeps things straight. . . . 
 
 " Some children dread the water : the origin of this fear 
 is very often caused by roughness in washing them, or by 
 hustling them too suddenly into a bath. Eickety children 
 are essentially tender to the touch, and they require gentle 
 handling when in the bath. 
 
 '•As the bath is essential for both the healthy and the sick 
 child, the nurse must use her ingenuity to overcome the fear. 
 An ordinary warm bath should be of the temperature of 98° 
 F., and this should be decided by the use of a thermometer 
 and not by the nurse's hand. Let the child be quite ready for 
 the bath when the bath is ready for the child, or it will be 
 cooling. When the bath is over, have at hand a warmed 
 blanket on which to place the child whilst being dried ; let 
 the drying be done quickly and the child be put into its 
 
NURSING OF SICK CHILDREN. 371 
 
 warmed garments for bed. If a douehe-bath is ordered and 
 the regular appliances are not handy, place the child in an 
 ordinary warm bath, standing if possible, and then pour a jug 
 of cool water down the spine from a height, or on to that par- 
 ticular part for which the douche is ordered. Eub the part, 
 well with a rough towel, so as to get up good, circulation, and 
 knead it with the hand. If a bath is ordered to reduce the 
 temperature, its temperature should be 65° F. The bath being 
 broTight to the bedside, the patient is lowered in on a blanket 
 and kept in five or ten minutes, according to the doctor's orders ; 
 then the patient is dried quickly and put back to bed. . . . 
 
 " It is an essential in the clothing of a sick child that it 
 should be loose, light, easily changed, and sufficient. A sick 
 child does not make the same use of its bedclothes that the 
 sick adult does, and so some warm jacket must be put on to 
 keep its chest and shoulders protected. The bedclothes also 
 must be light and warm, and not doubled in a heavy fold over 
 the chest, perhaps already overweighted with some difficulty 
 in breathing. 
 
 " When the patient first gets up it is necessary that the 
 surface of the body be thoroughly well covered with light 
 warm clothing, put on quite loosely. Woollen clothing is 
 more warmth-giving than cotton, and is lighter. ISTeither in 
 sickness nor in health should the child's body be confined in 
 stiff clothing; binders and stays of all kinds are a mistake; 
 they interfere with the free use of the muscles, and do not 
 improve the shape. In construction also the clothing should 
 be simple and easily put on and off. It would not be advisable 
 in this chapter to advise any patterns or styles for the chil- 
 dren's dress ; but, laying down these rules as above, feminine 
 ingenuity may easily devise a shapely garment that will har- 
 monize with them and with the child's requirements. In 
 sickness, the flannel vest and bed-gown require frequent 
 changing; and it is a great soother of the night's rest to 
 change the garments entirely at the child's usual bedtime. 
 In dealing with surgical cases which must be kept in one 
 
372 MOTHER AND CHILD. 
 
 position, it facilitates the process to liave a night-gOTm open 
 dovm its Tvhole length; the same applies to patients -^th 
 typhoid fevei\ . . . 
 
 '• In preparing a bed for an operation, or where the patient 
 must remain on it for a long time, a firm hair mattress should 
 be selected, and a continuous board placed under it, two sheets 
 folded straight down the centre, so that they can be easily 
 withdrawn and kept in their places with a draw-sheet, and 
 then the rest of the clothing arranged so as to give the most 
 warmth. All creases must be carefully avoided, as they will 
 cause a sore ; and if pillows are required to support a limb, 
 they should be firm, like sand ]Dillows, and as small as possible. 
 A good feather pillow is often of use for slinging a limb ; but 
 every appliance must be adjusted to the restlessness of child- 
 hood and to the tender nature of its skin. It is wonderful 
 how tolerant children are of one posture and of long confine- 
 ment in bed, if only they are placed in a comfortable position 
 and well amused ; and they will maintain an ordinary standard 
 of health under such circumstances, if fed sensibly. 
 
 " It may strike the reader that many of these details are 
 needlessly minute ; but it is by attention to such miautige that 
 the work of nursing a sick child back to health may be accom- 
 plished. Xothing is too small that contributes to such an ob- 
 ject, and those who have had much experience in the care of 
 sick children know that aU their success will depend upon care- 
 ful thought for these details. 
 
 '•' There can be no doubt that it is very hard work to nurse 
 a sick child; but there also can be no doubt that the hard 
 work amply repays itself in its results." 
 
 All medicine should be kept out of a child's reach ; indeed, it 
 is always Avell to have a small medicine-chest under lock and 
 key. 
 
 A mother or nurse should make it a rule always to read the 
 directions on the bottle before administering any medicine. Mis- 
 takes frequently occur, especially during periods of excite- 
 ment, and the wrong medicine administered. 
 
NURSING OF SICK CHILDREN. 373 
 
 la concluding this chapter, we will quote from an article^ by 
 Dr. Byers, of Charlotte, North Carolina, on disinfection. The 
 greatest attention to detail is necessaiy to prevent the spread 
 of contagion from the sick-room, and as many of the acute 
 affections of infancy and childhood are due to contagious disease, 
 this matter assumes an additional interest and importance. 
 
 " In each particular disease there is always some peculiar 
 or special portion of the body involved which is occupied by 
 and reproduces the exciting causes of infection. It is to 
 these parts that we must alwaj'S first direct our attention 
 when beginning to disinfect for the disease. Fortunately for 
 prophylaxis, the exact location of the centres for breeding is 
 known in quite a number of diseases, and we can attack these 
 seats directly. In all the exanthemata this is the case, and in 
 them it is the skin and the mucous membranes which should 
 receive the most attention ; while in typhoid fever and cholera 
 it is the discharge from the bowels, and possibly from the kid- 
 neys also, which we must particularly attend to. 
 
 '•' For personal disinfection, Labarraque's solution, diluted 
 with twenty parts of water, is suitable for washing and bathing 
 the body. A weak carbolic solution, or a one-per-cent. solution 
 of chloride of lime, will also be found efficient for the same 
 purposes. Oily disinfectant inunction for the skin is one of 
 the best methods of preventing the detachment of epithelia 
 and pus, and should be used from the commencement of 
 measles, small-pox, scarlet fever, and chicken-pox. It is found 
 better and more agreeable when mixed with camjjhorated olive 
 oil or with carbolic acid and olive oil. The throat and fauces 
 in these diseases should also be washed with Condy's fluid, or a 
 weak solution of sulphurous acid. All discharges from the 
 nose, eyes, and mouth should be received upon rags and imme- 
 diately burned, or, if upon towels and handkerchiefs, these 
 should be put in a solution of chloride of lime. The stools 
 should be disinfected by a solution of bichloride of mercury, 
 
 ^ Keating's Cyclopaedia of the Diseases of Children, vol. iv. 
 32 
 
374 MOTHER AND CHILD. 
 
 one-half ounce to the gallon of water, and all clothing treated 
 by placing it in boiling water to which have been added two 
 ounces of chloride of lime for each gallon. With regard to 
 the disinfection of the apartments, furniture, and hangings, an 
 observance of the directions in the general remarks that are to 
 follow will be amply sufficient for all jDurposes. 
 
 " Heat. — Extremes of temperature have long been known to 
 be disastrous to animal and vegetable life, and are doubtless 
 among the most efficient and satisfactory agencies that can be 
 employed for disinfection. Of course it is not necessary to 
 say that fire will destroy the principles of infection, since it is 
 complete combustion. Heat in particular has a powerful and 
 constant effect upon all albuminoid substances, both in coagu- 
 lating and in desiccating. It is undoubtedly the best means 
 of disinfecting bulky material, such as bedding, curtains, and 
 clothing, and, if they be properly exposed to its action, all the 
 contained life or contagion will certainly be destroyed. Heat 
 is employed as a disinfectant in several ways, among which 
 may be mentioned dry, moist or boiling, and steam heat. Drs. 
 Parsons and Klein have made numerous and elaborate experi- 
 ments both on the degrees of heat and on the time necessary 
 for disinfection. The results of their investigation show that 
 dry heat is best adapted to the usual purposes of disinfection. 
 Ordinarily this kind of heat can be supplied by a common 
 laundry drying-closet or a baker's oven, and will be sufficiently 
 powerful to destroy all contagion unaccompanied by spores. 
 Dry heat has one principal objection, however : it penetrates 
 bulky and badly-conducting substances very slowly, and the 
 time usually allotted for the destruction of germs is far too 
 short for it to be effijctive. Hence if the drying-closet or oven 
 be used the articles should remain in it at least four hours, and 
 the temperature should not be below 200° or 225° F.,the latter 
 being much better. With respect to the amount of heat that 
 can be borne by ordinary fabrics, scorching is said to occur at 
 different temperatures in different materials. White woollens 
 are always soonest affected, and should be carefully watched. 
 
NURSING OF SICK CHILDREN. 375 
 
 To avoid these bad effects in them, the temperature should 
 never exceed 250° F. ; aod even this may in a majority of 
 cases be too much for the finest woollens. Dry heat is gen- 
 erally applicable to all that class of goods which can be boiled, 
 and is said to be materially aided in penetration by the addi- 
 tion of a certain amount of moisture, though the moisture is 
 of no assistance in facilitating the destruction of the germs. 
 
 " Dr. Henry has been successful in destroying the infective 
 principle of scarlet fever, contained in clothing, by means of 
 a dry heat of only 140° F. kept up for three hours. Most 
 authorities, however, recommend a temperature of at least 
 225° F, for all kinds of exanthematous disease, such as small- 
 pox, measles, chicken-pox, and the like. . . . 
 
 " Koch has found that bacteria in general, free from spores, 
 cannot resist a temperature of 212° F. for many minutes, and 
 that if it is continued for an hour and a half they invariably 
 perish. 
 
 " As to the action and results of moist heat or boiling as a 
 disinfectant, experiences are not very satisfactory. Still, if the 
 boiling be kept up for several hours, and a little carbolic acid, 
 or chloride of lime or of zinc, be added to the water, the results 
 can be relied on as effective. Should there be any doubt about 
 the destruction of the germ when lodged in clothing or other 
 articles of similar character, we should not hesitate to employ 
 the highest dry heat compatible with the safety of the goods. 
 The finest fabrics will withstand for a reasonable time an ele- 
 vation of 225° F., and linens, cottons, and woollens may be 
 trusted to it without the apprehension of any injury or danger. 
 Two hours of dry heat such as has been described will be amply 
 sufficient, and no evil consequence will follow either to the 
 safety of the goods or in the form of disease. 
 
 " Steam is considered to be a rapid and powerful disinfectant, 
 experience showing pretty conclusively that at 212° F. it will de- 
 stroy all contagion, and the complete penetration by steam for 
 five minutes is found capable of thoroughly disinfecting. . . . 
 Steam penetrates far more rapidly than dry heat, and is much 
 
376 MOTHER AND CHILD. 
 
 more destructive, in the time occupied, to all germs. A press- 
 ure of twenty-five pounds is said to assist materially in its 
 destructive action. 
 
 " Chemical Disinfectants. — These are employed in the form 
 of gases, liquids, and solids. 
 
 " Gaseous substances are employed principally for aerial 
 fumigation, and are aj^plicable for the disinfection of apart- 
 ments, etc. I shall not undertake to enumerate the various 
 articles of this class that have been used from time to time, 
 but shall simply confine myself to a description of a few of the 
 leading ones, such as experience demonstrates to be effective. 
 
 " A number of chemical substances are known to evolve 
 oxygen very freely when brought in contact with organic 
 bases, and in this manner disintegration of the obnoxious mat- 
 ters is presumed to take place. Chlorine, bromine, nitrous 
 fumes, and ferric compounds are supposed to disinfect to some 
 degree by this method. With respect to the chemical reactions 
 that take place in the use of the other substances which will 
 be mentioned farther on, very little appears to be known. 
 
 " Fumes of Sulphur — Sulphur Dioxide. — The most available, 
 inexpensive, and reliable disinfectant that can be employed for 
 fumigating apartments and preventing the spread of exan- 
 thematous diseases is sulphur dioxide, (SOJ. The Greeks and 
 Eomans were acquainted with the preservative properties of 
 this gas, and used it as an antifermentative in wine. It is two 
 and a quarter times as heavy as air, and is usually generated 
 by burning sulphur. It has a peculiarly pungent and dis- 
 agreeable odor, which is perceived when a sulphur match is 
 ignited. Guyton de Morveau, who first studied its action, was 
 of the opinion that it would completely disinfect miasms. Its 
 chemical action is supposed to be due to its power to deoxidize 
 the resultant acid coagulating albuminous matter. For the 
 disinfection of rooms recently vacated by diseased persons, 
 three pounds of sulphur should be burned for each thousand 
 cubic feet of air space. The sulphur can best be ignited by 
 pouring over it two or three ounces of alcohol and applying a 
 
NURSING OF SICK CHILDREN. 377 
 
 lighted match. The room during the entire period of fumi- 
 gation should be kept completely closed, and about twenty- 
 four hours afterwards opened and thorough ventilation allowed. 
 Before using this agent, however, all carpets should be taken 
 up, the wall-pajDer removed and burned, the hangings thor- 
 oughly loosened, and every part exposed so that the gas can 
 penetrate everywhere. . . . Suljjhurous acid and sulphur di- 
 oxide are both destroyed by chlorine and permanganate of 
 potassium, and should never be used in conjunction with either. 
 The great solubility of sulphurous acid renders it one of the 
 most valuable substances with which to disinfect liquids. Dr. 
 Edson, of the New York Board of Health, in a recent report, 
 says that sulphur dioxide is the most practicable and reliable 
 means that he has ever seen employed for the disinfection of 
 the exanthemata and dii^htheria. 
 
 " Chlorine. — This is a pale yellowish-green gas at ordinary 
 temperatures, about two and a half times as heavy as ordinary 
 air. It is a powerful oxidizing agent, and extremely irritating 
 to the air-passages when inhaled. It decomposes ammonia 
 and sulphuretted hydrogen, and affects all compounds arising 
 from the putrefaction of organic matter. It is commonly 
 used for the same purpose as sulphur dioxide, and, like that 
 agent, renders the occupation of the apartments temporarily 
 impossible. It bleaches organic matters and destroys odors, 
 either by withdrawing hydrogen or by direct oxidation. 
 Chlorine is usually generated by means of chloride of Kme, 
 moistened either with water or wdth dilute sulphurous acid. 
 There are several popular disinfectants which contain this gas 
 in sufficient proportions to be of service : among these may be 
 mentioned Piatt's chlorides, Labarraque's solution, and Javelle 
 water. Chloride of lime is often used without the addition of 
 an acid, being scattered as a powder in vaults, privies, and 
 gutters. ... 
 
 " Fumigation should always be regarded in the light of an 
 accessory, and should be, when practicable, accompanied by the 
 processes of baking, steaming, and washing. All the wood- 
 
378 MOTHER AND CHILD. 
 
 work — walls, floors, and furniture — ^must be rubbed down and 
 washed with a solution of carbolic acid, one pint to the gallon 
 of water, or a solution of bichloride of mercury, an ounce to 
 the gallon of water, and the clothing and bedding baked, or 
 washed in a solution of chloride of lime. A failure to make 
 these processes complete by leaving a single place or article 
 overlooked will create a new centre for infection, and all the 
 work will have been in vain. 
 
 " Carbolic Acid. — An important advance was made in disin- 
 fectants when the virtues of this substance were discovered 
 and brought forward. The great advantage of it, as a liquid, 
 is that it is slightly volatile, and therefore capable of being 
 sprinkled in apartments and upon substances where it will 
 penetrate every corner and crevice and be of service. It 
 requires about twenty-five parts of water for thorough solution, 
 and in this proportion is a powerful disinfecting liquid against 
 all contagion. It coagulates albumen in the proportion given, 
 and enters readily into union with organic substances wherever 
 it meets them. . . . Its chief property and that of the com- 
 pounds associated with it is the power of destroying vegetable 
 and animal organisms, and preventing putrefaction and fer- 
 mentation in them. 
 
 " Bichloride of mercury [corrosive sublimate'] in solution is the 
 most powerful and remarkable disinfectant known to science. 
 Investigation shows that it is a deadly poison to all the lesser 
 forms of life, which it kills instantly when emploj^ed in jiroper 
 quantities. It cannot be used in connection with lead, tin, or 
 copper, owing to its corroding quahties. Its power to destroy 
 germs, even in dilute solution, is unique. In the proportion 
 of one to five hundred it destroys vitality in ten seconds, in 
 one to two thousand in one and one-third minutes, and in one 
 to twenty thousand in from fifteen to twenty minutes. Thus 
 it will be seen that time is an. element always to be considered 
 when the solutions are used in ordinary proportions. 
 
 " The fact that corrosive sublimate combines with albumen 
 leads to the conclusion that it interferes somewhat with the 
 
NURSING OF SICK CHILDREN. 379 
 
 process of destruction, and this is always to be remembered 
 when using it as a disinfectant. 
 
 " The following solution is recommended by Sternberg as 
 quite capable of killing all the germs of infectious diseases : 
 bichloride of mercury, four ounces ; sulphate of copper, one 
 pound ; water, one gallon. 
 
 " Dr. Parsons recommends the following solution as suitable 
 for clothing, excreta, etc. : bichloride of mercury, half an ounce ; 
 hydrochloric acid, one ounce ; aniline blue, five grains ; water, 
 five gallons. Mix. This is the standard Solution No. 1 of the 
 Public Health Association, and has been tested thoroughly. It 
 should be labelled ^poison.' 
 
 " Sewage. — A large number of substances have been proposed 
 for the disinfection of sewers, cesspools, and water-closets. 
 The mercurial mineral salts are not ajDplicable to sewers or 
 drains, owing to the fact that they corrode the metallic pipes. 
 Carbolic acid, crude, dissolved in water in the proportion of 
 07ie to fifty, is a very efficient arrester of decomposition in 
 drains and cesspools, and is in every way preferable. Calvert's 
 powder, composed of about twenty-five parts of carbolic acid 
 and seventy-five parts of alumina and silica, is applicable to 
 the same conditions of use as quicklime. 
 
 " The solid absorbent disinfectants, such as dry earth, char- 
 coal, sulphate of iron, chloride of zinc, and chloride of lime, 
 will be found to be efficient in drains and sinks under ordinary 
 circumstances. It should be strictly enjoined, however, that 
 under no circumstances are the dejecta of yellow fever, cholera, 
 and tyjphoid fever patients to be emptied into sewers or privy- 
 vaults until they have been thoroughly disinfected by the 
 standard solution of mercuric chloride which has been recom- 
 mended. Filth such as is found in closets, sinks, and privies, 
 it should be remembered, is the chief source of nutrition for 
 the different disease-germs, and therefore such places cannot be 
 too clean nor avoided too widely. Let them be cleaned out 
 often, after being disinfected ; and do not allow accumulations 
 to take place under any circumstances, always remembering 
 
380 MOTHER AND CHILD. 
 
 that bad odors are the best, if not a certain, indication that 
 something is out of order and that there is danger ahead. 
 
 " Sternberg advocates a dilute chloride-of-Ume powder com- 
 posed of one pound of chloride of hme and nine pounds of 
 plaster of Paris. This is clean to handle, and can be sprinkled 
 over everything fearlessly. 
 
 " Perchloride of iron is useful for the disinfection of sewage, 
 and when added to it throws down a precipitate of ferric oxide, 
 which is due to its action upon the sulphide of ammonium 
 nearly always present in sewage. It is conjectui-ed that this 
 reaction leads to the hberation of sulphur, which in tiu-n acts 
 as a disinfectant. 
 
 " Permanganate of potassium prevents putrefaction in sew- 
 age for a short time, and also acts as a deodorant ; but it is 
 necessary to use it in large and expensive quantities to get 
 these results, and hence it is not ]3ractical." 
 
 CHAPTEE XLYI. 
 
 ACUTE AND CHRGXIC NASAL CATARRH. 
 
 Foe, the answers to the following questions, which are in- 
 teresting to mothers in this connection, we are indebted to Dr. 
 Alexander W. MacCoy, of Philadel]5hia. 
 
 Sow to treat an ordinary cold in the head, with household reme- 
 dies, for a child over six months of age. 
 
 A cold in the head should never be neglected. At the be- 
 ginning, an attack (ushered in by fits of sneezing and slight 
 feverishness") can often be arrested before the watery flow be- 
 gins by the prompt use of quinine suppositories, from one- 
 half to two grains each, according to age, introduced into the 
 bowel once or twice in the day; also small quantities of sweet 
 spirits of nitre in iced water (or for older children in lemonade), 
 taken freely. Sometimes large quantities of cold water taken 
 
ACUTE AND CHRONIC NASAL CATARRH. 381 
 
 will act so promptly on kidneys and skin as to quickly relieve 
 the nose. For some delicate children whiskey and water in 
 proper doses may be used. Hot (mustard) foot-baths upon 
 retiring is a time-honored and very efficacious treatment if the 
 extremities are well protected during the night. If the nostrils 
 show watery and mucous discharge, the nasal chambers should 
 be looked after, and the stuffiness and stoppage to breathing 
 through them must be combated by lubricating them within 
 with bland oils dropped in or snutfed up or, better, used as a 
 spray in an atomizer or vaporizer. Albolene and benzoin are two 
 of the most agreeable and effective substances available ; com- 
 bined with a one-per-cent. to two-per-cent. solution of cocaine it 
 is most efficient in relieving the nasal distress and stoppage in 
 the nostrils. Plain cosmoline and vaseline, warmed, and applied 
 in and around the orifices of the nostrils, will greatly add to the 
 comfort and repose of infants. Very often infants suffer more 
 from the accumulation and adherence of the secretion, which 
 soon dries up and renders the small nasal orifices stiff, uncom- 
 fortable, and occluded. The frequent application of a weak 
 solution of baking soda (bicarbonate of soda) to the nostrils 
 on a soft rag or absorbent cotton will easily remove this dried 
 secretion, and if immediately followed by the free use of oil 
 or cosmoline, will prevent this annoyance from recurring. 
 Guarding the child from overheated rooms during the day, 
 and especially at night, Avith the judicious use of quinine sup- 
 positories and the application of some benzoin with camphor- 
 ated oil in the nose, will generally relieve and cure an ordinary 
 cold in the head in one or two days. 
 
 1. At what age do ehildren show symptoms of chronic post-nasal 
 catarrh ? What are its earliest symptoms ? 
 
 The time at which a discharge irom the head occurs, either 
 from the nose or throat, may be coincident with the child's 
 birth. An acute cold in the head often develops during the 
 first week of life, and, followed by a succession of other at- 
 tacks during the earlier months of infancy, may give rise to 
 symptoms of chronic nasal catarrh as early, at least, as the 
 
382 MOTHER AND CHILD. 
 
 first year. (Depending upon some hereditary taint, the symp- 
 toms are familiarly known as " snuffles," and date from birth.) 
 A post-nasal catarrh — a dropping of mucus or phlegm from the 
 head into the throat — is only a symptom of a nasal catarrh ; 
 without a nasal catarrh existing at the same time there can 
 be no post-nasal discharge. It is probably true that, in young 
 children, for a long time there is no actual inflammation behind 
 the palate — post-nasal space — in discharges from the head 
 into the throat, but the secretion comes from the back of the 
 nose and slides down the palate into the throat ; the throat 
 may look red, but this is caused solely by the mucus lying 
 there or constantly passing over it. An acute cold in the head 
 will give rise to a discharge into the throat, which in children 
 will be much naore noticeable in the recumbent position. This 
 is also true in the chronic form. One of the earliest symptoms 
 manifested in an infant or child suffering from nasal catarrh is 
 a short, irritative cough, generally very persistent and occur- 
 ring chiefly at night, disturbing the child's rest to a distressing 
 degree. A cough arising from mucus flowing out of the back 
 of the nose and down the throat, finally tickling the " speak- 
 ing-box" (larynx), is not amenable to ordinarj^ treatment by 
 cough-syrups, etc., but requires the removal of the secretion 
 from nose and throat. The cough comes on generally after 
 the child has been asleep for some time and the recumbent 
 position has started the secretion downward in the direction 
 of gravity. During the day, the usual watery or mucous dis- 
 charge from the nose is seen, and frequent attempts at swal- 
 lowing may be noticed. It is quite unusual for parents or 
 nurses to give much consideration to a cold in the head, and 
 it is more rarely understood that this disturbing cough at night 
 is dependent upon the state of the nasal 'passages. If a cold in 
 the head is overlooked or neglected, as is so often the case, the 
 constant discharge of mucus into the sj^ace behind the palate 
 and its continuous flow downward will, in time, produce an 
 enlargement of a gland at the top of this space behind the 
 palate, as well as cause a pharyngitis, which gives rise to a 
 
ACUTE AND CHRONIC NASAL CATARRH. 383 
 
 scrions condition and makes what is often called "a weak 
 throat." And the trouble does not end here, but often causes 
 change in the. voice, rendering it husky and hoarse, and if left 
 to itself, in many cases causes inflammation of the windpipe 
 and also of the bronchial tubes ; and in very many subjects 
 too often renders them weak-chested and liable to acquire 
 some grave pulmonary disease. In the space behind the palate, 
 up in the roof, where this gland of which I have just spoken 
 lies, an enlargement of the gland develops ; in some cases 
 where this occurs the tissue hangs down over the nasal 
 openings behind, and causes impeded breathing through the 
 nose, producing mouth-breathing, and causing the voice to 
 become flat and nasal in character. This nasal voice is also 
 dependent upon obstruction in the nasal passages themselves, 
 and gives the true explanation why we are said, as a nation, 
 to " talk through our noses." 
 
 2. Are there any precautions that can he taken to prevent it ? 
 
 The precautions necessary to be taken to prevent a chronic 
 nasal catarrh are comprised under the hygiene of infants and 
 children, and the adaptation of children, from birth, to their 
 environments. It is a lamentable fact that infants and chil- 
 dren suffer the greatest neglect of proper care of the nasal 
 passages. From the first bath after birth onward, the 
 mucous membrane of a child is put on the defensive. Too 
 frequent bathing (daily) of infants and children, with much 
 too warm water, in overheated rooms, followed by too little 
 friction of the body, is a fruitful cause of •' colds in the head." 
 The important task of bathing is generally given over to the 
 " child's nurse" after the first few months. This position is 
 frequently filled by a young girl remarkable chiefly for her 
 inexperience and stupidity. The little innocents are at the 
 tender mercies of such persons, not only in the matter of 
 bathing, but in that of dressing, undressing, proper regulation 
 of amount of bedclothing, and ventilation of the bedchambers. 
 If the natural guardians of children would give more atten- 
 tion to the details of these daily matters of so great interest 
 
884 MOTHER AND CHILD. 
 
 to the physical welfare of their offspring, the ^^^'svalent nasal 
 catarrh would become much less frequently seen. Overheated 
 bedrooms (furnace-heat night and day) and too many bed- 
 clothes contribute greatly and promptly to an attack of cold 
 in the head, or add to one already present. The child, after 
 being asleep for one or two hours, is found bathed in sweat ; 
 such discomfort renders it restless, and it naturally seeks 
 rehef, and is soon outside of the coverings. This condition of 
 affairs, kept up night after night, soon renders the skin re- 
 laxed, and greatly enhances the risk of taking cold from the 
 rapid evaporation from the body. The selection of suitable 
 bedclothing is an item of great importance to the child's 
 welfare. Light, porous blankets are the only bed-coverings 
 advised. Luxurious eidei"-down and. wool comfortables, and 
 all coverings of impervious character, are to be avoided. 
 Eider-down is especially liable to be used, because of its light 
 weight, when the atmospheric conditions do not warrant its 
 use. It is only suitable for arctic climates and bedrooms 
 without heat. A great amount of exercise in the open air 
 (life in the country) is one of the best preventives of nasal 
 catarrh. 
 
 3. Should a child he taught to blow its nose ? and should loater 
 be snuffed up by it to aid it, or its nose be washed out with a spray 
 daily ? 
 
 A child should be taught to blow its nose if done properly, 
 but as the nose-blowing is generally done it is conducive of 
 harm to the middle ear, and is thought by some to greatly 
 increase the chances of earache and running ear. But if the 
 handkerchief is simply placed under the nose and the dis- 
 charge blown into it, there can only good results follow, viz. : 
 emptying of the respiratory tract of the nose, and the pro- 
 motion of free nasal respiration, — a very important function. 
 Water should never be snuffed up the nose by children (or 
 adults), except in ease of nose-bleed, as it is apt to be painful 
 and also bring about a feeling of fulness in the nose, and 
 thereby increase the obstruction. Water well warmed, and 
 
ACUTE AND CHRONIC NASAL CATARRH. . 385 
 
 containing an alkali combined with carbolic acid, may be 
 employed ; its value is greatly enhanced by the addition of 
 glycerin.^ Used in the form of a spray, it can be made quite 
 eflScient in dislodging the retained secretion, cleansing and 
 purifying the passages. Unless the discharge is profuse and 
 purulent, a spray of fluid cosmoline can be used to better 
 advantage, often combined with some drug which has a heal- 
 ing action. This simple remedy frequently suffices to effect a 
 cure. 
 
 4. If a child snores^ can it be prevented ? Is it a sign of 
 catarrh f 
 
 This question may be answered " yes" and " no." If a child 
 snores, this may and often does arise from obstruction to nasal 
 breathing produced by nasal occlusion in various parts of the 
 canals. It also very frequently arises from enlargement of 
 the tonsils, — probably the next most common condition causing 
 m.outh-breathing and rendering snoring possible. There are 
 some cases of snoring in children that do not arise from any 
 diseased condition of the mucous tract, but appear to come on 
 during profound sleep, such as is often noticed in adults. 
 Snoring in adults, in many cases, does not depend upon any 
 obstruction in the nose or throat ; this I have often verified 
 by careful inspection of subjects given to snoring. The pre- 
 vention of snoring which is dependent upon disease will only 
 be successful by removing the cause, — removal of all obstruc- 
 tion and the cure of mouth-breathing. 
 
 5. Should a child that hawks or snores use douche or spray ? 
 If so, how often, and what should be used with it ? 
 
 Very young children never hawk ; the act of swallowing 
 repeatedly or coughing takes the place of hawking, and the 
 secretion in the fauces and post-nasal space is generally swal- 
 lowed, as in infants. A nasal douche should never be used for 
 a child except in cases of dry or fetid catarrh, when it is of 
 great use in expelling the retained secretion. A douche used 
 
 ^ Dobell's solution, with a Davidson atomizer, No. 63. 
 K 3 33 
 
386 MOTHER AND CHILD. 
 
 under any other circumstances as a treatment for children is 
 liable to do much harm to the middle ear and increase the 
 cold in the head. As said before, a spray can be used with 
 advantage, but only as often as is compulsory, say once or 
 twice a day, and even then the mildest solution should be 
 used, — one or two grains to the ounce of boracic acid, chlorate 
 of potassium, in glycerin and water, or, better, benzoin or 
 albolene combined with tar-camphor or menthol. Medication 
 of the nasal chambers can be very efficiently instituted by 
 the use of the " Oliver vaporizer." using fluid cosmoline or 
 glycerin, to which may be added such drugs as are suited to 
 the condition. 
 
 6. Please give all the best methods for stopping nose-bleed. 
 
 E"ose-bleeding occurs in the vast majority of cases in chil- 
 dren from a superficial ulceration on some portion of the 
 middle line of the nose, just within the opening of the nostril. 
 This abrasion is caused from picking the nose, the finger-nail 
 or handkerchief scraping ofi" the outer layer of the mucous 
 membrane. This superficial ulcer on the middle line remains 
 unhealed for a long time, by reason of the free motion in the 
 parts in blowing the nose, together with the low vitality of 
 tbis thin mucous membrane covering the cartilage. Aside 
 from injuries (falls, blows, and sharp substances thrust up the 
 nostrils), the ulcer is the source of most of the nose-bleeds. 
 Blowing the nose and wiping it with too much vigor, attacks 
 of sneezing, cough, etc., also bring about the flow. Eemem- 
 bering that the seat of the bleeding is very low down in 
 the nostril, and not high up, as is generally supposed, the ease 
 with which the hemorrhage can be arrested by a little pressure 
 will add greatly to the prompt and successful treatment of 
 these attacks. The finger (if the child's nostril is sufficiently 
 large) can be introduced and pressed up against the middle 
 line of the nose for a sufficient length of time to stop the 
 bleeding. Then, carefully withdrawing the finger and pro- 
 hibiting blowing of the nose will often be sufficient. If the 
 opening of the nostril is too small to allow the finger to be 
 
ACUTE AND CHRONIC NASAL CATARRH. 387 
 
 introduced, enough cotton, wool, or soft sponge can be ]Dushed. 
 into the orifice to slightly distend, the nostril, and pressure 
 made against the outside of the nostril with the finger. If 
 kept up long enough this will often succeed. If the bleeding 
 has been great, or long continued, saturating the cotton with 
 some astringent, such as a loeak solution of alum, tannin, or 
 tincture of iron, will cause arrest of the bleeding much more 
 promptly. Probably the most satisfactory astringent to use 
 on cotton is the watery extract of witch-hazel, familiarly known 
 as " Pond's extract." Saturating the piece of absorbent cotton 
 or sponge and squeezing out about one-half, then introducing 
 into the nostril, will be immediately successful. If there 
 should be too much nervousness to try the introduction of 
 any of these substances, a simpler plan is to apply ice or iced 
 water to the nose, forehead, or back of neck at short intervals. 
 Cold water snuifed up gently will often arrest the hemorrhage, 
 or, if the child is too young to snuff up fluid, it can be squirted 
 up the nostril with a small syringe. If urgent, extract of 
 witch-hazel had better be used, and it will be with the hap- 
 piest effect. It can be used full strength, but is painful, and 
 had better be diluted with water, one-half or two-thirds in 
 very 3-oung children, and in proportion in older ones. The 
 witch-hazel is in most cases entirely satisfactory, but if, after 
 all these methods have been tried, the bleeding continues, a 
 surgeon must be called and the nostrils plugged more perfectly. 
 The position generally assumed in nose bleed — that of holding 
 the head downward over some vessel — is a yqtj bad one and 
 should be avoided. The head should be held more erect, and 
 the blood allowed to flow into a towel, handkerchief, sponge, 
 or absorbent cotton. To make a permanent cure, the ulcer — 
 the cause of the bleeding — must be removed. This will have 
 to be done by one sufficiently skilled to examine the nose care- 
 fully and treat the parts intelligently. The ulcer is often slow 
 in getting well unless carefully managed. If the nose-bleeding 
 arises from some other cause, or during an attack of acute 
 illness, the nose should be promptly examined with a good 
 
388 MOTHER AND CHILD. 
 
 light and the cause discovered and removed by the surgeon. 
 At times, in children of plethoric habit, a small bleeding at 
 the nose need not make the parent feel at all anxious, but it 
 may be looked upon as simply an attempt of nature to get 
 rid of too much pressure in the blood-vessels. 
 
 CHAPTEE XLYIT. 
 
 DISEASES or THE ETi:.^ 
 
 To the laity, almost all inflammations of the eyes of new. 
 born babes are known as " ophthalmia ;" but we want to specify 
 and say that physicians, in a general way, recognize two forms. 
 One caused by cold — the harmless variety — can be easily cured 
 by careful cleansing and the use of astringent washes, such as 
 rose-water or alum or borax (one grain to one ounce of water). 
 The other, a most dangerous and easily-contracted disease, 
 threatens blindness. This latter form is not apt to spread 
 among careful people, at their homes, but at public institu- 
 tions, unless isolated at once, will be sure to sweep through 
 and attack every child. 
 
 Just here we want to call the attention of those interested 
 in " Day Xm-series" where frequently enough care is not ex- 
 ercised. No child with a suspicion of "sore eyes" should be 
 admitted, whatever be the excuse, for physician and manage- 
 ment alike are morally and legally responsible for eyes lost, 
 even though their work be pui'ely one of charity. 
 
 If asked how a baby's eyes should be treated immediately 
 after birth, we would say, certainly not to a dose of soapsuds 
 in the — to be condemned — popular primary scrubbing with 
 which many a poor babe is tortured. The bad colds (snuflles) 
 
 1 For this chapter we are indebted to Dr. Charles S. Turnhull, of Phila- 
 delphia. 
 
DISEASES OF THE EYE. 389 
 
 which attack such over-scrubbed babies affect the eyes, as well 
 as the nose and throat, and often alarm the medical attendant 
 and worry the mother and nurse. 
 
 If, as in such cases, the eye looks red and the secretion be 
 gummy and sticky, Hke the white of an egg, or if a yellowish- 
 white discharge be present, gathering in the corner of the eye, 
 or iDerhaps gumming the lids together, we have a simple (benign) 
 case of inflammation (conjunctivitis), and a soothing eye-wash, 
 composed of 
 
 Borax, five grains ; 
 
 Paregoric, one teaspoonful ; 
 
 Infusion of sassafras pith, eight tablespoonfuls, 
 
 should be frequently applied with a pledget of absorbent cot- 
 ton, and about twice, early in the day, a few drops may be 
 allowed to run between the open lids. 
 
 Should, Jioioever, the eyelids, within the first twenty-four hours, 
 puff up and swell, so that the eye cannot he opened, and particu- 
 larly should the secretion oozing from between the lids he creamy 
 and of a yellowish, pinkish, or greenish color, then look out ; the 
 dread ophthalmia has started} 
 
 Ophthalmia of the new-horn is the disease which contributes 
 so largely to the causes of blindness in our asylums, and calls 
 for the most heroic treatment on the part of the medical at- 
 tendant, and eternal vigilance on the part of the nurse. At 
 this juncture both physician and nurse must incessantly and 
 
 1 Our first anxiety must be for the full dilatation of the pupils, and to this 
 end the doctor -will use one drop of the " atropine solution," put into the 
 eye (at its outer angle) twice each day. 
 
 Atropine, one grain ; 
 
 Water (boiled), two teaspoonfuls. 
 
 The bottle containing these drops should be marked " Poison,'^ and must 
 be kept under lock and key. If after the instillation of one drop of the 
 atropine solution the baby's skin should become red, and look as if it had 
 scarlet fever, it has been poisoned (harmlessly) ; but do not put another 
 drop into the eyes until you have talked with your doctor. 
 
 33* 
 
390 MOTHER AND CHILD. 
 
 conservatively, yet resolutely, attack the disease, and unceas- 
 ingly fight night and day. 
 
 The swelling and inflammation must be combated by cold 
 applications, day and night, made by means of small pledgets 
 of linen, which are lifted cold and wet from a block of ice and 
 laid upon the eye ; but be careful that they cover no more than 
 the burning eyelids. These pledgets will be required to be re- 
 newed frequently, at intervals of from fifteen to twenty 
 minutes. The lids, at the same time, must be gently sepa- 
 rated, and the discharge allowed to escape, or be carefully 
 wiped away with pieces of absorbent cotton, dipped in fresh 
 water or salt, borax, or corrosive sublimate (one to ten thou- 
 sand), to make a weak solution.^ 
 
 Use vaseline to anoint the ej'elids, cheeks, and to grease the 
 e3'elashes (ciha), to prevent their sticking together from se- 
 cretion, which must always be encouraged to escape. 
 
 Sponges are dangerous. jSIever use them. Use absorbent 
 cotton or " lintine," as it is clean and can easily be disposed of 
 Burn it. 
 
 Great care must be exercised that the cold applications be 
 not kept up too long at one time, — i.e., without intervals of a 
 few minutes' rest, say fifteen minutes every two hours. They 
 have only to be continued until the swelling of the lids and the 
 
 ^ The doctor should, in the absence of the apothecary, he willing to per- 
 sonally supervise the daily preparation of a peculiar sort of ^^ antiseptic 
 wash," to which we wish to call particular attention, which we have been 
 using for some years with unusual success in the treatment of purulent 
 ophthalmia of the new-horn. We find this wash invaluable in every case 
 of specific ophthalmia. It is in reality a "mercurial wash" equal to about 
 one to four thousand ; nevertheless, we invariably insist upon the solution 
 being made up according to the following formula : 
 
 Red oxide of mercury (hydrarg. biniodi. rub.), one grain; 
 Iodide of potassium, two grains ; 
 Water (boiled), eight ounces. 
 
 To be used with a pledget of absorbent cotton or in irrigating the eye 
 with a pipette. 
 
DISEASES OF THE EYE. 391 
 
 profuse creamy discharge have disappeared. Be careful also 
 about the ears, and see that no water trickles into them ; also 
 see that the hair be kept dry, and the pillow as well; and be 
 most particular that the patient's and attendant's hands are 
 kept clean and never put near the face, for fear of inoculation, 
 always regarding the discharge and every sort of eye-wash 
 used as rank poison. 
 
 So long as the discharge be creamy, it must be considered as 
 corrosive in its effects upon the eyes (like acid or vitriol), and 
 it is during the first stage, when the swelling is so great that 
 the lids cannot be oj)ened, that the following " anodyne wash," 
 to be repeated (instead of the mercurial wasli) every thiee 
 hours, must be gently squirted (with a round-end medicine- 
 di'02D23er) from the inner (nasal) angle of the fissure between 
 the eyelids, — 
 
 Sulphate of morphine, two grains ; 
 Chloride of zinc, two grains ; 
 Eose-water, ten drops ; 
 Distilled water, five tablespoonfuls. 
 
 Now recollect, such eyes cannot be watched and cleansed 
 and treated up to bedtime and then neglected because the 
 baby or its attendants sleep. Oh no ! Lest the little one's 
 eyes melt away during the night. Long naps are not desir- 
 able neither for the children nor the nurse, as " a good night's 
 rest" has cost many an eye. We repeat, the treatment must be 
 kept up night and day. We have said the secretion is corrosive 
 in its action upon the structures of the child's eyes, and as 
 the eyeball, from pressure of swelling, is damaged, the dis- 
 charge is doubly dangerous. Then, too, the child might turn 
 on one side in its bed, and the discharge, by gravity, would 
 run into and inoculate the fellow-eye. This is not all; it 
 is deadly poison when transplanted to any other person's eye, 
 and nurses, mothers, and medical attendants cannot be too 
 careful. Even the poor laundress often becomes a victim, and 
 this poison has too often been the cause of the loss of valuable 
 
392 MOTHER AND CHILD 
 
 eyes, to which, through ignorance or carelessness, it has, by 
 touch only, been conveyed. Keep the poor little one's excori- 
 ated cheeks and skin, rubbed raw by washing, we repeat, well 
 anointed with vaseline ; so also the edges of the eyehds, nose, 
 and nostrils. Keep pledgets of cotton (not absorbent cotton) 
 in the ears. Keep the patient's strength up by extra and 
 tempting diet, and give the usual fever mixtures, — "sweet 
 spirits of nitre," quinine, and, perhaps, anodynes. 
 
 The baby's sleep will be greatly disturbed, its nervous 
 system racked ; it may take cold, it may become sick, it may 
 die from irritation and exposure. Take the risk, and if you 
 falter in accepting the odds, think of the heart-rending appeal 
 of a pair of sightless orbs. Think that the flaxen-haired girl 
 might be a " bhnd Nydia," or the boy a dependent, helpless 
 man. "We are emphatic, because we have seen the deplorable 
 ravages of the disease we have but partially described : so we 
 ui'gently warn you to immediately care for it, and promptly 
 seek counsel and experience to fight this dreadful disease. It 
 blinds other individuals in families; it blinds children in our 
 asylums, and two or three at a time ; it blinds grand nurses, 
 loving, faithful Sisters of Charity, and even prominent and 
 skilful physicians. 
 
 Unless a physician be at hand to apply local caustic reme- 
 dies himself, ice consider it criminal to recommend such, or, even 
 worse, to order caustic solutions to he dropped into the eyes. The 
 physician only must turn the lids, brush over any caustic 
 solution necessary, and immediately (for fear of over-effect or 
 damage to cornea) wash it off again ; but stronger applications 
 than those we have named must not be permitted for home' 
 use. 
 
 We have only referred to the treatment of individu5.1 cases 
 at home. In asylums, where infants are brought in daily, we 
 insist upon immediate isolation of the child as well as its 
 attendants and their wash. 
 
 If this disease in any case be progressing to a favorable ter- 
 mination, the discharo-e will become less, the swelling" of the 
 
DISEASES OF THE EYE. 393 
 
 eyelids will diminish, and the child will be able to open its 
 eyes. At this stage we commence the use of a slightly-stimu- 
 lating salve, — 
 
 Yellow oxide of mercury, one grain ; 
 Vaseline, three drachms, — ■ 
 
 to be rubbed on the edges of the eyelids about three or four 
 times u day, or just before the babe goes to sleep. Beyond 
 this we cannot advise any other treatment save that which 
 your medical attendant may order. 
 
 We would with this disorder make an exception, and say 
 that without medical advice and guidance "ophthalmia in the 
 new-born" must, as a rule, mean blindness, whether of one or 
 both eyes. In the contagious ophthalmia of asylums, where 
 one sore-ej-ed baby poisons the rest, and where simple yet 
 decided local treatment is required, we particularly commend 
 a peculiar compound called fiffcy-per-cent. "boroglyceride." 
 This is m^de by boiling together boric acid and glycerin — 
 sixty-two parts of the former to ninety parts of the latter — 
 until the product loses weight and weighs but one hundred 
 parts. This, on cooling, resembles in consistency and appear- 
 ance ice or " glacial phosphoric acid," and is found to be very 
 hygroscopic. To dilute it, glycerin must be employed ; and 
 the best method for its preparation is, when freshly made, to 
 add to it glycerin in such proportion as to make a fifty-per- 
 cent, solution. This makes a preparation of the consistency 
 of honey, to which can be added iodine, tannin, resorcin, car- 
 bolic acid, iodoform, morphine, atropine, eserine, etc., as may be 
 desired. 
 
 Ointment of boroglyceride is made after the following for- 
 mula : 
 
 Solution of boro-glyceride, fifty per cent. , two drachms ; 
 
 Vaseline, six drachms ; 
 
 Oil of rose, a drop or two. Make an ointment. 
 
 This makes a thoroughly stable ointment, which . neither 
 becomes granular nor precipitates the boric acid. We feel 
 
394 MOTHER AND CHILD. 
 
 confident that in this compound we have a most valuable 
 remedy, and when called upon to combat the appalling epi- 
 demic, such as so often occurs in our asylums, we feel much 
 more secure — especially in the case of young children — when 
 using this excellent remedy. The fifty per cent, solution of 
 boro giyceride, on account of its great affinity for water, and 
 the rapidity with which it absorbs it and liberates the finely- 
 divided particles of boric acid, not only acts as an astringent 
 but also as an antiseptic. "We believe that it is just the sub- 
 stance that we are in need of for the treatment of all forms 
 of chronic inflammation of the eyelids, especially " contagious 
 or asylum ophthalmia." 
 
 The use of the ointment mentioned we consider an essential 
 j5art of the " boro-glyceride treatment," and it must be con- 
 tinued for at least two months after all discharge has ceased. 
 
 This disease, like every form of ophthalmia, is only trans- 
 mitted by inoculation, and under proper care need not be 
 transmitted even to the fellow-eye. 
 
 What is proper care ? Proper care is such as can only be 
 secured by two skilled and trusty nurses, — the one for the day, 
 the other fur the night, — who are never to leave the patient 
 alone; or, as an extra precaution, better saj' four attendants, 
 so that one of the two on duty will be sure to keep awake. 
 
 As soon as the little sufferer shows the least tendency to open 
 its eyes, it should be encouraged in its endeavors. Darken the 
 room moderately, so that the influence of the bright light does 
 not cause spasmodic closure of the eyelids. The opening of 
 the eye is beneficial in two ways, — the movements of the lids 
 work the corrosive secretion out from between the eyelids and 
 stimulate the circulation in the affected parts. 
 
 When a child opens its eyes the danger is generally over, 
 only we must not relax our vigilance, for a relapse must not be 
 allowed to occur. The ice applications, we repeat for em- 
 jDhasis, have only to be continued until the swelling of the 
 lids and the profuse creamy character of the discharge have 
 disappeared. !N"o child need lose its eyes from purulent oph- 
 
DISEASES OF THE EYE. 395 
 
 thalmia, and no child does, if faithfully treated in the way just 
 described. 
 
 Dr. H. Knapp says he is convinced that nothing is so power- 
 ful in diminishing the violence of this dreadful inflammation 
 as cold, and he is afraid that warmth may temporarily increase 
 it, and favor destruction of the eye ; and says, furthermore, 
 " among all questions in ophthalmolog}', — that of cataract, per- 
 haps, excejDted, — there is none so important as the treatment 
 of contagious ophthalmia." 
 
 Spots like pimples (called pustules) are often seen on the eyes 
 of children during warm weather^ especially troubling those 
 suffering from disordered digestion. These pustules may come 
 on the clear part of the eye (cornea), or upon the while or pink 
 part of the ball of the eye (conjunctiva). They are painful, 
 and cause j)rofuse watering of the eye (lachrymation) and 
 dread of the light (photophobia). The child usually burrows 
 its head into the nurse's shoulder, its pillow, or a chair or sofa 
 cushion, and being fretful and wofully unhappy and uncom- 
 fortable, becomes a frightful (no other word expresses it) care 
 to both nurse and mother. With its head burrowed into a j)il- 
 low, esj)ecially a feather one, it is in the condition of a child 
 with a poultice to boih eyes. The tears wet the pillow, the 
 face keeps it warm, and hourly the eyes grow worse. Such 
 cases must be cared for at once, as the affection lasts from 
 weeks to months, and even years, wrecking the health of both 
 the child and its attendant. By force or persuasion the little 
 one must he kept on its back when in bed in a darkened room. Use 
 a hair pillow. 
 
 The successful treatment of such cases depends upon our 
 ability to be particularly attentive to hj-giene and diet. Megu- 
 larity of feeding (meals), the omission of all forms of starchy and 
 sweet foods, selecting milk, soft-boiled eggs, rare meat, broth, 
 and if it must be, stale (baker's) bread. A sponge-bath each 
 morning we urge as an essential in the treatment of " phlyc- 
 tenular ophthalmia" (keratitis or conjunctivitis), as the doctors 
 call it. This sponge-bath we order for children over two years 
 
396 MOTHER AND CHILD. 
 
 of age, to be given each morning. Sponge quickly with warm 
 or even hot water, and immediately follow with cold water; 
 such cold water as would be about the temperature of ordinary 
 apartments, — i.e., 65° to 70° F. 
 
 Indiscretion in diet is apt to cause a recurrence of the trouble, 
 which as a relapse will always be more severe than the primary 
 attack. We formerly used atroj^ine (belladonna) to dilate the 
 pupils in such cases, but now we use eserine (Calabar bean) to 
 contract the pupils. '&j this means we secure a beneficial effect 
 locally, by making the pupil smaller, and mechanically keep 
 out the light, which is painfully irritating and annoying. The 
 solution we recommend is, — 
 
 Salicylate of eserine, one-half grain ; 
 Water (boiled), two drachms. 
 
 Mark " Poison.'^ Put one drop into the eyes two or three 
 times a day. (Druggists must dispense this solution in dark 
 glass or paper-covered bottles.) 
 
 Keep the apartments well ventilated hut darkened, hence cooler, 
 and take the child out at night, say between sunset and bed- 
 time (10 P.M.). Do not be anxious for fear it may " take cold." 
 Air from fresh water, such as we secure on lake or river (ferry- 
 boat), is especially good. A sun-bonnet is the proper •' head- 
 gear" for children with ii'ritable eyes, be they caused by this or 
 any other inflammatory trouble. Make the sun-bonnet out of 
 " wash goods," with casings into which to slip, in and out, strips 
 of card or pasteboard, which will give the bonnet stiffness. 
 These strips of pasteboard can be removed when the bonnet is 
 washed, and easily replaced. Starched bonnets will not answer 
 for children who use them as eye-shades, as the stiffness will 
 not last any time. 
 
 Permit us in this connection to recommend woven-wire or hair 
 pillows, or, still better, a combination of both, which can be 
 had in this city ; and for baby beds and pillows we cordially 
 endorse this innovation. 'Note how infants and children per- 
 spire when sleeping, and how hot they seem about their heads, 
 
DISEASES OF THE EYE. 397 
 
 and try hair or wire mattress and pillows, and you will have 
 the great satisfaction of making the little ones both comfort- 
 able and more healthy. 
 
 For hums of the eye, drop into the eye clean sweet castor oil, — if 
 by mistake anything has been dropped into the eye, like am- 
 monia or other caustic, or it may be, spilled hot water or tea, 
 or even whitewash, etc., after cleansing as thoroughly as pos- 
 sible. 
 
 Stoppage of the tear-duct (occlusion) accompanying nasal 
 trouble may be temporary, and soon disappear after the use 
 of a wash of ]30wdered borax and water (a pinch to a wine- 
 glass of water), always remembering to anoint the inside of 
 the nostrils with eosmoline or other grease. Continued occlu- 
 sion may cause abscess of the tear-sac at the inner corner of the 
 eye, alongside of the nose. This must have the surgeon's 
 immediate attention. 
 
 Wounds of the eye, either incised and from pieces of flying 
 glass, scissor-points, or fork-tines; cuts or tears from flying 
 fragments of stone or metal, or impinged pieces of stick or wii-e, 
 must not he meddled with. Better not bandage, but devote every 
 effort to keep the child's hand away from its eye. If the 
 doctor cannot be seen within a few hours, ask your druggist 
 for the proper solution of atropine (belladonna), and put one 
 or two drops between the lids. 
 
 In every case, better omit any interference with an injured eye 
 than fight your little patient. 
 
 The rule to-day is not to confine, by tying up or bandaging, 
 all operated eyes : hence the advisability of following the above 
 rule. 
 
 Bleeding (hemorrhage') from the eye usually means a damaged 
 eyelid ; seldom is it that the eye bleeds. Injuries involving the 
 edges of the eyelid call for careful adaptation of the parts, and, 
 if at all possible, the parts must be carefully stitched. If such 
 damaged lids are left to heal, Nature, strange to say, seems to 
 forget herself, and the scar produces a marked deformity, and 
 when the lashes are, by malposition, turned in upon the eye, 
 
398 MOTHER AND CHILD. 
 
 great damage to the member usually results, to say nothing of 
 the discomfort from the scratching of the misplaced eyelashes. 
 Where the cut has at the sam.e time so damaged an eye as to 
 cause its contents to " run out," great pain, usually absent in 
 other grave injui-ies, will call for absolute rest and a soft cotton 
 pledget to close the lids of both eyes ; this pledget to be held 
 in place by a hght cheese-cloth bandage until you can hunt 
 uj) your doctor. 
 
 G,ose both eyes if you would keep one eye at rest. 
 
 Squint, or cross-eye, makes its appearance at any time after 
 the fourth or sixth month. Just as soon as the baby uses one 
 or both eyes the defect should be looked after, because if taken 
 in time but few eases ever come to operation, and in some 
 instances not even glasses will be required. We venture in a 
 general way to promise parents who heed this warning immu- 
 nity from the annoyance of squinting children. 
 
 Paralysis of the upper eyelid, usually congenital, involving one, 
 seldom both lids, must not be allowed to remain uninterfered 
 with, because by covering the eye, squinting and loss of vision 
 are induced (cross eye), and the child's head is given a most 
 unnatural position. The head is constantly tilted backward. 
 Such cases require the surgeon's attention after massage has 
 been given a thorough trial. 
 
 Instinct teaches a child to rub its eyes with its fist. Would that 
 adults would take heed and do the same, and so save themselves 
 from infection from " dii'ty fingers." 
 
 Provide your children v:ith broad-briramed hats or sun-bonnets 
 for protection against the strong sunlight of summer-time, and 
 shade the eyes of the babies, as they lie upon their backs in 
 their baby-coaches. 
 
 Forget about the " alum-eurd" and piece of raw beef as an eye- 
 poultice. Milk of any sort must not be used as an application 
 for the eyes. All these substances are poisonously dangerous. 
 
 Always put your baby to sleep in the dark, and when it awakens 
 admit the light gradually. Do not forget and rush with it 
 into a brilliantly-lighted apartment. 
 
DISEASES OF THE EAR. 399 
 
 No child should go to school before the seventh year. 
 Modern "kindergarten" systems, as a rule, develop eye- 
 defects, and, in our opinion, damage children's eyesight. 
 
 CHAPTEE XLYIIL 
 
 DISEASES OP THE EAR.^ 
 
 The symptoms of earache in a babe are so vague as at first 
 not to be distinguishable from other forms of irritation. Ex- 
 cept slight fever, more or less restlessness, rolling of the head 
 from side to side, perhaps backward burrowing into the pillow, 
 nothing is noticed until the attendant rejDorts a "running ear." 
 The drum or middle ear fills with a watery-like fluid (the 
 watery part of the blood, serum), or it may look like pure 
 blood, which fluid, by pressure, causes more or less severe 
 pain, and subsequently breaks through the drum-membrane 
 and escapes from the ear. Often the perforation closes over 
 night, and apart from the coating of the auditory canal with 
 a whitish residue from the serum, or staining of the external 
 ear from blood, nothing is noticed. The perforation, however, 
 does not always heal. It may remain open for some time, — 
 this being apt to occur in weak or strumous children. In 
 some cases it never closes nor does it materially interfere with 
 hearing-power. 
 
 Discharges from the ear — caused by " taking cold" — behave 
 like, and may be compared to, the discharge from the nostrils 
 under similar circumstances. The secretion is first watery, 
 then thin mucus, followed by thicker stringy or tough mucus, 
 then by " matter" (pus), and last of all badly-smelling matter 
 (fetid discharge). Discharges from the ear should only be 
 
 ^ For this chapter we are indebted to Dr. Charles S. TurnbuU, of Phila- 
 delphia. 
 
400 MOTHER AND CHILD. 
 
 curefully wiped out with plain absorbent or, better, sublimated 
 or borated (the so-called " medicated"') cotton. Do not on any 
 account allow rags or a pocket-handkerchief to be used for 
 cleansing purposes, nor use cotton to plug the ear. When the 
 discharge is offensive there is danger ahead, and if the doctor 
 has not been called, now is the time. 
 
 If a babe seem to have earache, until competent advice is at 
 hand, have resort to the hot foot-hath, and use dry heat to the 
 ear, — the " hot-water bag" or hot salt in a flannel bag ; never 
 forgetting, when the pain is not relieved, paregoric, which drug, 
 properly labelled and directions carefully read, will stand you 
 in good stead. Further than this, your doctor must prescribe 
 all necessary medicines. 
 
 We strenuously object to the use of drops of any kind. 
 Water or other fluids must not be dropped or syringed into 
 the ear. Fluid so used makes a subsequent ocular examina- 
 tion of the ear quite impossible on the part of the doctor, and 
 syringing with water macerates the parts and retards the subse- 
 quent healing process. Healthy babes' " running" ears always, 
 get well if they are kept clean, as directed, and not meddled 
 with : so recollect that sins against the ears of children are more 
 usually those of commission than of omission. 
 
 Soap and water we consider poisonous to the ear, and the 
 picture, familiar to almost every one, usually accompanying 
 advertisements of soap, shows the grandmother washing her 
 boy's ears with soap. It may have been the way "in the 
 olden time," but the expression of the boj-'s face goes to show 
 that nature would teach him to protest, if he dared ; now we 
 are pleading his cause and begging mothers not to allow soap 
 and water to be used. Children naturally rebel, and interfer- 
 ence with their ears is generally a cause of war in the nursery ; 
 and it is just here we wish to put in a plea for the juveniles, 
 and condemn the usual practices of the best-intentioned 
 mothers and nurses. 
 
 In cleansing discharging ears, or attempting to thoroughly 
 free the auditory canal, never swab it out, but use fluffy 
 
DISEASES OF THE EAR. 401 
 
 pledgets of absorbent cotton gentl}' pushed into the meatus, 
 carefully agitate with the little finger, and so long as the dis- 
 charge can be wiped out continue to use pledget after pledget. 
 Never use anything smaller than the little finger, to force cotton, 
 in wiping the auditory canal. Deeper wiping is forbidden in 
 the case of children : the innermost parts will not suffer. In 
 adults, where the secretion mechanically interferes with hear- 
 ing, other methods may be emploj'ed. In larger children or 
 adults Yalsalva's experiment may be employed. This proced- 
 ure, which the aurists term '^ auto-inflation,'" is accomplished 
 by shutting the mouth firmly, holding the nose tightly, and 
 blowing with one's " might and main," so that the air, not 
 being able to escape through the mouth and nose, must be 
 forced up through the Eustachian tube, out of the middle car 
 through the perforation and into the auditory canal, taking 
 with it all the secretion which may block the way. 
 
 In syringing ears, except for collections of wax or of foreign 
 bodies, there is danger, especially in children, from impure 
 water and varying temperature. The auditory canal, in chil- 
 dren, is particularly shoi-t, and another source of danger is the 
 susceptibility of the parts, from anatomical relations ; particu- 
 larly, contiguity of the brain. 
 
 Most discharges from the ear, in our opinion, unless they be 
 sour or fetid, strange as it may seem, must be regarded as 
 harmless in so far as hearing is concerned, provided there has 
 been no meddling, no /watev used, and the general directions 
 just given have been carefully followed. 
 
 J^ow, how can this all-important process be accomplished in 
 the case of children ? In only one way, — by forcible inflation, 
 or by having them blow their noses. Every child shoidd he 
 taught to blow its nose. If it has not been taught to free the 
 nostrils of mucus, its chances of retaining hearing-power in 
 cases of disease of the ear are much poorer than in the case 
 of one who has learned to blow its nose. In using the word 
 child in this connection, we refer to those between four and 
 twelve years of age. Younger than four need no such meddle- 
 aa 34* 
 
402 MOTHER AND CHILD. 
 
 some interference ; older than twelve are more amenable to 
 treatment, as a rule, than adults. 
 
 Our method of inflating the middle ear for children of tender 
 years carries with it no alarm, and it is rather the rule than 
 the exception for us " to have a good time of it" together. 
 First, induce the little one to blow, as if blowing out a light 
 (and if necessary strike a match and show it how to blow 
 it out). Having won the child's confidence, place one end of 
 an ordinary otoscope (substantial piece of black rubber, one- 
 sixteenth-inch hosing, about two feet long) in the nostril of the 
 side to be treated and with the other end in your mouth, having 
 taken the precaution to close the child's other nostril, give a 
 gentle blow or puff to show the child what you propose doing. 
 As the child blows we puff a little harder, and as we grow en- 
 thusiastic over the sport our little one blows vigorously, and 
 we give a forcible simultaneous blow which forces the air up 
 the Eustachian tube into the middle ear. In nine cases out 
 of ten children clap their hands to the ears and say they 
 have heard the air enter. 
 
 Win the confidence of the httle ones by patience, gentle- 
 ness, and tact, and their treatment will be an oasis in the day's 
 practice among adults. 
 
 Because we advocate the educating of all children in the 
 art of blowing their noses, we wish it to be distinctly under- 
 stood that, as a habit, we would condemn it. Children left to 
 themselves, except for the habit of mimicry, would never 
 think of blowing their noses. Our practice, be it in the pri- 
 vate office, hospital, or dispensary, is, as a rule, confined to 
 those children carrying handkerchiefs, which from time to 
 time are more or less vigorously used. Such blowers, as a 
 rule, are our patients for running ears. Those who sniffle all 
 day long, unpleasant as it may sound, or wipe their noses — 
 dreadful as it may seem — on their dress-sleeves, seldom, if ever, 
 are annoyed with running ears. 
 
 Allow us to score a point in this connection. When a child 
 suffers with ordinary influenza, " a cold in the head," allow it 
 
DISEASES OF THE EAR. 403 
 
 to sniffle, nay, urge it to do so (and the same is the case in 
 adults), and take our word for it, the duration of the attack — 
 although made, if possible, more annoying — will be greatly 
 shortened ; the watery secretions will give way to a thick 
 jelly-like collection which will soon change to the natural 
 muciis of the parts, and all of a sudden the " cold" will disap- 
 pear, leaving no unpleasant symptoms such as usually follow 
 in the cases of those who have not moral courage enough to 
 refrain from blowing their noses. 
 
 The great secret in the successful treatment of all discharges 
 from the ears is the recognition of the fact that, so long as the dis- 
 charge is not allowed to ferment, it will not become fetid, seldom 
 ever purulent. 
 
 As soon as the discharge from the ear makes its appearance, 
 something is invariably dropped into it, or, in conformity with 
 custom, it must be " syringed out." Nothing is more damaging 
 to the successful termination of such cases. We would not 
 complain if pure warm water were iised to syringe the ear, or, 
 still better, if a salt}- or alkaline solution were used, but the 
 " Castile soap" is invariably added. Perhaps warm milk may 
 be used. The soapsuds make an irritating solution, the milk 
 one that rapidl}- ferments and becomes acid, so that the audi- 
 tory canal — it may be a warm cavity filled with simple mucus 
 or perhaps serum — is converted into one that is inflamed and 
 filled with a fermenting fluid. What next is done ? A fluffy 
 piece of cotton is rolled into a dense mass and stuffed into the 
 ear. The sour, fermenting, perhaps fetid mass, now corked 
 up, fairly boils, and, where a harmless inflammation was in ex- 
 istence, an active and dangerous one has certainly been started. 
 
 To remedy affections of the ear general surgery has done 
 but little ; in most instances medical men are glad to get rid of 
 " patients with running ears ;" and this, added to the prejudices 
 in the minds of the community at large, and in some of the 
 profession, too, after the injurious effefct of healing or "drying 
 up," as it is termed, discharges from the ear, has caused this 
 affection, through ignorance or apathy, to be much neglected. 
 
404 MOTHER AND CHILD. 
 
 "We cannot, in this connection, omit a quolation from Saunders^ 
 (a.d. 1806 /). He tersely ventures a question or two concerning 
 those prejudices which even to-day, alas ! are urged against 
 the cure of running ears. 
 
 " What argument can be assigned against the cure of this 
 disease that is not equally conclusive against all others? Is 
 any one an abetter of the obsolete humoral pathology? He 
 will contend that the stoppage of a drain which nature has 
 established is pernicious, and the morbid matter will be deter- 
 mined on the internal part ; but how can such person venture 
 on the treatment of any disease, even the healing of a common 
 ulcer? Some years ago I thought this absurd doctrine had 
 been totally exploded, and yet I constantly hear it adduced to 
 deter parties from interfering with this disease. Is a child 
 subject to it, some other subterfuge, equally futile, is employed. 
 The truth is, the disease is alwajT'S tedious and diflficult, and 
 not always curable, and many are disinclined to embarrass 
 themselves with the case who have not the candor to make 
 the true statement." 
 
 "We have often been met with the objection, — and we must 
 confess it is generally well put, — " "Why dry up the discharge 
 from the ear, since, when suppuration is actually taking place, 
 patients, as a rule, hear better?" True enough, as the dis- 
 charge ceases in the ease of a running ear, hearing-power is 
 usually materially diminished ; but we always make the reply 
 by asking the question, " Which is better, half a loaf or no 
 loaf?" That is, had we not better stoj) the discharge and 
 save some hearing which will be permanent, or allow the dis- 
 charge to continue and destroy the parts, and in greater or 
 less time lose all hearing? Then, too, if only for the abolition 
 of the disgusting fetor which accompanies such cases, if for 
 nothing else, it is well worth while risking any fancied exten- 
 sion of the inflammatory process. Children with " running 
 ears" are tabooed by their school- and play-mates. So, like adults, 
 
 ^ Johin C. Saunders, M.D., The Anatomy of the Human Ear, etc. 
 
DISEASES OF THE EAR. 405 
 
 they are tolerated, while, self-conscious of the sickening odor 
 from their ears, they shun society and companions, and imagine, 
 not without good cause, that every one is aware of their in- 
 firmity. The majority of such patients are generally willing 
 to forego the greater or less amount of loss of hearing-power, — 
 usually temporary, — if the offensive discharge can be prevented. 
 
 Beyond a doubt a discharging ear is "a thorn in the flesh!' It 
 must he removed in the shortest possible time. Apart from the 
 risk of damage likely to occur frorn a chronic discharge from 
 the ear, the hearing and subsequent haj)piness of the individual 
 is undoubtedly compi'omised, to say nothing of the unfortunate's 
 health. Fetid ear-discharges run down into the throat and 
 poison the system. This is no fancied deduction, but a fact. 
 By simple cleansing of the ears and teaching our patients 
 how, by Valsalva's method, to blow the air and with it the 
 discharge outward from the middle ear into the auditory canal, 
 which we must keep thoroughly cleansed, we have met with 
 most pleasing results in these same children, who, from pale 
 and emaciated subjects, have grown to be fat and ruddy speci- 
 mens of humanity. 
 
 Again, we are often confronted with the objection that "If 
 the discharges from the ear should be stopped the disease will 
 go to the brain." How did this idea originate? Because 
 heretofore such heroic measures were used to check the dis- 
 charge, because into the ears such caustic solutions were poured, 
 and jDowders were insufflated ; furthermore, because no intelli- 
 gent treatment was employed. In the majority of cases no 
 regular ocular inspection of the parts was ever made, and ex- 
 tension of inflammation and disease to the inner ear, or even 
 brain, resulted. 
 
 The majority of cases of running ears in children under two 
 years of age would recover, and the hearing would not he damaged, 
 if they were simply let alone. 
 
 Now this statement may seem startling, but it is neverthe- 
 less true. Ordinary cleanliness is all that is necessary for the 
 proper management of such cases. In the use of medicated 
 
406 MOTHER AND CHILD. 
 
 solutions to be dropped into the ears of children, the anatomy 
 of the pans must be understood. The auditory canal is short 
 and the Eustachian tubes are patulous, and solutions dropped 
 into such ears of children run directly into the throat. For 
 this reason, if for no other, the syringe should not be used. 
 
 Admitted that nothing but pure water has been used, even 
 this is too irritating for the ear, Eustachian tubes, and fauces, 
 for it must not be forgotten that the mucous membrane or lining 
 of the drum or middle ear serves the purpose of the periosteum, 
 the same membrane that covers and nourishes the bone. 
 Those who have accidentally gotten water up the nose will 
 recall its unpleasant iriitating effect. 
 
 After scarlet fever, measles, diphtheria, whooping-cough, 
 chicken-pox, bronchitis, etc., dentition (cutting teeth) is the 
 most fruitful source of running ears, and the tendency of all 
 such cases is to recover without damage to hearing, provided 
 they be kept clean and nature be given a chance. 
 
 How should the ears be kept clean ? 
 
 We want to impress upon parents, and those who are to ad- 
 vise them, the necessity of using the utmost care in the art of 
 cleansing the ears of children. Wax (cerumen), with which 
 nature has furnished the auditory canal, is usually swabbed out 
 weekly, if not oftener, with the twisted corner of a towel, 
 handkerchief, or wash-rag soaked with water or soapsuds ; 
 and more frequently than is supposed a pin or hair-pin is 
 called into requisition. By these means the wax is pushed in 
 and well rammed down layer after layer, and at each washing 
 a layer of desquamating epidermis is added (as cow's hair is 
 to the mortar), and this serves to bind the mass together and 
 make its removal more difficult. Water and wax will not mix. 
 
 Masses of wax or dried skin — in fact, all sorts of foreign sub- 
 stances, pushed into the ear by unsuccessful attempts at 
 cleansing with the wash-rag, etc., or foreign bodies designedly 
 placed in the ears by children — is often the cause of a most 
 distressing cough, for wbich the little ptxtient is mercilessly 
 dosed. " Ear-cough,'" to the experienced, is quickly recognized 
 
DISEASES OF THE EAR. 407 
 
 as peculiar and spasmodic, and observant children often com- 
 plain of a tickling or irritation in the throat, just below and 
 behind the angles of the jaw, which symptom — and perhaps 
 accompanying deafness — must point to the ear as a cause. 
 
 Impacted wax, with but few exceptions, is ftjund only in the 
 ears of those who have had water, soap and water, or wet 
 cloths used to cleanse their ears from what is usually called 
 " dirt," and what we must recognize as absolutely essential to 
 perfect hearing and a healthy condition of the ears. Such 
 masses must be first soaked by the instillation of a warm 
 alkaline solution (baking soda, one teaspoonful to one teacupful 
 of warm water) ; these can always be safely removed by syring- 
 ing with warm water, which procedure is the only one in which 
 we consider the use of water permissible ; even hero, however, 
 had water not been injudiciously used in the first place the 
 wax would never have become packed. 
 
 In case it becomes necessary, on account of superfluous wax 
 or the lodgement of dust, to wipe out the auditory meatus, it 
 should be done with a damp towel, or a dry soft cloth, preferably 
 a soft gi'easy rag. Wc prefer to allow the children to manipu- 
 late the greasy rag, as the size of their fingers just suits their 
 ears. 
 
 About Foreign Bodies in the Ear. — Children seem especially 
 possessed with a mania for placing buttons, beads, seeds, pebbles, 
 etc., into their ears, and the majority of doctors are prone 
 to attempt to spoon, gouge, or .dig them out. Whosoever 
 attempts the removal of any foreign body from the ear of a 
 child by any other means than the syringe and warm water, 
 and, if the child be frightened, without the use of an anaes- 
 thetic, certainly shows great want of experience or heed to 
 the warning of those who are able to advise. 
 
 For living insects in the ear pour in oil, or even water. Pref- 
 erably oil, even '' kerosene." Drown first and subsequently 
 remove by syringing. 
 
 Now that we have the petroleum products, — vaseline, cos- 
 moline, and fluid cosnioline, — all of which have the charming 
 
408 MOTHER AXD CHILD. 
 
 recommendation of never fermenting, we never order anything 
 else to be dropped into the ear ; other oils usually distilled 
 must be omitted, because such vegetable products as olive and 
 almond oils act, sooner or later, as irritants. 
 
 Except for earache in larger children and adults, we use the 
 following preparation, which we designate " earache drops"' 
 (the aromaties contained prevent the small proportion of 
 almond oil from fermenting) : 
 
 Cocaine muriate, two grains ; 
 " Baume tranquille," three drachms. 
 Put a few drops into the ear with a glass dropper, previously heated 
 
 "by dipping in hot water. 
 
 Babies should aliuays wear an under-flannel cap, and larger 
 children should wear bonnets during the cold weather, which may 
 be made of any warm material to suit the taste. These 
 should tie under the chin and protect the ears. Too frequently 
 warm caps are worn during the week and to school, while on 
 Sunday, as well as on high days and holidays, is substituted a 
 gorgeous hat, which leaves the head and ears unprotected. 
 Especially necessary is a warm cap for a child who has suf- 
 fered from ear-disease. 
 
 On no account should cotton ever be worn in the ears. Why ? 
 Because it acts like a cork, prevents the ventilation of the ears, 
 and acts only as an irritant. 
 
 A Child with a Munning Ear may go out in Cold Weather. — Un- 
 less there be actual pain present or commencing inflammation 
 of the ears, a child should be warmly dressed and sent out just 
 as usual. Housing of children with running ears is more apt, 
 by engendering ill health and disordered digestion, to do harm 
 rather than good. If the feet are kept dry and warm, fresh dry 
 air is to be especially recommended, with out-door exercise." 
 
 Parents cannot be too observant in looking after their chil- 
 dren. Apart from the many specific directions given in this 
 book, let us ask you to notice the children when they are sleep- 
 ing. Is the little one's face in placid repose ? Is the mouth as 
 
DISEASES OF THE EAR. 409 
 
 well as the eyes shut ? If the mouth be open and your child 
 not suffering from a recent influenza, it is a " mouth-breather." 
 Why a "mouth-breather?" Because air does not enter the 
 lungs through the upper air-passages. Think of it! If you 
 were to close the child's mouth it would smother. The obstruc- 
 tion to breathing must be in the back of its nose, or perhaps 
 caused by enlarged tousils just back of the tongue. What harm 
 if it does sleep with its mouth open? First of all, the mouth 
 becomes parched and dry, the teeth and tongue are covered 
 with sordes (dried secretions). The arch of the upper jaw, 
 into which the teeth are set, from pressure of the upper lip of 
 the gaping mouth, is pressed upon and does not develop prop- 
 erly. As a consequence, the several portions of the mouth and 
 nose become deformed, and the results of chronic inflammation 
 of the delicate parts therein contained, by enlargement, induce 
 many forms of disease of the ear. The roof of the mouth be- 
 comes vaulted. Notice your child at play, and, unlike its 
 comrades both in repose and action, the mouth is still open. 
 Surely your child's voice has a nasal twang. 
 
 It may be that your child has had several falls or suffered 
 a number of injuries to its nose. These in turn will catise 
 mechanical obstruction, and make a " mouth-breather" out of 
 your child. 
 
 Some children, if not directly after birth, certainly within 
 six months, give evidence of nasal and post-nasal obstruction, 
 mostly caused by the various forms of adenoid growths which 
 have their origin and spring from the posterior, wall of the 
 pharynx (supra-post-nasal space). For such troubles we must 
 invoke the aid of the rhinologist and laryngologist. The " nose- 
 man" it is who must exercise his skill. 
 
 After years of experience we are fully satisfied that we are 
 but commencing a new era in the treatment, nay, in fact, the 
 intelligent comprehension, of most of the diseases of the ear. 
 The majority of such cases are not, as is usuallj^ erroneously 
 supposed, due to some local cause commonly supposed to have 
 its origin in the throat, and usually explained as an extension 
 s 35 
 
410 MOTHER AND CHILD. 
 
 of reflected inflammation from the mucous membrane of the 
 lungs, pharynx, or nose, but are distinctly traceable to an error 
 in the mechanism of the action of the Eustachian tubes and 
 their muscles. We are anxious to place ourselves on record when 
 we state that eight out of ten cases of aural disease are due to 
 nasal obstructions. Unless the aurist be skilled in the treat- 
 ment of diseases of the nose, he might as well give up the 
 successful treatment of diseases of the ear. This is throwing 
 a shell into the camp of the otologist. We throw down the 
 gauntlet. His armamentarium of ten years ago must in great 
 part be laid aside. About half the instruments used but five 
 years ago may bo put on the shelf with such curios as the 
 bivalve aural speculum. Eustachian bougie, etc. We have but 
 to study the function of the Eustachian tube, have in mind its 
 condition during the act of deglutition, and critically note the 
 effect that mechanical opening or closing of the nostrils will 
 have upon the membrana tympani, and in turn the ossicles, — 
 in short, the middle ear (tympanum), — and note for ourselves 
 the peculiar feeling induced in our perfect cars. Just by way 
 of experiment, kind reader, hold your nose closed and swallow ! 
 How do your ears feel ? 
 
 We have had particular reference to diseases of the ear in 
 infants and children, finding it impossible, in passing, to neglect 
 the adult, and have confined ourselves to the study of the 
 practical, common-sense treatment, such as hygiene and our 
 experience lead us to commend. 
 
 In conclusion allow us to say that, in prescribing for the ear, 
 entirely too much guesswork is indulged in, and by waiting 
 too much precious time is lost. Do not be hoodwinked when 
 a sage tells you that a child will " outgrow'' deafness or a dis- 
 charging ear. It is recklessness — and this is putting it very 
 mildly — for any one to prescribe for an ear without having first 
 made a careful ocular examination of it, and those who order 
 anything to be dropped into the ear, or order an ear to be 
 syringed before making an ocular examination, you may 
 depend upon it, are not to be trusted. 
 
DISEASES OF THE THROAT AND AIR-PASSAGES. Ill 
 CHAPTEE XLIX. 
 
 DISEASES OF THE THROAT AND AIR-PASSAGES. 
 
 The diseases which probably cause the most alarm among 
 mothers, and justly so, are those which affect the throat ; 
 especially when there is the slightest possibility of the dis- 
 order being either diphtheria or membranous croup. We pro- 
 pose to give in as simple language as possible, so that it can 
 be readily understood, a description of these various acute 
 diseases of the throat in children, not for the purpose of 
 enabling the mother or nurse to make a diagnosis, — that is 
 not her business, — but simply to enable her to carry out thor- 
 oughly, conscientiously, and intelligently the nursing which 
 forms so important a part in the treatment of these diseases. 
 Undoubtedly, in times gone by, children suffered very much 
 more from croup than they do at present. The change in 
 this respect has been brought about by the doing away with 
 the short-sleeved and low-necked dresses of children, and 
 the thorough understanding of the fact that in a climate as 
 changeable as ours the whole surface of the body, from the 
 neck to the feet, should be protected from the sudden chilling 
 of the surface by wearing a garment, bo it ever so thin, of 
 either wool, or wool and silk mixed, the j^ear round. 
 
 We hear a great deal of diphtheria, and it is well for us to 
 understand what is meant by this term. The word has been 
 applied to a disease which is characterized by a deposit upon 
 the throat, and, consequently, every time a deposit is noticed 
 upon a child's throat it is at once thought to be diphtheria. 
 The uneducated but avaricious (so-called) " doctor" applies the 
 term diphtheritic to all mild and readily-curable affections of 
 the throat, to his advantage. What really constitutes this 
 dreaded disease is a profound constitutional poisoning, caused 
 by exposure to sewer-air, polluted water or milk, exposure from 
 
412 MOTHER AND CHILD. 
 
 contagion of the same disease, by which the system is pro- 
 foundly poisoned with the local trouble, manifesting itself in 
 the throat, larynx, or air-passages. A child may have diph- 
 theria without any appearance of membrane in its throat ; then 
 again deposits may be found on the tonsils, as in quinsj', which 
 is not diphtheria at all ; but, for the sake of caution, children 
 affected with sore throats should be isolated until seen by the 
 doctor. Those who are well should not use the same spoon or 
 drinking-cup as those that are ailing; this applies to adults 
 as well as to children. 
 
 There are mild forms of diphtheria, affecting adults, during 
 which the constitution is not sufficiently affected to prevent 
 their going about their daily avocations, and such individuals 
 are beyond a doubt the means of carrying contagion to those 
 with whom their breath comes in contact. There is no doubt 
 hut that many times diphtheria, a?id other diseases even worse, are 
 carried to children by the foolish and useless practice of kissing to 
 ichich the poor little ones are subjected. It seems strange that a 
 child who will be protected most energetically from draughts, 
 from every form of open contamination, will be permitted to 
 come in direct contact — the most thorough means of propa- 
 gating contagion — with diphtheria, whooping-cough, scarlet 
 fever, a:nd worse, by kissing. We ^well upon this, because we 
 feel that parents should instruct their nurses to prohibit chil- 
 dren being kissed by other children and by strangers. 
 
 A sore throat should always be looked upon with suspicion 
 in a child, and carefully treated ; and especially if the child's 
 neck is swollen on the outside, the glands enlarged, should 
 there be a coated tongue, offensive breath, and gTeat prostra- 
 tion. No one should attempt to treat a case of this kind 
 without immediately consulting the doctor ; it is a recognized 
 fact that should by chance the little patient have been ex- 
 posed to sewer-air from a defective stationary wash-stand in 
 the bedroom, or from the bath-room or closet, a simple catarrh 
 of the throat from cold will allow the diphtheritic germ, or 
 whatever the poison may be, to be engrafted upon it or be 
 
DISEASES OF THE THROAT AND AIR-PASSAGES 413 
 
 absorbed into the system, and the only means of counteracting 
 its influence "vvould be the most active local treatment to the 
 throat, and j^lacing the child upon stimulants and medication 
 that will strengthen it. 
 
 Whenever a child complains of a sore throat and there 
 seems to be redness of the throat inside, or the tonsils become 
 swollen and the child complains when swallowing, has a cough, 
 it is always safe and indeed a proper thing to spray the throat 
 and nose with some mild solution that will at once cleanse 
 and soothe it. This will never interfere with the doctor's 
 treatment, and can be done before the doctor comes. The 
 best forms of atomizers that we know of, and one of which 
 should be in every household, are the Davidson small hand 
 atomizer and the Burgess atomizer, which are valuable for 
 spraying the throat an4 nose, and that of Oliver, a more 
 expensive one, but the very best so far made for inhaling 
 lime-water or such substances as are used in cases of croup. 
 A solution known as " Dobell's solution" can be used in these 
 cases ; also in cases of whoo]Ding-cough, or in all forms of sore 
 throat. 
 
 There are many diseases of children that are accompanied by 
 sore throat, or sore mouth, which require constant cleansing 
 of the mucous membrane, or the deposit, or mucus, will accu- 
 mulate, become offensive, or finally, as in diphiheria, become 
 putrid. Great attention should be paid to the slightest throat- 
 ailments of children, because an irritated throat is often an 
 opening for the entrance of infectious disease. 
 
 A child complaining of difficulty of swallowing should under 
 no circumstances be allowed to go out of doors, especially if 
 the weather is damp or at all raw or cold. The throat should 
 be gently sprayed with the solution just mentioned, and some 
 counter-irritation made to the outside, using St. John Long 
 liniment, or simply rubbing with vaseline, sweet oil, or cod-liver 
 oil. If the child's voice is slightly muffled in speaking, if it 
 speaks through its nose, should there be tenderness upon press- 
 ure and slight enlargement of the glands under the angle of 
 
 85* 
 
414 MOTHER AND CHILD. 
 
 the jaw, on one side, and the attack come on suddenly (in an 
 older child with a chill or high fever), the probability is that the 
 attack is one affecting the tonsils, — one of quinsy. The house- 
 hold remedies lo be used in such a case would be a fever-drink 
 of two teaspoonfuls of spirits of Mindererus (liquor ammonite 
 acetatis), one teaspoonful of sweet spirits of nitre to half a 
 glass of water, sipped at frequent intervals, for a child about 
 five years of age. The feet should be put in a hot mustard- 
 bath and the stockings kept on afterwards, the throat sprayed, 
 the child allowed small pieces of cracked ice ; the food for at 
 least twenty-four hours should consist of beef-tea or chicken- 
 broth, or probably still better, if the child will take it, milk 
 and lime-water, or Yichy water, half and half In all these 
 acute throat-troubles of children we have found the early appli- 
 cation of a handkerchief wrung out in cool water, tied round 
 the throat like a cravat and covered by oiled silk, of very 
 great service. This treatment will often avert an attack of 
 croup. Throat-troubles in children are by far too serious to 
 allow any time to elapse before receiving the most thorough 
 treatment ; when a child complains, it is far better to send at 
 once for the doctor. 
 
 CROUP. 
 
 There are some children who are particularly liable to 
 croup : it seems a family characteristic. Boys are more apt 
 to have it than girls, — possibly because they are more ex- 
 posed; indeed, the tendency to "harden" children by letting 
 tbem go barelegged, or with low necks and short sleeves, will 
 sooner or later bring either a bad attack of croup, or bronchitis, 
 as a consequence. Children who go constantly, as do many 
 of the poor, without shoes or stockings are not as apt to con- 
 tract these catarrhal diseases as those who temporarily have 
 their feet exposed to cold, sudden changes, or dampness ; but 
 the child who is overdressed will perspire and be as liable to 
 attacks of croup or bronchitis as one who is insufficiently 
 
DISEASES OF THE THROAT AND AIR-PASSAGES. 415 
 
 dressed. What is ordinarily known as croup is that affection 
 which comes on suddenly at night, accompanied by a dry, 
 ringing cough, difficulty in breathing, and all the evidences of 
 threatening suffocation, without any marketl previous symp- 
 tom. It usually occurs at night. The child will wake from sleep 
 with all the symptoms that are most terrifying. Its evident 
 spasmodic character has given it the name of spasmodic croup. 
 It may be the result of cold or of an overloaded stomach, and 
 children who ai-e subject to this affection should not be 
 allowed heavy suppers. 
 
 Although the breathing is greatly interfered with during 
 this attack, the sounds are ringing, the cough sonorous and 
 brassy and loud ; this is an important matter, as it shows 
 there is no deposit of membrane to muffle the sound. The 
 treatment of such a case should be as follows : a sponge 
 wrung out in water as hot as can be borne by the child 
 should at once be tied round the throat, and kept there by u 
 towel, or, better, oiled silk or rubber sheeting ; the feet and 
 legs as far us the knees should be immersed in a hot bath con- 
 taining a few teaspoonfuls of mustard flour, and be kept in 
 the water for at least fifteen minutes, then thoroughly dried, 
 and a pair of stockings put on. The child should be given a 
 half-teaspoonful or a whole teaspoonful of syrup of ipecac, — 
 the latter if the child is over four years of age,— followed by 
 a drink of water every fifteen minutes until it vomits; after 
 which the spasms will cease, and the child will turn over from 
 exhaustion and sleep the remainder of the night. A powder 
 of half sugar and half alum, given in teaspoonful doses or 
 given with the ipecac, will hasten its emetic action. If the 
 child is anxious and restless after the attack of croup has 
 subsided, sleep seems impossible, or some cough still remains, 
 for a child from a year and a half to two years old, ten 
 drops of paregoric in a teaspoonful of glycerin, repeated in an 
 hour, will have a quieting effect, or ten drops of sweet spirits 
 of nitre in a little sugar and water can be given every half- 
 hour or hour until the child is quiet. If the bowels have 
 
416 MOTHER AND CHILD. 
 
 not been moved during the day, or are constipated, an injection 
 of warm suds will frequently bring relief. 
 
 Possibly after a good sleep the next day the child will be in 
 ordinary health, without any marked evidence of exhaustion 
 from the attack of the previous night; or it may droop 
 slightly, have an occasional cough which is rather ringing, 
 or the appetite may be impaired. If such is the case, it 
 would be well to give the child a dose of castor oil, and by 
 all means keep it in the nursery. If the child is over a year 
 old, give it from five to ten, or if three years old, fifteen, 
 drops of the aromatic spirits of ammonia, every three hours. 
 If children who have a tendency to hoarseness and croup 
 have their feet washed in cool water every night before 
 retiring, they will often escape an attack. It should also be 
 borne in mind that it is not essential that a child should have 
 a bath every day, as some mothers believe ; if the weather is 
 damp or raw, and the child at all drooping, the surface should 
 be quickly sponged with salt water, simply for cleansing, 
 and the circulation increased by thorough I'ubbing with a 
 soft towel. We think if the custom — which seems to be a 
 cast-iron one with many mothers — of bathing children every 
 day and taking them out in all kinds of weather were occa- 
 sionally discontinued, there would not be so man}- sick children. 
 
 MEMBRANOUS AND DIPHTHERITIC CROUP. 
 
 There is no disease more appalling, or that seems more 
 strenuously to resist all efforts at successful medical treat- 
 ment, than that form of croup which is accompanied by 
 thick mucus in the air-passages of the larynx, or by diph- 
 theritic membrane. When speaking of diphtheria we dwelt 
 upon the fact that it is a constitutional blood-poisoning which 
 may exist without the presence of membrane in the throat, 
 and also that the membrane, when it does exist, need not 
 be limited to the portions of the throat that we can see, 
 but may extend over the whole surface of the mucous mem- 
 brane down to the lungs and upward into the nose; indeed, 
 
DISEASES OF THE THROAT AND AIR-PASSAGES. 417 
 
 when it does so, it clings firmly to the mucous membrane, 
 leaves a raw surface when detached, and if allowed to remain 
 acts as an obstruction to the entrance of air, or decomposes, 
 becomes putrid, and in this way acts still further as a poison. 
 For these reasons the spraying of the throat with an alkaline, 
 antiseptic solution, such as Dobell's solution, which softens 
 the membrane and prevents its decomposition, has been recom- 
 mended in the most trivial throat-complaints as a precau- 
 tionary measure while waiting for the doctor. 
 
 Membranous croup is recognized to be of two varieties, — 
 one the result of catarrh, when the obstruction is caused by 
 very thick mucus in the larynx, which may become tenacious 
 like membrane, and the other due to the deposit of diphtheritic 
 membrane, which may be found in connection with the deposit 
 in the other parts of the throat, or may be simply limited 
 to the air-passages. A child with membranous croup will 
 probably be ailing for a few days; its cough will at first be 
 croupy, its voice will become husky; the cough will cease, 
 or nearly so; the breathing will become labored, and, finally, 
 will be plainly heard at a distance. The child will show by 
 its movements that there is narrowing of the passage in its 
 larynx; the nostrils will dilate with each inspiration; the 
 child will breathe with its mouth open; it will desire to sit 
 up, so as to get all the air possible ; the lips will become 
 blue, owing to the interference with the circulation ; the child 
 will become anxious, restless, appealing to every one around 
 it for relief; it will refuse food, but will drink water in sips. 
 If the obstruction continues or increases, the extremities 
 become cold, the pulse rapid and at times irregular ; and 
 finally, if nothing is done for the relief of the child, it will 
 gradually die of asphyxia, or a sudden shutting oif of the 
 supply of air. 
 
 A peculiarity of the breathing in obstruction of the larynx 
 
 is the contraction, or sinking in, of the lower portions of the 
 
 ribs, or pit of the stomach or epigastrium (in health these 
 
 parts expand), and the marked depression, or sucking in, of 
 
 bb 
 
418 MOTHER AND CHILD. 
 
 the lower portion of the neck, just above the breast-bone. 
 But probably" eight cases out of ten of membranous croup 
 with which one comes in contact are due to a diphtheritic 
 blood-poisoning, which we may attribute, in our larger cities, 
 to defective stationary wash stands in the sleeping apartment 
 or nursery, absolutely conveying the most poisonous form of 
 sewer-air from a bad cesspool or drain directly to the infant's 
 room. One should never rest assured that the trap of the 
 bath-tub, or its overflow, is secure, or that of the stationary 
 wash-stand in the child's nursery or sleeping apartment ; these 
 should be banished to an adjoining room, where they may have 
 free communication with the fresh air, and should be well 
 supplied with some form of disinfectant, as Labarraque's solu- 
 tion. But then, again, ti child with a slightly sore throat 
 may be exposed to the gases coming from an open sewer, 
 or to the air supplied to a furnace, which is passed over 
 putrefying matter, or to stagnant water in the cellar ; to the 
 breath of one convalescent from the disease, or w^ho has it in 
 a mild form (communicated by kissing). In addition to these 
 causes, millc, when mixed with water which has been contam- 
 inated by sewage, has been known to produce this disease. 
 For the«e reasons the catarrhs, especially of the croupy kind, 
 however slight, should be attended to at once in children, as 
 they constitute a point of entrance of the diphtheritic poison 
 into the system ; and as children over a year old are very 
 much more subjected to the sudden changes that produce 
 these catarrhs, all forms of membranous croup are more apt 
 to take place at that time. 
 
 Let us dwell for a few moments upon the nursing of such 
 cases. There are two facts most important to bear in mind as 
 causes of death : the one, the interference with the entrance 
 of air into the larynx or air-passages ; the other, the poisoning 
 of the system and the weakening of the heart which accom- 
 pany diphtheria, and cause the patient to more readily succumb 
 to the influences of deficient aeration. 
 
 If a child has a croupy cough during the day, with rapidity 
 
DISEASES OF THE THROAT AND AIR-PASSAGES. 419 
 
 of breathing and slight fever, no time should be lost in influ- 
 encing the mucous membrane, establishing secretion, and thus 
 
 giving relief. The child should be kept in its nursery ; and we 
 may say that in all cases of bronchitis or pneumonia, and even 
 croup, when it has to be lifted constantly from its bed, or cannot 
 
420 MOTHER AND CHILD. 
 
 be comfortable for any lengtb of time in one position, the child 
 should have a long flannel wrapper, extending much below its 
 feet, that can be oj^ened in front and at the back, with high neck 
 and long sleeves. It is absolutely necessary that the air of the 
 nursery be not only pure but warm, the temperature about 80° 
 F. The air should also be moist, and for this purpose some ar- 
 rangement must be made to have a constant supply of steam ; 
 this can be done by placing a kettle on the stove, if there is one 
 in the room, or if not, by using a teakettle with a lamp under 
 it. If the case seems to be one of more than an ordinary slight 
 cold, no time should be lost in causing the vapor of an alkali 
 to come in contact with the mucous membrane, and there 
 is none better for this purpose than that which comes from 
 slaked lime. Lime can be placed in a bucket beneath or beside 
 the child's crib, and the crib covered over with a sheet in the 
 form of a tent, allowing the vapor to accumulate within. If 
 the child is only satisfied when on the mother's lap, the vapor 
 can readily be brought in contact with it by throwing the sheet 
 over the bucket and extending it over her own shoulder. The 
 advantages of the vapor from lime are its moisture, its warmth, 
 and its alkalinity; and if membrane should form in the throat, 
 lime-vapor honey-combs it the same as lime-water does the curd 
 of milk. The Arnold steam-sterilizer has fitted to it an arrange- 
 ment for conveying the steam, in such cases, to a canopy placed 
 over the crib to form a tent. An excellent and ingenious de- 
 vice for domestic use that we saw recently consisted of an um- 
 brella opened over a baby-carriage, in which the child was placed, 
 and the whole covered with a sheet. The steam was con- 
 veyed by a long piece of rubber tubing attached at one end to 
 the spout of a teakettle placed on the coals in an open grate. 
 If the child seems to suffer very much from the obstruction, — 
 that is to say, if the breathing becomes rasping, — the spray from 
 an atomizer (and a steam one is much to be preferred) should 
 be used constantly; or if the child is old enough, it can probably 
 for several minutes at a time inhale the vapor from the Oliver 
 vaporizer. The solution to be employed in these cases .is one- 
 
DISEASES OF THE THROAT AND AIR-PASSAGES. 421 
 
 half lime-water and one-half Dobell's solution, or if two vapor- 
 izers are in use, as should be the case, so as constantly to have 
 some form of steam inhaled, one solution should be of turbid 
 lime-water, made by adding a teaspoonful of liquor potassce to 
 two ounces of lime-water. Early treatment in these cases 
 is so important that we do not hesitate to suggest that the 
 mother or nurse, if she cannot get the advice of a physician 
 at once, should lose no time, but place the child under the 
 following treatment until the doctor arrives. 
 
 If the child's croupy cough or hoarseness should continue 
 during the daytime, even after the hot foot-bath and the warm 
 applications to the throat (flannel wrung out in hot vinegar 
 and water and covered by oiled silk), the following fever mixt- 
 ure, which will possibly also loosen the cough, should be given 
 until the doctor's arrival : 
 
 Solution of acetate of ammonium, one ounce and a half; 
 Solution of citrate of potassium, one ounce ; 
 Compound syrup of squill, one drachm ; 
 Simple elixir, sufficient to make three ounces. 
 A dessertspoonful in water every two hours for a child of two years. 
 
 Should it be impossible to get a doctor (and only in such 
 event, for the matter is a serious one), the administration 
 of an emetic may be important if suffocation seems immi- 
 nent. If the child struggles for breath, if its face becomes 
 bluish, its extremities cold, and the other signs of which we 
 have spoken exhibit themselves, a half-teaspoonful of alum, 
 with the same quantity of powdered sugar, or given with 
 water, will be the safest emetic. A harsh emetic, such as 
 ipecac, may disorder the stomach without a correspondingly 
 good effect ; indeed, may increase the debility, and should not 
 be given without the doctor's advice. In addition to this, a 
 child of over a year should take, at least every hour, five 
 drops of the aromatic spirits of ammonia, in water. 
 
 Warmth and moisture should be applied to the chest and 
 throat. Some physicians recommend the use of a material 
 
 36 
 
422 MOTHER AXD CHILD. 
 
 that will readily absorb large quantities of liquid; a mass of 
 lint or folds of flannel or a sponge, soal^ed in warm water 
 (wi'ung out to prevent its dripping), may be connected by 
 shoulder-straps and tapes at the side, placed on the front and 
 back, and covered with oiled skin; this should be changed 
 about twice a day or oftener. Care should be taken when the 
 change is made ; it sbould be done by placing the. hand beneath 
 the wrapper, and without exposing the child's chest at all. 
 Others prefer ordinary flaxseed poultices, made in the same 
 way. Our own preference is for two flannel bags filled with 
 hops and quilted ; these can readily be attached by safety- 
 pins on the outside, and thus kept in place ; oiled silk can be 
 stitched on to each one, so as to prevent evaporation, and 
 these bags can either be wrung out in water or some soothing 
 or stimulating liniment, as the occasion requires. 
 
 The child's diet must be carefuU}- attended to. It should be 
 encouraged to drink freely of milk and lime-water or Vichy 
 water, chicken-broth or beef-tea, or, if it prefers it, small 
 quantities of beef-juice, or beef extract or peptonoids. Wine- 
 whey, in cases where there seems to be debility, is absolutely 
 essential ; or a teaspoonful of port wine, whiskey, or brandy, 
 in water, should be given every three or four hours. Pep- 
 tonized milk is a most valuable article in such cases, and if 
 there be diffictilty in swallowing, the nourishment may be 
 given in this form by the bowel. The peptonizing-tubes can 
 be had. with full directions for their use, at any drug-store. 
 
 In regard to the feeding of sick children, absolute regularity 
 and accuracy must be observed in their diet. The food should 
 be of the most nourishing character, requiring least digestion, 
 and in as small bulk as possible. There should be a schedule 
 kept of the exact amount, and when given, so tliat the doctor 
 may judge as to whether the child needs more or less in 
 the twenty four hours. In some diseases, such as diphtheria 
 and typhoid fever, the child's life depends on this systematic 
 nourishment. In the latter, the dietetics form the most im- 
 portant consideration, because for a long period (at least 
 
DISEASES OF THE THROAT AND AIR-PASSAGES. 423 
 
 three weeks) the cbild"^ life is to be sustained by a diet so regu- 
 lated that it will give all possible nourishment and at the same 
 time not unduly stimulate the moving of the bowel or act as 
 an irritant to tho^e portions which are already inflamed or 
 ulcerated. In the nursing of diphtheria, the most important 
 points to bear in mind are, first of all, that it is a disease capable 
 of being greatly modified by careful treatment and nursing ; 
 that it is directly contagious by means of contact with the 
 membrane ; that systematic nourishment and stimulation are 
 absolutely essential. 
 
 Indeed, all continued eroupy coughs should be looked upon 
 as serious, even should no evidences of diphtheria be detected 
 in the throat. Recently the great facility with which a tube 
 can be introduced through the mouth into the larynx has been 
 demonstrated, with the result of a great saving of life. It is 
 an operation devoid of the horrors attendant upon opening 
 the trachea, and can be made use of very early in the case, 
 before the child is exhausted and the air-passages are filled 
 with membrane or thick mucus. 
 
 Whether due to diphtheria or not, the treatment and nursing 
 of membranous croup are practically the same. A child suffer- 
 ing from this disease should have its throat washed and sprayed 
 frequently with an antiseptic cleansing solution, such as Do- 
 bell's solution or listerine, twenty drops in an ounce of water, in 
 order to prevent decomposition of the membrane ; the air that 
 it breathes should be pure, and at the same time charged with 
 those materials that soften the membranous deposit and pre- 
 vent its putridity. For this we have the vapor of steani con- 
 taining lime, the products of tar, carbolic acid, or chlorine ; 
 but as we have gone over this matter thoroughly when writing 
 of scarlet fever, it will not be necessary to repeat it here. 
 
424 MOTHER AND CHILD. 
 
 CHAPTEE L. 
 
 WHOOPING-COIJGH.^ 
 
 Whooping-cough alone does not cause sucli a large mor- 
 tality : it is fatal in its complications. In other words, being 
 a disease that lasts six weeks, or sometimes two months, 
 parents or nurses become careless and the babies die from 
 debility, pneumonia, bronchitis, bowel-complaiat, or some com- 
 plication caused by the great straining induced by the cough. 
 
 Let us for a moment study the nature of this disease from 
 the most recent investigations of the subject. It. has been 
 well known and thoroughly described by medical writers for 
 many years; certainly for over three hundred years it has 
 been acknowledged as a contagious affection, not simply a 
 nervous cough. 
 
 It is a disease usually occurring in childhood, but is limited 
 to no particular age. We once saw a child who had it at birth, 
 undoubtedly, and we frequently hear of it at the age of sixty 
 or over. It is rare for a person to have it twice. It begins 
 as an ordinary cold, though, after tbe child has had apparently 
 a cold in its head and a dry cough for some days, the cough 
 comes on in paroxysms, usually upon taking food, or following 
 excitement ; but the child tries to suppress the cough, and in 
 doing so the face becomes much congested. Soon the paroxysm 
 of coughing will provoke vomiting, and then the whoop, or draw- 
 ing in of the breath, after several forcible expulsive coughing- 
 spells have taken place. These paroxysms increase in force 
 and frequency ; the child's face becomes blue and puffy ; the 
 little sufferer seizes on the nearest object for support; the 
 spells are agonizing to behold ; finally, after successive cough- 
 
 ^ This chapter appeared, as an article by Dr. J. M. Keating, in Babyhood 
 for September, 1886, and is republished by permission of the publishers. 
 
WHOOPING-COUGH. 425 
 
 ing-spells, eacli followed by a gasping which produces the 
 whoop, a violent attack of vomiting takes place, mucus runs 
 from the mouth and nose, and the child falls back limp and 
 exhausted, in a few moments to resume its play, without any 
 evidence, except the puffing about the eyes, of any trouble in 
 the respiratory tract. These are the characteristic features of 
 the disease. 
 
 It is impossible at first to make a definite statement as to 
 the existence of the disease ; it is only after the first week or 
 ten days, when the cough assumes the features above described, 
 that one is certain ; and especially is this the case if the child 
 has been exposed to the disease. ' It is not the most contagious 
 malady of childhood. — not nearly as much so as measles, 
 chicken-pox, or scarlet fever; it requires, in all probability, 
 either the breath direct from another case, or inhaling the air 
 of a crowded room or car in which a child with the disease 
 has been. 
 
 In the article on scarlatina what is meant by the period of 
 incubation is explained, — that time which elapses between the 
 direct exposure to the poison of a disease, or the absorption 
 of its contagious principles, and that of the appearance of the 
 first symptoms. For whooping-cough this is about two weeks, 
 as nearly as we can calculate it. 
 
 The disease is a contagious one, — that we all know. Its 
 contagious material resides undoubtedly in the breath of the 
 one afi'ected with it ; it is probably taken up by the air during 
 its passage over the secretions from the throat and nose. The 
 air probably retains it for a long time, and these secretions 
 usually, at the height of the disease, being excessive, are easily 
 communicated from one child to another in play, by kissing, 
 etc., or they dry, are finely pulverized, and are scattered 
 throughout a badly- ventilated room. During the whole period 
 of excessive secretion, from the first week till the cough 
 almost disappears, the child with whooping-cough is capable 
 of giving the disease to others with whom it comes in contact. 
 
 It is almost criminal, then, for parents and nurses to take these 
 
 36* 
 
426 MOTHER AND CHILD. 
 
 children into open squares or parks {places of amusement) where 
 healthy children congregate. . And yet this is done daily. 
 
 Investigators have detected by the microscope certain germs 
 — which have since been found in all cases of this disease — in 
 the sputum and in the secretions from the nose. In all prol a- 
 bility these come in contact with the mucous membrane, are 
 directly absorbed, multiply and diffuse themselves through the 
 blood during the period of incubation, or act in some way es- 
 pecially upon the delicate membrane of the nose and respira- 
 tory tract. Animals have been inoculated with this mucus 
 and have exhibited all the symptoms of the disease. 
 
 It is a disease that runs a regular course of its own, if 
 not treated. In Japan it is called the '< hundred-day disease." 
 It usually, in mild cases, lasts about two months, possibly 
 sometimes three, though active treatment and careful nursing 
 will shorten it to a very great extent, or make it very much 
 less severe. 
 
 It is not expedient here to examine carefully the medical 
 treatment of this disease. As far as known, no drug will at 
 once cut short an attack, but the physician has many re- 
 sources at his command that will mitigate its severity, diminish 
 the intensity of its paroxysms, and lessen the great liability 
 to hemorrhages, to heart-disease, to disease of the lungs, whose 
 delicate tissue is easily damaged by forcible coughing ; and it 
 is for him to decide what is especially advisable for each par- 
 ticular ease. He will probably give the child belladonna or 
 quinine, or possibly recommend an infusion of chestnut-leaves. 
 At night he may find it necessary to give the bromides of 
 potassium or ammonium, with chloral. 
 
 To the mother belongs the equally important duty of 
 warding off danger bj^ careful nursing, by guarding her child 
 against exposure, by proper clothing, careful and nutritious 
 diet, and abundance of fresh air. 
 
 Every child with whooping-cough should have pure, fresh 
 air, and be out of doors as much as possible in suitable 
 weather. The sea-air, when accessible, is greatly to be de- 
 
WHOOPING-COUGH. 427 
 
 sired; the moisture in it, and possibly the salt, help to liquefy 
 the secretions. It has a sedative eifect, allaying nervous irri- 
 tability; then it is always fresh and pure, and this is most im- 
 portant in the treatment. The fresh air prevents debility, 
 and therefore wards off those serious complications due to 
 '' run down" and loss of appetite. If the patient is obliged to 
 remain in the city, it is well to dress the child warmly, make 
 a ])lay-room of the top story of the house, and open the 
 windows to insure a constant access of fresh air, purer than 
 that directly from the street. 
 
 Diseases of the lungs are most to be dreaded as a complica- 
 tion; therefore all children suffering from whooping-cough 
 should have some woollen garment, light in summer and 
 heavier in winter, covering the entire body. It is a mistake 
 to clothe children too warmly; active perspiration during 
 play will only invite colds should the child be exposed to a 
 draught. Indeed, this is the case with all children, sick or 
 well. Often severe catarrhs are brought about in children 
 who are overclothed. 
 
 A child should be accustomed to a daily bath or sponging 
 in cool water; its chest, back, and feet should be thoroughly 
 sponged, and then reaction brought about by a good rubbing. 
 
 There is a curiously close relationship between the foet and 
 the mucous membrane of the air-passages. We all know how 
 quickly wet feet, when exposed to draughts, will give a 
 catarrh. A foot-bath of cool or cold water at night will do 
 much to lessen the liability to colds. 
 
 A child with whooping-cough should receive a full supply 
 of digestible, nutritious food : gruels, soups, or broths ; Mellin's 
 food; a light dinner of chicken or steak, if it is old enough, 
 with vegetables, such as well-cooked young beets, spinach, cauli- 
 flower, roasted or mashed potatoes, and stewed fruits, as 
 apples or peaches, that will keep the bowels regular. Milk 
 should, of course, be plentifully used, and it is well to dilute it 
 with lime-water, or Vichy water, to prevent it curdling in 
 heavy masses. A child is apt to have a paroxysm and vomit 
 
428 MOTHER AND CHILD. 
 
 a meal just after it is taken. Some light, nourishing food 
 which will be retained should at once be given ; either a cup 
 of broth with barley, or milk and lime-water, or some sherry 
 and water with sponge-cake, will serve the purpose. 
 
 We have often noticed that a copious discharge of thick 
 mucus follows a paroxysm, and that until this discbarge 
 takes place the cough will be repeated. The mother should 
 recognize this fact and do all in her power to aid the child. 
 In the case of an infant this can be accomplished by turning 
 the child over on its stomach, with the head low, and detach- 
 ing the mucus from the mouth with her finger. If the child 
 is older it should be taught to blow its nose thoroughly, or 
 probably by inducing vomiting at once relief will come and 
 the paroxysm be cut sliort. A child can be very materially 
 aided in this way and the severe strain avoided, 
 
 A large amount of the thick mucus which cannot be gotten 
 rid of by the cough may seriously threaten suffocation. In 
 such a case a tea&poonful of syrup of ipecac, or the same of 
 powdered alum mixed with syrup, should be at once given to 
 provoke immediate vomiting. 
 
 Counter-irritation to the chest by means of various lini- 
 ments is certainly valuable ; a suitable one will be selected by 
 the physician, containing possibly the oil of amber, croton oil, 
 or turpentine, in soap liniment, or possibly chloroform lini- 
 ment. Our own experience has taught us that the spray 
 from" an atomizer is a valuable aid in the treatment of this 
 disease. It can be used to make the thick mucus more watery, 
 and also as a means of carrying medicamenis directly to the 
 surface. But it requires an immense amount of patience on 
 the part of the mother. The nose and throat should receive 
 in this way a thorough treatment five or six times a day. 
 The nose should be frequently cleansed by the spray of 
 Dobells solution (carbolic acid, borax, soda, and glycerin). 
 
 Whooping-cough is a distinct disease, with a history of its 
 own, and belongs to the same category as the other conta- 
 gious affections of childhood. We have avoided discussion of 
 
FEVER. 429 
 
 its medical treatment ; that belongs to the doctor. Wliatever 
 tends to weaken the child invites most serious complications, 
 and these are the causes of the great mortality mentioned. 
 All patent nostrums of uncertain combination, or of such com- 
 position as to derange the secretions, produce constipation, or 
 cause loss of appetite, are to be avoided by all means. Good 
 nursing is more than half the battle. Fresh air, proper cloth- 
 ing, good, nutritious diet, regulation of the bowels, efforts to 
 mitigate the intensity of the paroxysms by aiding the child in 
 discharging the mucus, giving it an easy and comfortable posi- 
 tion which relieves the strain, supporting it for the same pur- 
 pose, pressure of the hand over the eyes to prevent their 
 strain, — all these are as important as the medical treatment. 
 
 CHAPTEE LI. 
 
 FEVER. 
 
 It is well to make a few remarks upon the subject of fever, 
 as mothers are often much worried at the symptoms of 
 heightened temperature, and are frequently at a loss to know 
 what to do until the doctor arrives. Fever is a symptom : it 
 may be initiatory of any of the diseases of childhood, or it may 
 be an evidence of indigestion, or of the retention of poisonous 
 matters, usually called biliousness ; nevertheless it is only a 
 symptom, and it is necessary to be cautious in our treatment 
 of it until we know its cause. 
 
 We are greatly opposed to that smattering of medical knowl- 
 edge which justifies the adage, " a little knowledge is a dangerous 
 thing," — dangerous, because it either makes one careless when 
 confronted by the greatest though concealed danger, or over- 
 confident and rash when caution and experience are most re- 
 quired. On this account we have always kept fever thermom- 
 eters away from mothers ; sufiice it for them to know by touch 
 
430 
 
 MOTHER AND CHILD. 
 
 Fig. 37. 
 
 and general symptoms that their child has fever, and then let 
 them send for the doctor and give him the sole control and re- 
 sponsibility of the case. But circumstances may arise when the • 
 registration of a temperature is important, and on that account 
 we will speak of it here. The ordinary fever thermometer is 
 represented in Fig. 37. The thermometer is a deli- 
 cate instrument, and requires care in handling. Be- 
 fore using it, the detached black line or register 
 should be below the arrow, or mark of normal heat. 
 With children old enough to understand that it is 
 not to be chewed, the temperature is best taken 
 under the tongue, with the lips holding the ther- 
 mometer, and it should remain there for two min- 
 utes. With younger children, the armpit is the 
 place usually selected, care being taken to hold the 
 arm tightly across the chest and to keep the part 
 
 Fig. 38. 
 
 covered. With babies, we prefer the groin or the bowel. If 
 introduced into the bowel the end must be held on to firmly, 
 and care taken that in introducing and withdrawing it the 
 instrument is not broken. 
 
 The record should be noted, the register being shaken back 
 into its place below the normal mark (the arrow). To do this, 
 take the thermometer by the upper part, not the bulb, with 
 the whole hand grasped about it, bulb end uppermost, and 
 
FEVER. 431 
 
 then swing the arm from the shoulder forward with some force. 
 The thermometer should be carefully wiped with alcohol or 
 cologne before putting it away. 
 
 It is a great mistake for a mother to constantly take the 
 temperature of her child for curiosity's sake ; it only unnerves 
 her, and renders her less capable of exercising proper judgment 
 during its illness. The doctor will manage that part of the 
 case, and he alone is capable of attaching due importance to 
 the readings. 
 
 To return to our subject. A child is languid, refuses to play, 
 its head is hot, the skin is dry ; in other words, it is feverish. 
 Its face is flushed, it is irritable, or possibly drowsy, or it may 
 be unduly excited. What should the mother do ? It may be 
 indigestion ; it may be biliousness ; it may be one of the eruptive 
 fevers coming on. Put the child to bed at once, after giving 
 it a hot foot-bath, to which a little mustard (a teaspoonful 
 to a basin of water will suffice) is a good addition. Give it 
 half milk and half boiling water, if it craves drink and needs 
 nourishment ; keep light covering over it, and prepare a drink 
 consisting of a tumbler of water, a teaspoonful of sweet spirits 
 of nitre, and two teaspoonfuls of spirits of Mindererus, to be 
 taken at intervals, if it is thirsty. Some children crave pure 
 water when feverish, or weak lemonade with but little sugar; 
 if so, let them have it. Water in fever, internally and ex- 
 ternally, we now know to be the best thing, and we look back 
 with pity upon the sufferings of those poor creatures who were 
 refused it most emphatically not many years ago. If the 
 fever increases, and the child becomes restless, hot. delirious 
 even, sponge it off with water that feels slightly cool to the 
 hand, and to which has been added cologne, alcohol, or vinegar. 
 This sponging should be done every, hour or two, the child 
 protected carefully from draughts, and each part properly 
 covered after it has been sponged ; even should the attack be 
 one of an eruptive fever it will do no harm but much good. 
 Keep the head cool in the same way. If the doctor does not 
 come within a few hours, look at the tongue ; if it is coated, 
 
432 MOTHER AND CHILD. 
 
 dusty-colored towards the centre and back, give the child of 
 one year or older a tablespoonful of solution of soda mint and 
 a teaspoonful of spiced syrup of rhubarb, and in an hour or so 
 an enema of warm water and sweet oil. If the belly seems 
 distended, add a teaspoonful of the tincture of assafoetida to the 
 enema. ^SText morning, when there is a good light, examine 
 the body for an eruption ; if you find on the neck and chest 
 a uniform rash, if the tongue is red on the edges, if the throat 
 is red, and possibly the child has been nauseated, or indeed 
 has vomited, you have a case of scarlet fever to deal with. 
 But the chances are that your anxiety will be allayed by the 
 subsidence of the sjrmptoms; the bowels will move copiously, 
 the passage consisting of bilious, slimy matter, or the child 
 may vomit some undigested material, break out in a profuse 
 perspiration, and fall asleep, to awake bright and well. If 
 so, diet well for a few days ; keep to soups and broths ; avoid 
 solid food and too rich milk ; or you may find that the 
 throat — with a few white flake.s like curds on the tonsils, 
 which so frightened you and caused you rightly to send for 
 the doctor at once and to urge haste — has lost the red, angry 
 look and deposit under the judicious treatment by a laxative, 
 preferably calomel and soda, and spraying with Dobell's solu- 
 tion, which he instituted. These sudden fevers, together with 
 throats like this, look surprisingly like diphtheria, and cause 
 just alarm, though they are probably only the result of indi- 
 gestion. Some cases of diphtheria start in this manner, and 
 as we cannot at the outset distinguish between them, the 
 utmost care in treatment is reqtiired. 
 
FA MIL r MED J CINE- CHES T. 
 
 433 
 
 LIST OF ARTICLES FOR THE FAMILY MEDICINE-CHEST. 
 
 Castor oil. 
 
 Aromatic syrup of rhubarb. 
 
 Distillate of hamamelis. 
 
 Paregoric. 
 
 Laudanum. 
 
 Sweet spirits of nitre. 
 
 Spirits of Mindererus (liq. ammon. ace- 
 tatis). 
 
 Aromatic spirits of ammonia. 
 
 Chlorodyne. 
 
 Brown's essence of Jamaica ginger. 
 
 Soda-mint tablets. 
 
 Valentine's or Wyeth's meat extract. 
 
 Benzoated oxide of zinc ointment. 
 
 Cold cream. 
 
 Vaseline (white preferred). 
 
 Court plaster. 
 
 Adhesive plaster (rubber). 
 
 Roll of carbolated antiseptic gauze 
 (Johnson & Johnson). 
 
 Sulphonal, five-grain compressed tablets. 
 
 Bromide of potassium, five-grain com- 
 pressed tablets. 
 
 Phenacetin, five-grain compressed tab- 
 lets. 
 
 Chloride of ammonium, five-grain com- 
 pressed tablets. 
 
 One dozen compressed tablets, each one 
 containing one-sixth of a grain of cal- 
 omel and two grains of bicarb, of soda. 
 
 Tincture of iodine. 
 
 Syrup of ipecac. 
 
 Essence of peppermint. 
 
 Tincture of assafcetida. 
 
 Mustard leaves (two strengths). 
 
 Belladonna plaster. 
 
 Subnitrate of bismuth. 
 
 Alcohol and a lamp. 
 
 Syringes for enemas, one a fountain, and 
 
 another of hard rubber, holding two 
 
 ounces. 
 St. John Long liniment. 
 Medicine-dropper. 
 Graduated medicine-glass. 
 Compressed tablets of tincture of aconite, 
 
 one minim each, for fever. 
 Bicarbonate of sodium. 
 Glycerin suppositories, put up in tin-foil 
 
 or waxed paper and in a glass-stoppered 
 
 bottle. 
 Dobell's solution and Burgess's atomizer 
 
 (or Seller's antiseptic tablets). 
 Compressed tablets for making lime- 
 water. 
 Chlorate of potassium in five-grain 
 
 tablets. 
 Elixir of cascara sagrada (laxative), or 
 
 compound liquorice powder. 
 Menthol or red pepper (solid linunent). 
 Powdered alum. 
 
 A few bandages (in rolls of two widths). 
 Compressed quinine pills, two grains 
 
 each (fifty). 
 Lady Webster pUls. 
 Dover's powder, compressed pills, five 
 
 grains each. 
 Tarrant's aperient, or Seidlitz powders. 
 Glycerin. 
 Listerine. 
 Gallic acid. 
 Absorbent cotton. 
 A fever and a bath thermometer. 
 
 Of course this is a very complete list, and many of the articles suggested will 
 only be necessary for a family going to reside for a time at a distance from a physi- 
 cian or drug-store. One should never travel without a supply of whiskey, mustard 
 flour, flaxseed meal, and some pieces of old linen and flannel. 
 
 37 
 
434 MOTHER AND CHILD. 
 
 CHAPTEE LII. 
 
 SCARLET FEVER.^ 
 
 Scarlatina is the Latin name for scarlet fever in all its 
 forms, those most grave and those most mild. There is 
 another point of great importance, which is, that the mildest 
 cases of scarlet fever have often the saddest ending, owing to 
 the want of attention to those details of nursing which ex- 
 clude the possibility of serious complications by exposure or 
 neglect. Every doctor has heard the statement, when ques- 
 tioning in regard to the antecedents of dropsy or possibly 
 some destructive disease of the ear, "My child had only 
 scarlatina; it was so mild that really we did not see the 
 necessity of punishing the httle one by confining it to its 
 bed or room." 
 
 Scarlatina is scarlet fever, and a mild attack of this most 
 treacherous disease may become as serious as a very severe at- 
 tack, — often more so, as the one will be cared for and the other 
 neglected. It is, therefore, necessary thoroughly to understand 
 the principal features of this disease. 
 
 It is undoubtedly caused by the entrance into the system 
 of a something which has all the characteristics of matter. 
 This something, which, as we shall see, requires a certain time 
 thoroughly to infect the blood in which it circulates before 
 the symptoms of the disease show themselves, is called a 
 germ. This germ has weight, proven by the fact that it occu- 
 pies a certain space ; can be carried in clothing or merchan- 
 dise, or by the air ; it does not evaporate or become gaseous ; 
 it is transmissible, and at the same time is very subtle, can 
 
 1 This chapter appeared, as an article by Dr. J. M. Keating, in Baby- 
 hood for February, 1886, and is republished by permission of the publishers. 
 
SCARLET FEVER. 435 
 
 insinuate itself in cracks and crevices, in the breath of indi- 
 viduals, in their hair, in clothing, in letters. It is a living 
 material, whose vitality may lie dormant for years, and then, 
 like grain, grow under favorable conditions; it can be de- 
 stroyed by heat, probably by intense cold, or by chemical 
 agents. But it is unlike the grain in one most important 
 characteristic, which is this: a grain — say of wheat — may 
 have remained dormant since the time of the Pharaohs, and, 
 taken from a mummy-coffin, placed in heat and moisture, it 
 will sprout, but will only produce one stalk. The germ of 
 scarlatina may lie dormant, but when aroused into activity by 
 suitable associations it will act as a leaven, — as a ferment; 
 this minutest microscopic object will perpetuate its species 
 until it invades every organ and tissue of the body. On 
 this account this disease is classed as zymotic (from zyma, fer- 
 ment). 
 
 Scarlet fever can be communicated by infected milk ; and, 
 so far as we know, the milk has only to stand in the room 
 where the disease exists, or has existed, to absorb the germs, 
 which are so subtle, so light, and yet so tenacious, as to float 
 in the air and adhere to -particles of dust. 
 
 We all know how much dust is constantly floating in the 
 air ; let a beam of sunlight pass through an opening in the 
 shutter, and we can readily see how the scales of the skin 
 from the body, pieces of lint, etc., can carry these microbes 
 which may be thrown off in the mucus from the nostrils and 
 mouth or in the perspiration, and even in the urine. 
 
 jSTot only are these secretions germ-carriers, — that is, con- 
 tagious (and they have all been proven so by direct inocula- 
 tion), — but the passages from the bowels as well as the urine 
 are so. In that way sewer-air may be a means of their con- 
 veyance ; drinking-water also, as well as the vapor from the 
 soil on which these matters have been thrown. Bear in mind, 
 then, that the scarlatina poison can be carried in this way 
 hundreds of miles ; that it does not need the personal contact 
 of individuals ; that it retains its vitality for months and even 
 
436 MOTHER AND CHILD. 
 
 years unless it be subjected to certain influences that either 
 entirely destroy it or deprive it of its malignancy ; these are 
 intense heat, especially boiling or steam, plenty of fresh air, 
 and certain chemical substances, as chlorine, sulphurous acid, 
 and others. 
 
 The poison of scarlatina is either inhaled by the individual 
 or swallowed ; it is then taken up by the circulation, and, 
 finding itself surrounded by material which develops it, vivi- 
 fies it, is rapidly reproduced, and the symptoms of the dis- 
 ease show themselves. This period between the reception 
 of the poison and the appearance of the S3'"mptoms is called 
 the period of incubation ; this is known to be from one to six 
 days ; in some cases longer. 
 
 Unless we definitely know that the child has been exposed 
 to the disease, we cannot detect its presence till the rash ap- 
 pears, and this takes place within twenty-four hours of the 
 first symptoms. What are these ? Chill or convulsions, de- 
 lirium, intense headache, sore throat, swelling of the glands 
 of the neck behind the jaw (kernels), nausea or vomiting, 
 associated with high fever, bounding pulse, and dry skin. The 
 first three of these may be absent in mild cases ; the others 
 are nearly always present to a greater or less degree. 
 
 Under such circumstances what should be done ? The 
 child should be put to bed by itself in a separate room ; it 
 should have a hot foot-bath, the water — with or without mus- 
 tard — about as warm as the hand can bear. It should be 
 lightly covered with a sheet and light blanket ; it should be 
 kept as quiet as possible, and given frequently warm milk in 
 small quantities, with lime-water or so-called " cambric tea," 
 and no solid food. Do not purge ; in fact, avoid all medicine 
 — ^with the exception possibly of a little sweet spirits of nitre, 
 a teaspoonful to half a tumbler of sweetened water — until the 
 doctor arrives. At the end of from six to eighteen hours the 
 rash will appear. It will be noticed in patches, fading into 
 the normal color of the skin, on the neck, shoulders, and chest, 
 then on the abdomen, and finally on the trunk, arms, and 
 
SCARLET FEVER. 4:Z1 
 
 legs. It resembles the redness produced by a mustard-plaster, 
 and feels rough to the hand when fully developed. 
 
 The disease is now fully determined ; the fever is high, the 
 restlessness is usually increased, the throat symptoms are 
 marked, and the secretions are diminished. The most urgent 
 care is now to be taken in the nursing. All superfluous hang- 
 ings, such as curtains or pictures, should be removed from the 
 room. The child should be nursed by one who has all the 
 details of the case under her charge, who should wear the 
 simplest kind of clothing, that can be daily changed and 
 washed or aired. She should have an adjoining room in which 
 to keep her clothes and make her toilet. Everything that 
 comes in contact with the child, such as towels, brushes, blank- 
 ets, or sheets, should be kept i-igidly separate, and thoroughly 
 boiled and aired before being taken from the premises. 
 
 The room should be kept thoroughly ventilated, either by 
 keeping open a window in the adjoining room or by some 
 arrangement attached to the window of the sick-room which 
 will allow the ingress and egress of air without a draught ; 
 the temperature should be kept at about 68° F., and regulated 
 by a thermometer. If the room receives its heat from a fur- 
 nace, the hot air should be made to pass over a pail of water 
 containing either diluted Labarraque's solution or Piatt's 
 chlorides, and a towel with one end dipped in such a solution 
 should be tacked over the register. If there be a stove, or, 
 better than all, an open grate, these solutions can be placed 
 near by, so as to be readily evaporated and distributed 
 throughout the room. 
 
 The chamber should always contain some such solution in 
 which to receive the excreta. A small quantity of urine 
 should daily be collected in a clean vessel for the doctor's 
 examination. It is usual to anoint the child with some greasy 
 substance ; this allays the intense itching or pricking, which 
 is most annoying, it softens the skin, which is inflamed and 
 swollen, it depresses the fever to a certain extent, and it 
 serves to collect the scales of the skin, which, if shed, act 
 
 37* 
 
438 MOTHER AND CHILD. 
 
 as carriers of contagion, and which are usnally shed in flakes. 
 "Washed lard, white vasehne, or carbolated or thjmolated vase- 
 Hne are used. The child should have its mouth washed once 
 or twice daily, as also other parts of its body, for purposes of 
 cleanhness, and the water used should contain either very diluted 
 Labarraque's solution, vinegar, Jisterine, or phenol-sodique, and 
 possibly the doctor will order the frequent use of the hand-spray, 
 using some good disinfectant for the throat in these cases. 
 
 What are the dangers incident to scarlet fever ? Extensive 
 disease of the throat with complications of diphtheria, dis- 
 ease of the ear with permanent deafness, disease of the eyes ; 
 more important than all, serious complications due to inflam- 
 mation of the kidneys, made evident by dropsy and convulsions, 
 often ending fatally. To avoid these, which may take place 
 in the mildest cases, from exposure to draughts, imprudence, 
 and want of cleanliness and attention, great care is necessary. 
 
 The question of bathing or sponging a child ill with scarla- 
 tina must be decided by the doctor. Sometimes it is necessary 
 to depress the temperature, as a prolonged high temperature 
 will kill ; but in all cases, however severe, cleanliness should 
 be insisted upon, — the face and hands, the eyes, ears,, mouth, 
 and genitals, should be kept clean and free from secretions. 
 
 The temperature usually remains high till the decline of 
 the disease, — about the fourth or fifth day in ordinary cases. 
 As soon as the fever has subsided and the eruption has faded, 
 and the skin-shedding is well established, it is customary to 
 sponge the body off thoroughly in tepid water and clean the 
 head, using a fine sponge or soft linen, avoiding draughts, and 
 keeping the body well covered, with the exception of the part 
 being washed. We have found a preparation known as "Lit- 
 tle's soluble phenyle" admirable in this connection, a few drops 
 of it being added to the water. It is disinfectant and leaves the 
 skin soft. As kidney-troubles usually show themselves during 
 or following the scaling stage, greater precautions than ever 
 are to be used at this time. The urine should be examined 
 every day or two. The diet should be mostly liquid. — that is, 
 
SCARLET FEVER, 439 
 
 milk, or milk and lime-water, gruels, soups, and such like ; the 
 child should be encouraged to drink freely of water, the bowels 
 must move daily, if necessary by an enema, and under no cir- 
 cumstances should the patient be permitted to leave the room 
 unless great precautions have been previously taken. In this 
 climate we have to be very particular, owing to the sudden 
 changes of temperature, and it is far better that the child 
 shoiild be kept in-doors a few days longer than the parents 
 usually think necessary than to run the great risk of kidney 
 diseases, or rheumatism with its serious effect upon the heart, 
 which may follow such exposure. 
 
 After the child has had several changes of underclothing, 
 has been well washed a number of times, and at least two 
 weeks have elapsed since the disease declined, it can be re- 
 moved to another room, and the sick-room fumigated. This 
 should be done by igniting some sulphur in a saucer in the 
 room, all the windows and doors having been previously closed 
 and the cracks stuffed. After twenty-four hours the room can 
 be opened and full ventilation permitted. All the furniture 
 should be wiped with a damp cloth, and the paint-work washed 
 with water containing the chlorides or borax. The room should 
 remain unoccupied for some time and be thoroughly aired. 
 
 The school-room is undoubtedly the place most to be blamed 
 for the distribution of scarlatina poison. To get rid of the 
 other children they are sent there while the mother is nursing 
 the sick one at home. Some children possess a remarkable 
 immunity from this disease; nevertheless they act as carriers 
 of contagion. Then, again, servants or child-nurses often carry 
 it in their heavy shawls from house to house, taking it directly 
 from a sick-room to the nursery. 
 
 Scarlatina, so far as we know at the present time, only 
 comes from previous cases of the disease. Cleanliness not only 
 lessens the danger of serious complications which are often fatal, 
 and mitigates the severity of an attack, but it is the great germ- 
 destroyer, and prevents the spread of this dread disease in house- 
 holds. 
 
i40 MOTHER AND CHILD. 
 
 CHAPTEE LIIL 
 
 MEASLES — 3IUMPS — YARICELLA, OR CHICKEX-POX. 
 
 There are so many things in common bet^veen scarlet 
 fever and measles that it will be unnecessary to repeat. 
 Measles is a disease which comes from a special poison of its 
 own, one which only produces measles ; this poisonous prin- 
 ciple, or germ, is especially active in the breath, in the secre- 
 tions from the eyes aud nose, and the whole respiratory tract; 
 and as these secretions are very much more active — in fact, con- 
 stitute a marked feature — in this disease, the child affected with 
 it forms a focus of contagion for those who come in contact 
 with the air which has passed over the surface of its mucous 
 membrane. The anointed skin in scarlet fever, the absence of 
 marked catarrh and of profuse secretion, the thorough isolation 
 which is always insisted upon, probably account for the fact 
 that measles seems by far the more contagious disease. There 
 is another peculiarity which also accounts for this : the catarrh 
 of measles, resembling an ordinary cold in the head, may be 
 mistaken for such, and the child for the few days preceding 
 the rash may associate with other children, and thus dissem- 
 inate the elements of contagion. The period of incubation in 
 this disease is from twelve days to two weeks, but of course 
 during this time, unless there be a history of exposure, there 
 is nothing special to attract our attention. The disease usually 
 manifests itself by all the symptoms of a violent cold in the 
 head : the eyes become suffused, very watery, and intolerant 
 of light; the discharge from the nose is constant, the child's 
 face puffy and red, apparently swollen ; there is a tendency to 
 drowsiness. Of course there is fever, the child's skin is hot 
 and dry, and the little sufferer rolls and tosses from side to 
 side. These symptoms are not very marked at first, and the 
 child is supposed to have caught cold ; but they increase in 
 
MEASLES. 441 
 
 severity, and it is not until about the fourth day that the 
 rash makes its appearance upon the face. Previous to this, 
 however, if the throat be examined, the outline of a rash char- 
 acteristic of measles can be determined upon it. All this time 
 the child suffers with paroxysms of a dry, ringing, croupy 
 cough ; the tongue is usually slightly coated, the appetite is 
 lost, and the fever, with the catarrh of the mucous membrane, 
 gives rise to intense thirst. The first appearance of the rash 
 is upon the temple, the forehead, the neck, extending down 
 the chest and arms, and finally covering the body. The word 
 rash is a misnomer when applied to the eruption of measles, 
 and refers more especially to that in scarlet fever. When 
 noticed upoii the forehead, the temple, or the neck, it seems at 
 first as if it were beneath the skin, — a number of small clusters 
 or points, resembling flea-bites, that form a crescent ; when the 
 finger is passed over the surface, a slight elevation is noticed. 
 These elevations increase until they rise distinctly above the 
 surface and form a papule. As soon as the whole body be- 
 comes covered with the eruption, the skin is decidedly rough 
 and papular to the touch, and the crescentic outline of the 
 papules in these patches over the entire surface of the body 
 can be distinctly noted. There is no mistaking a case of 
 measles at this stage, or confounding it with scarlet fever. 
 The suffused eyes intolerant of light, with swollen eyelids, 
 the pufiy face covered with its speckled eruption, the exces- 
 sive nasal discharge or evidences of swelling of the mucous 
 membrane of the nose, the croupy cough, which is constant 
 and annoying, are in themselves sufficiently plain to be the 
 distinguishing features. The rash after three or four days 
 gradually fades from the surface, leaving in many cases a 
 slight staining of the skin in freckles or spots, disappearing 
 first from the parts first affected. The fever gradually subsides, 
 though the cough and evidences of bronchitis may remain for 
 some time longer. The skin will not come off in flakes, as is 
 usual in cases of scarlet fever, especially where no ointment 
 has been used ; it is usually shed in small bran-like scales. 
 
442 MOTHER AND CHILD. 
 
 The lungs bear the brunt of this disease in neglected or 
 severe cases, and just as we guard the kidneys in scarlet fever, 
 to prevent their congestion, so in this disease we protect the 
 lungs from the very first, by carefully guarding against draughts, 
 impressions of cold, internal congestion, by endeavoring to es- 
 tablish the eruption over the whole surface of the body, by 
 protecting the eyes from light and the skin from draughts. 
 Measles is a disease which is very fatal among the poor, much 
 more so than scarlet fever. — that is, in the earlier stages. — 
 owing to the fact that acute diseases of the lungs, as congestion, 
 pneumonia, kill very much more quickly than the diseases of the 
 heart and kidneys that follow scarlet fever, which probably do 
 not show themselves for weeks or months after the termination 
 of the disease. Croup in all its forms, bronchitis, congestion 
 of the lungs, pneumonia, may occur in the earlier stages of 
 measles and be fatal, through exposures to draughts and 
 through improper nursing ; nor, indeed, is a child entirely safe 
 until all evidences of catarrh of the respiratory organs have 
 disappeared. Taking a child into the cold air too soon may 
 bring on a fatal pneumonia ; exposure to sewer-gas in the sleep- 
 ing-room may produce a fatal diphtheritic croup ; exposure 
 to the contagion of whooping-cough may engraft this disease, 
 with serious results ; throwing off the bedclothes, thus chill- 
 ing the body, may congest the lung or eventually affect 
 the heart; then, again, indigestion may produce an irritation 
 of the bowel, and a serious diarrhoea follow. The mucous 
 membrane of the stomach and bowel is affected in this disease 
 simultaneously with the mucous membrane of the I'espiratory 
 passages. Although vomiting is not so apt to occur as an initial 
 symptom as in scarlet fever, still diarrhoea, especially in the 
 heated term, is often a serious complication, probably indicating 
 inflammation of the bowel, and should be carefully watched. 
 Xot alone do we have complications of so serious a nature as to 
 threaten life, but in scrofulous children, or those who are simply 
 run down, loss of sight or of hearing may be the result of careless 
 nursing, or the child may die of. "marasmus" (tuberculosis). 
 
MEASLES. 443 
 
 The same general principles regarding the ventilation of the 
 sick-room, cleanliness of the body, diet, ought to be observed 
 in the mn^sing of measles as we have just laid down for that of 
 scarlet fever, possibly slightly modified, owing to the difference 
 in the two affections. Thus, in measles the tendency to pul- 
 monary congestion will necessitate keeping the feet warm to 
 promote circulation, and possibly the use of poultices to the 
 cliest, or of cotton or some non-conducting substance. A chikl 
 with measles should be guarded as carefully against going out 
 too soon as in scarlet fever. "We will once more impress upon 
 mothers the fact that if they have a dry, well- ventilated, sunny 
 nursery, apart from the sleeping-room, it is a mistake to run 
 any risk by taking a child out of doors when the weather is the 
 least objectionable, — that is, on damp, raw, and foggy days, or 
 when the winds are piercing. "We insist upon this, not only in 
 the case of children who are convalescing from disease, but 
 even for those who are perfectly well. There would be fewer 
 catarrhs and sore throats if this plan were more generally 
 adopted. Great care should be taken, when a sick child has a 
 movement from its bowels or bladder, that it is well covered 
 and protected from draughts. 
 
 'We need not repeat all that has been said when speaking of 
 scarlet fever, in regard to the diet and home treatment ; tho 
 mildest form of nourishment should be given, — milk, diluted 
 with an alkali, given at frequent intervals ; also chicken-tea, egg 
 albumen in water, beef essence or juice, with cracked ice, toast- 
 water and wine-whey, or wine-whey and barley-water. No 
 solid diet should ever be given in fevers. The child should be 
 allowed to drink water freely, but in small quantities at a time. 
 Glycerin and water, the proportion being a teaspoonful in half 
 a tumbler of water, will often relieve the dryness of the mouth 
 and throat, at the same time allaying thirst. "Weak lemonade 
 sweetened with a little glycerin, not immediately after milk, 
 is most refreshing in fevers. Sweet spirits of nitre, a teaspoon- 
 ful to a tumbler of water, will quiet the nervous system, if the 
 child drinks frequently of it during the night, and is likely to 
 
444 MOTHER AND CHILD. 
 
 promote sleep. A hot foot-bath is always efficacious, if the feet 
 are kept warm afterwards. A teaspoon ful of spirits of Min- 
 dererus, with a teaspoonful of sweet spirits of nitre, in a half- 
 tumbler of "water, forms a household fever-mixture which can 
 be safely sipped by a child from time to time until the doctor 
 arrives. Anointing the body, as in scarlet fever, with carbo- 
 lated vaseline or cold cream, allays irritability even from the 
 onset of the eruption. The room should be darkened, as the 
 eyes are weak. 
 
 MUMPS. 
 
 This most painful affection is a common disorder of child- 
 hood after the fifth or sixth year. Every one knows the ap- 
 pearance of a child with the disease, and the frightful disfigu- 
 ration which exists when one or both parotid glands become 
 inflamed and swollen. The parotid gland is situated over the 
 articulation of the jaw, in front of the ear, and either one or 
 both are involved in this disease. Great pain is caused by 
 moving the jaw, or, indeed, by any sapid substance in the 
 mouth which m.ake8 the gland secrete saliva ; the pain radi- 
 ates in all directions, owing to the nerves that are in con- 
 nection with the parotid gland and the involvement of the 
 chain of glands in the neck. The disease may occur without 
 there being any other case in the neighborhood, but, as it is 
 most contagious, it usually spreads from family to family, 
 sparing none. 
 
 It begins wnth slight fever, followed in twenty-four hours 
 by stiffness in the jaw and earache, the stiffness extending 
 down the neck ; then slight tumefaction over the gland of either 
 one or both sides. The skin being tense, the swelling of the 
 gland gives rise to great pain, which may be constant or par- 
 oxysmal. The swelling extends to the glands below the jaw, 
 and the face then becomes greatly disfigured. The disease 
 usually reaches its height in four or five daj's and then declines ; 
 but sometimes it runs a much slower course, not ending for 
 two or three weeks. 
 
MUMPS. 445 
 
 The treatment of this disease is, of course, that usually 
 adopted in fevers of all kinds, — rest in bed, avoidance of solid 
 food, water to drink, liquid diet, and, if the little patient is 
 constipated, an enema of warm water and sweet or castor oil 
 to unload the lower bowel. Should a doctor not 'be obtainable, 
 the mother should at once carefully examine the child's throat 
 to note the presence or absence of membrane, or enlargement 
 of the tonsils (quinsy), as diphtheria and quinsy are the two 
 affections most likely to be confounded at first with this disease. 
 But as soon as the tenderness and pain in the angle of the 
 jaw develop, and the throat has been found free of patches 
 and swelled tonsils, the true nature of the complaint is made 
 evident. The blandest nourishment and fluids, as that is all 
 the patient will tolerate, should be given, such as warm milk 
 and Manitou, Vichy, or lime-water, peptonized milk or gruels 
 made quite thin, wine-whey in small quantities, if the child is 
 delicate ; the white of egg in warm water, dissolved and sweet- 
 ened slightly ; but all soups or beef-tea or any material that 
 requires salt should not be given. As the jaw becomes swollen 
 and painful it should be rubbed gently with warm sweet oil and 
 laudanum, a tablespoonful of the former to a teaspoonful of 
 the latter, or a sponge wrung out in hot water and covered 
 with oiled silk, rubber cloth, or waxed paper, should be placed 
 on the tender gland or made large enough to extend down the 
 painful chain of glands of the neck. Avoid draughts, as catch- 
 ing cold is a bad thing; avoid getting the nightclothes and 
 bedclothes wet, but allow plenty of fresh air in the sick-room. 
 
 Carefully sponge the child's body daily with tepid water, 
 cologne, or listerine, and very carefully wash the mouth out 
 several times a day with a soft linen rag and listerine or 
 Dobell's solution. The viscid mucus, which is secreted in 
 abundance by the inflamed gland, collects in the throat and 
 causes choking or difficulty in swallowing, or gives a bad taste, 
 while the pain caused by the slightest movement of the jaws 
 prevents the child from getting rid of it. Ice to suck in small 
 pieces, or crushed, is often most refreshing and acceptable; in- 
 
446 MOTHER AND CHILD. 
 
 deed, vanilla ice-cream is frequently the only nourishment a 
 child will take, and is often a most valuable nutrient for the 
 sick. 
 
 Eemember the contagiousness of this disease and keep the 
 other children away from the sick-room. It is astonishing 
 how an attack of this sort will prostrate a child, so care must 
 be taken, especially in winter, not to let one go out of the sick- 
 room until all evidences of the disease have vanished, nor out 
 of the house till there is strength enough to resist change in 
 temperature. During convalescence a child should be liberally 
 fed, at stated short intervals, with light puddings, — rice, sago, 
 etc. ; nourishing soups made from " stock ;" gruels flavored with 
 vanilla or raisins, so as to encourage the appetite ; milk, of 
 course, and plenty of bread and butter, in addition to the 
 regular diet of meat, eggs, vegetables, and fruit. 
 
 VARICELLA, OR CHICKEN-POX. 
 
 This disease, so common in children, is one of the mildest 
 of all the contagious diseases, and yet is important, owing to 
 the disfigurement which will follow unless carefully managed. 
 It usually occurs in young children, and aflects all in the 
 family. 
 
 There may be some fever, but there is nothing to call es- 
 pecial attention to any particular disease other than a bad cold 
 in the head ; but in twenty-four hours, probably as late as 
 forty-eight, little distinct rose-spots with a darker point in 
 the centre will appear, usually from, fifteen to twenty- eight 
 in numbei*, scattered over the body. Sometimes there are 
 more of them and sometimes they run together. On the 
 second day a fresh crop appears, and by this time the first 
 have turned into little bladders of clear water. In a day more 
 these little vesicles have become milky in appearance, and 
 by the fourth day from the milky appearance they have 
 turned yellow and dried up, forming a scab, which on the eighth 
 day falls off without leaving a permanent scar. But the erup- 
 tion is apt to be very itchy, intolerably so at times, and the 
 
SECOND DENTITION. 447 
 
 child will scratch it until it bleeds, causing the vesicles to 
 become confluent in places, and ultimately resulting in disfig- 
 uring scars. To avoid this the child's hands should have soft 
 mittens tied on them ; indeed, at times it would be well to tie 
 the hands down for a day or two. The body, especially over 
 the vesicles, or where they are most numerous, should be thor- 
 oughly but carefully anointed with carbolated or thymolated 
 vaseline (white). A warm bath towards the end of the attack 
 is most soothing. As there is very little fever attending the 
 disease, and children who catch it are usually young, but little 
 change from the ordinary diet is required. 
 
 CHAP TEE LIY. 
 
 SECOND DENTITION. 
 
 This work would be incomplete were we simply to devote 
 our attention to that time which is limited to the cutting of 
 the milk-teeth. There are various disorders of childhood that 
 are dependent more or less upon the disturbance of the equi- 
 librium that should be maintained between growth and devel- 
 opment. This disturbance is usually brought about by the 
 unnatural pressure which fashion or habit exerts upon the 
 growing tissues of the child, by brain-forcing and muscle- 
 cramping, by the want of that freedom and abandonment 
 which gives food for the muscles' growth and carries away 
 the ashes resulting from their destruction, and by the per- 
 nicious system of over-education, that endeavors to place an 
 adult brain in a child's body. Indeed, this attempt at forcing 
 is productive of the many disorders which attend the period 
 of permanent dentition. 
 
 It is not the cultivation of the mind that physicians object 
 to, but the system by which it is often accomplished is radically 
 wrong. 
 
448 MOTHER AND CHILD. 
 
 After a child has passed its first dentition there is little to 
 attract our attention, barring the complications that may arise 
 from contagious diseases. About the sixth year it will cut 
 the four first molars, about the twelfth year the four second 
 molars, and after the eighteenth year the so-called wisdom- 
 teeth. These teeth are all permanent ones, and the jaw has to 
 change in shape and size to accommodate them as they grow; 
 they produce a certain amount of pressure upon the nerve-pulp 
 at their base, and give rise to neuralgia and reflex disturbances, 
 together with irritation of the mouth, the throat, consequent 
 disorders of the tonsils, ear-troubles, and, possibly, disorders 
 of the intestinal canal, interference with digestion, with blood- 
 making, and perhaps, as a consequence, many of those pecu- 
 liar hysterical phenomena that attend puberty both in boys 
 and girls, but especially girls. In fact, a child's brain that is 
 excited by over-study, over-stimulated, — in other words, con- 
 gested, and by blood that is not of the purest, owing to defi- 
 cient exercise and under-feeding, — falls a ready victim to the 
 slightest pressure or irritation that results from the growth 
 of these permanent teeth. The other sets of permanent teeth, 
 that are cut from the sixth to the fourteenth year, simply take 
 the place of milk-teeth, and, consequently, do not produce the 
 same degree of irritation. It is, indeed, a difiicult matter to 
 decide in an individual case exactly how much disturbance is 
 due to teething and how much to the general impairment of 
 nutrition which results from the child's surroundings and 
 mode of life. 
 
 A strong, healthy child, brought up in the country, rarely 
 has any difiiculty at this time. 
 
 The general impairment of nutrition, followed by debility, 
 languor, all resulting from the loss of, or perverted, appe- 
 tite, and defective secretions, are the most frequent disturb- 
 ances that we meet with during second dentition. We have 
 at this time, also, disturbance of the mucous membrane of 
 the mouth, of the gums, due to the irritation of the milk- 
 teeth, whose roots become absorbed; possibly, want of clean- 
 
SECOND DENTITION. 449 
 
 liness may lead to incrustations or to a spongy condition of 
 the gum, with pressure and ulceration. Enlargement of the 
 tonsils, with various forms of inflammation, are also very apt 
 to occur at this time, especially that variety which is attended 
 by a grayish deposit, very readily mistaken for diphtheria, and 
 to which the physician's attention should be immediately 
 called. There is, too, a tendency to chronic enlargement of 
 the tonsils, which will give rise to earache, sometimes difficulty 
 in swallowing, snoring at night, with restlessness, and a ten- 
 dency to acute inflammation or quinsy upon the least exposure 
 to cold. 
 
 Such children are prone to attacks of headache, toothache, 
 or neuralgia of the face ; their tongues are apt to be coated ; 
 they have frequent bilious attacks. At this time, also, what 
 is known as scrofula is apt to develop ; enlargement of the 
 glands of the neck, weak eyes, nasal catarrh show them- 
 selves. These conditions, although occurring at the same 
 time as the second dentition, are by no means dependent 
 upon it in all cases ; they are attendant upon excessive growth 
 and faulty development, malnutrition, and inherited taints. 
 During this time also occur frequently those deformities which 
 are the result of improper deposit of lime in the bone, or of 
 the reabsorption of bone from pressure due to all sorts of 
 mechanical causes; among, these we find the diseases of the 
 joints, curvatures of the spine, and also the imperfect forma- 
 tion of the permanent teeth, which renders them brittle or 
 soft, readily broken, or easily affected by the acid eructations 
 that come from a disordered stomach, — a mere shell of a tooth, 
 as it were, which soon becomes carious, and unfortunately 
 cannot be replaced. 
 
 We see, then, that the mother's attention should be called to 
 her rapidly-growing child, in order to perfect its development 
 in such a way that its tissue^ will be well formed and nour- 
 ished, its functions established, by the time it reaches maturity. 
 There are certain other disturbances which occur during 
 second dentition that require our attention ; these are frequent 
 dd 38* 
 
450 MOTHER AXD CHILD. 
 
 bilious attacks, or certain fevers apparently due to growth, 
 that come on without any appreciable cause. A child will have 
 a slightly-furred tongue, will complain of pain in its bones, of 
 languor, loss of appetite, will be restless in its sleep, will suffer 
 from headache, which is usually frontal. Suddenly it will de- 
 velop a high fever, the face will be flushed, the eyes red, and in- 
 deed, if vomiting occurs, and the child has not previously had 
 the disease, we might almost expect the onset of scarlet fever. 
 The child should have a hot mustard foot-bath, and should 
 be given sweet spirits of nitre in its drinking-water; if the 
 tongue is coated, it should be given a dose of either Murray's or 
 Phillips's fluid magnesia, or a dose of castor oil or spiced rhubarb, 
 and the chances ai*ethat the next morning the child will awake 
 bright and cheerftil, without any bad results from its attack. 
 
 Kheumatism is veiy common at this period of life ; indeed, 
 many of the cases of so-called growing-pains are neither more 
 nor less than masked rheumatism. If a child complains con- 
 stantly of aching in its limbs, and seems loath to take exercise, 
 the attention of the doctor should be called to its condition. 
 
 Elsewhere we have written of the care of infants during the 
 period which terminates at about the age of five years. Before 
 this time there is not much to call our attention to any differ- 
 ence between the sexes : the girls are usually more delicate, 
 the hoys hardier ; the gii'ls, having more tender skins, are more 
 liable to eruptions. Boys are more difficult to bring up, owing 
 to the fierceness with which they are attacked by infantile 
 complaints, and their greater exposure. Usually the difference 
 in sex makes itself manifest in temperament as soon as the 
 infant becomes sufficiently independent to amuse itself, and 
 especially is this the case with the first-born, who has no one 
 to copy, no playmate older than itself by whom it can be led. 
 Even at this early age parents should as much as possible en- 
 deavor to train a child to enjoy out-door amusements, and give 
 it exercise, that it may grow hardy, graceful, and cheerful in 
 disposition. This will have to be encouraged in the girls ; the 
 boys take to it as ducks take to water. 
 
SECOND DEXTITION. 451 
 
 It is during these tender years, "while the bones qxq yet frail 
 and soft, that those deformities which become the source of so 
 much disease in later life develop themselves. People are apt 
 to imagine that rickets and scrofula are confined chiefly to the 
 lower classes, — to the poor. This is a great mistake ; they enter 
 every household where the conditions which favor their devel- 
 opment are found. 
 
 Let us dwell for a few moments upon a matter of so much 
 importance in infant life. All the long bones of the body are 
 composed of three parts: the two ends which come in con- 
 tact with the same part of other bones and form the joints, 
 and the shaft. In later years these ends become united to 
 the shaft, and the whole becomes one solid bone. Bones are 
 composed of two kinds of material : the gelatinous, which 
 gives pliability and elasticity to them, and the mineral, which 
 makes them firm and strong. Of the latter, the salts of lime 
 form the most important part. 
 
 In infant life the growing bone receives an immense amount 
 of nourishment ; it grows rapidly. The centre is spongy and 
 filled with blood-channels. The bones are by no means hard 
 at this age, and should anything diminish the amount of lime 
 they receive, or through malnutrition a low grade of inflamma- 
 tion be engendered, the movements of the child, the straining 
 of its muscles, the weight of its body, will cause the bones to 
 curve, and unless attention is immediately given, this curving 
 will be permanent. Especially is this the case where the bony 
 shaft is attached to the cartilage to form a joint ; naturally, 
 the rapid growth requires such joints to be loose and yielding 
 and elastic, and the constant strain will so stretch them as to 
 produce deformity. 
 
 A child who, instead of running out in the fields or gayly 
 .•^kipping along the street, filling its lungs to the utmost and 
 sending ample nourishment to every tissue of its body, sits by 
 the hour by its mother's side nursing its doll, though a beautiful 
 object, is also a melancholy one, as time will show that nature's 
 laws are being interfered with. We know that there is a 
 
452 MOTHER AND CHILD. 
 
 pressure of fifteen pounds to every square inch of sui-face on 
 all bodies at the level of the sea. In breathing, a certain 
 amount of force is required to overcome this. In a frail, deli- 
 cate child, whose .muscles are imperfectly developed, the lungs 
 are scarcely ever inflated to their full extent, and the constant 
 atmospheric pressure not being overcome, tends to flatten the 
 chest- walls, so that when the bones are hardened the breast- 
 bones assume the form known as pigeon-breast. One great 
 cause of consumption is thus introduced. 
 
 A child that is constantly made to breathe fully and deeply 
 by means of out-door exercise, and who at the same time has 
 its chest freed from all restraints of close-fitting garments or 
 the injurious requirements of fashion, will in the future bless 
 its parents for the great gift of health, which is an heirloom of 
 priceless value. The girls as well as the hoys should he straight- 
 limhed and full-chested. 
 
 The disease called rhachitis, or rickets, is brought about not 
 only in those children whose parents live in damp, ill-ventilated 
 dwellings, devoid of all the comforts of life, exposed to the 
 intense cold of winter and to the great heats and atmospheric 
 impurities of summer; it is also noticed among the rich, who, 
 possessing every comfort of life, may, either through ignorance 
 or carelessness, fail to supply food which nature has intended 
 to make bones firm and muscles strong, or they may neglect 
 to see that their children are kept in a proper state of health 
 to digest and assimilate such food. 
 
 Fashionable mothers are only too desirous of transferring 
 their duties to an experienced nurse, and consider that task 
 complete which was intended by heaven as a sacred dut}^, when 
 they have purchased the most fashionable baby-carriage and a 
 full supply of condensed milk. Experiment has shown that 
 the strongest animals can be made rickety by the character of 
 the food on which they arc fed, and experience shows that 
 children who have a tendency to rickets, if fed upon nutritious 
 food and given plenty of fresh air and exercise, can be made 
 strong, and will outgrow the predisposition. It is on this ac- 
 
SECOND DENTITION. 453 
 
 count that so much stress is laid upon the use of the various 
 cereals in the feeding of growing children, especially oatmeal 
 and cracked wheat. Every child — after the completion of its 
 first dentition — should be given three regular meals a day : the 
 breakfast consisting of bread and butter, a plate of well-cooked 
 oatmeal with cream and plenty of milk, a soft-boiled egg, a 
 mutton-chop, or a piece of steak finely minced. Avoid hot 
 cakes, very fresh bread, or rich dishes of any sort. For the 
 dinner, which should invariably be taken at an early hour, it is 
 an important matter, when possible, to give fresh vegetables, — 
 well-cooked potatoes and rice properly boiled, — and encourage 
 the children to eat bread and butter with their meals. They 
 should also have either cooked fruit or ripe raw fruits in 
 abundance. The final meal should be a varied one; meat 
 should be avoided ; and it should consi.st of soft custards, milk- 
 toast, or bread and butter made more inviting by a little good 
 preserve. This outline will give an idea of the character of 
 food that supplies brain, muscle, and nerve. It may be modi- 
 fied according to the peculiarities of the child, the time of 
 year, and the family circumstances. 
 
 Do not let a mother suppose that because she has nursed her 
 infant the usual time it cannot become rickety. Unless she 
 lives upon food which will give to her milk in full proportion 
 the quantities represented in the diet mentioned above, her 
 child, though nursed and to all outward appearances subjected 
 to only what is best for it, will in reality be no better off than 
 a bottle-fed baby ; indeed, a child carefully brought up on the 
 bottle by an experienced person will be healthy in all respects. 
 
 We think that most mothers forget the important point that 
 the nourishing quality of their milk depends on their own state 
 of health. 
 
 As far as the medical treatment of rickets is concerned, we 
 need only mention here those drugs which are in reality other 
 forms of food. Cod-liver oil is pre-eminently the most impor- 
 tant. It may have been ordered by the physician in early infant 
 life, but if, at the period of childhood of which we are now 
 
454: MOTHER AND CHILD. 
 
 speaking, no physician is at hand, a mother should not hesitate 
 to give it should the child complain of fatigue, grow thin, lose 
 its appetite, or give other evidences of bad nutrition. 
 
 Before concluding this chapter it may be well to make a few 
 remarks regarding the dress of young children. Habits of 
 regularity should be instilled at a very early age, and may be 
 so well established that by the second year the diaper can be 
 exchanged for drawers. Should summer make it convenient 
 to do so at an earlier period, it may be well to make the 
 change, as in some children the thick folding of the diaper is 
 apt to make them bow-legged, especially if it is not very care- 
 fully put on. This, of course, .only refers to children who are 
 walking. As regards the clothing of children in our damp 
 seaboard climate, flannel should be insisted upon all the year 
 round. 
 
 Teething children should wear fine merino stockings all 
 the year. Two important things to bear in mind are the 
 simplicity and loose fitting of all their clothing ; the latter is 
 most essential for growing children, as deformity, stooping 
 shoulders, contracted chest, and weakened backs depend a 
 great deal upon ill-fitting garments. "Would that mothers 
 were sufiiciently impressed with this fact ! 
 
 The nest thing is the proper change of clothing to suit the 
 seasons. Warm clothing is not necessarily cumbersome, and 
 merino undershirts with high necks are certainly imj)ortant, 
 even in summer, though they be of the thinnest kind. Croup 
 is, we think, not so prevalent as it used to be, and we can but 
 attribute this to the much more common-sense way of clothing 
 children than was fashionable some years ago; bare-necked, 
 bare-armed, and bare-legged babies in midwinter are no longer 
 seen. — those frail flowers of our hot winter houses, so often 
 the victims of fatal draughts. 
 
 All children should wear thick-soled shoes, easy and well 
 fitting, with room for growth at the toes; they should be 
 without heels. 
 
 The importance of light calisthenics at this age cannot be 
 
SECOND DENTITION. 455 
 
 overestimated. Not only do they give, under competent 
 management, a graceful and easy carriage, which means sym- 
 metrical development, but they supply muscular power, increase 
 the force of the circulation, develop the chest and thereby the 
 activity of the lungs, and give tone to the nervous system; in 
 other words, they improve the digestion and the appetite, and 
 in that way secure a flow of good, nourishing blood. 
 
 In conclusion, we will quote liberally from an excellent article 
 that recently appeared in the Spectator : 
 
 " The world has grown unconsciously much wiser as to the 
 management of children. IN'othing improves physique like 
 good milk, — that, and not porridge, is the cause of the tall 
 Highlanders, Irishmen, and Sikhs, — and the little children of 
 our day are nourished on cream-and- water, or milk procured 
 from the great dairies, which is as good as milk can be, and as 
 different from the milk of thirty years ago as Brand is different 
 from old beef-tea. The very cows are of different breed, not 
 to mention the improvement in their food and lodging. Then 
 a prejudice of an extraordinarily injurious character — we 
 write these sentences on first-class medical evidence — has 
 silently, no one knows why, entirely disappeared. Nothing 
 nourishes like good sugar, possessing as it does just the requi- 
 site heat-giving quality; but the mothers of 1830-50 dreaded 
 sugar. They had an idea that it sickened babies, who always 
 crave for it like horses for salt; that it spoilt the teeth of 
 growing children; and that it swelled the tongues of children 
 a little more advanced in 5^ears, — the last a fancy based on the 
 effect of sucking toffy. They therefore withheld sugar, thus 
 leaving the children half nourished, and permanently sensitive 
 to a climate which for seven months in the year is always 
 chilly., Nowadays, everybody among the cultivated knows 
 that sugar is beneficial, and the children are left to their in- 
 stincts, with the result that they make flesh, and are almost 
 always warm. Then the matrons of 1830-50 had a fixed idea, 
 incurable by the men, who never quite gave in to it, that 
 children, if let alone, would invariably over-eat themselves, a 
 
456 MOTHER AND CHILD. 
 
 theory true of about five per cent. The nurseries were dieted 
 like prisons, with the result — all nurses exaggerating the pop- 
 ular ideas — that the children who longed for food were never 
 fed enough, and the children who disliked much food — a pecu- 
 liarity of many good constitutions — were gorged to indigestion. 
 And finally, children are kept warm enough. The horrible 
 old idea of those two decades, that children should be ' hard- 
 ened' by exposure, has died away; the nurseries, besides 
 being properly ventilated, are kept warm, and the whole prin- 
 ciple of children's clothing has been radically, and we hope 
 finally, modified in the sense that the 'body,' as distinguished 
 from the limbs, is thoroughly and wannly clad. The result 
 is, that the child with a tendency to grow does grow, and that 
 a greatly increased percentage of boys run towai'ds five feet 
 eleven inches, and of girls towards five feet eight inches, and 
 five feet nine inches, than has ever been the case before. 
 Moreover, as the boys and girls grow naturally, they keep 
 their good looks, and, except for a year or two of life, it has 
 become a positive rarity to see 'gawky' lads and lasses, as 
 great a rarity as to see the latter with the shining red elbows 
 which forty years ago were at once the most dreaded and the 
 most frequent of the minor deformities. The improvement — 
 always, mind, in a strictly limited class which hardly considers 
 the cost of food — is manifest at every turn, and is reported not 
 only by every artist, but every caricaturist in the country. 
 The undersized lads and skinny girls have disappeared from 
 pictures of the middle class, even when drawn with distinctly 
 hostile intent. 
 
 " Food has been helped by training. It has become a custom 
 to let girls live in the open air, to suffer them to play games 
 which thirty years since would have been pronounced ' hoi- 
 denish,' — then a most opprobrious adjective, — and even to train 
 them through gymnastics with scientific attention and regu- 
 larity. They may take as much exercise as they like, and 
 owing to the partly accidental introduction of vigorous games 
 in which both sexes can share, they like to take a good deal. 
 
SECOND DENTITION 457 
 
 'Ladies' cricket" and 'ladies' golf are imitative tricks, with 
 nothing to recommend them but the open air ; but lawn tennis 
 is sharp, healthy work, a great deal better than the hay- 
 making of the last century, which overtaxed the spine ; and so 
 are riding, as now practised, and the walk of eight or ten 
 miles, even if it ends in a rather fatiguing trudge. Exercise 
 of tha't kind, while it makes the boys lissome, sets the girls up, 
 a change which is no doubt one cause of their apparent increase 
 in height. They stand on their feet and stand up as theu* 
 grandmothers, with all their drilling on backboards and in- 
 junctions to sit straight up against chair-backs, which were 
 tortures, never did. The girls stand like soldiers, without 
 their stiffness ; and because they can do it. and know they can, 
 they fall instinctively into a style of dress which displays their 
 ability, which recognizes, for example, the place of the waist 
 in the human figure. Girls do not 'lollop' now, have, indeed, 
 almost forgotten a word which forty years ago was incessantly 
 in their seniors' mouths, and was the origin in thousands of 
 cases of positive physical harm. A well-bred girl nowadays 
 does not sit as if she were listening to a rebuke, and stiffening 
 herself to disregard it ; but she does not ' lollop,' any more 
 than she ties her waist-belt about five inches too hio-h." 
 
 39 
 
INDEX. 
 
 Abortion, 23. 
 Absorbent cotton, 249. 
 disinfectants, 379. 
 Acacia water, 129. 
 
 Acidity of saliva, cause of caries, 382. 
 Adams, Dr. S. S., on diet after early den- 
 tition, 320, et seq. 
 Adhesive plaster, 250. 
 After-birth, dangerous when not ex- 
 pelled, 62. 
 destruction of, 62. 
 Air, bad, a cause of consumption, 189. 
 fresh, allowance of, per head, 223. 
 how to get rid of carbonic acid in, 
 
 287. 
 impurities of, divided into three 
 
 classes, 222. 
 need for moisture in, 227. 
 of sick-room moistened with steam, 
 
 367, 368. 
 open, for the infant, 52. 
 Air- and water-poisoning, effects of, 228- 
 230. 
 passages, diseases of the, 411, et seq. 
 Alcohol, dilute, 252. 
 Alkali in croup, vapor of an, 420. 
 Amenorrhcea, 172. 
 American model of seat and desk, 204, 
 
 205. 
 Amherst College, light gymnastics at, 
 
 215. 
 Antidotes, 268-274. 
 acid, 274. 
 alkaline, 274. 
 Antisepsis, 60. 
 Antiseptic gauze, 249. 
 wash for eyes, 390. 
 Antiseptics for use in childbirth, 49, 50. 
 
 in puerperal fever, 61-63. 
 Aperient, Tarrant's, 171. 
 
 Arnold steam sterilizer, 112, 420. 
 
 Aruott, Neil, 190. 
 
 Arrow-root not to be used in child's dietr 
 
 ary, 321. 
 Artery, wounded, 248. 
 Artificial light, how to get rid of its car- 
 bonic acid, 287. 
 
 spoils air for breathing, 287. 
 Assafcetida in teething, 314, 315. 
 Astigmatism, 213. 
 
 glasses for remedy of, 213, 214. 
 Atmosphere, pure, 222, 223. 
 Atomizer for sore throat, 413. 
 
 in whooping-cough, 428. 
 Aural disease due to nasal obstruction, 
 410. 
 
 Baby-band, crocheted, 55. 
 
 " Baby foods," indiscriminate use of, 157. 
 
 Back, hollow, 216. 
 
 Backache, 187. 
 
 Bacon's, Miss A. M., book on " Japanese 
 
 Girls and Women," 294. 
 Bandages, 249. 
 Barley, directions for preparing, 144. 
 
 in bottle-feeding, 143, 444. 
 Barrett's, Dr. Howard, book on cuts and 
 
 other wounds, 242. 
 Basket, child's, 53. 
 
 outfit for, 54. 
 Bath for debilitated child in hot weather, 
 303. 
 
 cold-water, 302. 
 
 of the infant, 80, 81, 298, et seq. 
 
 salt, when to be used, 300, 301. 
 
 temperature of, for infant, 298, 299. 
 Bathing, 298. 
 Bed after labor, 59. 
 
 for an operation, preparing of, 372. 
 459 
 
460 
 
 INDEX. 
 
 Bed prepared for childbirth, 58. 
 Beef, peptonized, 322. 
 
 Valentine's extract of, 161. 
 Beef-juice, directions for making, 161. 
 Beef-soup as supplemental food in nurs- 
 , ing, 158. 
 Beef-tea, 158. 
 
 as after-weaning diet, 321, 322. 
 Bichloride of mercury, 378. 
 Binder, abdominal, 46, 47. 
 
 child's, 83, 84. 
 Birth, miscalculations regarding, 23. 
 
 premature, 22, 23. 
 Bites of cats, 267. 
 
 of dogs, 267. 
 
 of rats, 267. 
 
 of venomous serpents, 266. 
 Bladder, irritability of, during preg- 
 nancy, 36. 
 Blair Sons, makers of sterilizer, 117. 
 Bland liquids, 274. 
 Bleeding from the eye, 397, 398. 
 
 stopping of, 246, 247. 
 Blind people, low vitality among, 208, 209. 
 Blisters for children, 365. 
 Blood-poisoning, 60. 
 Boarding-schools, 182. 
 Boiling milk, 107, 111. 
 Bones, development of, 451 , 452. 
 
 growing, in second dentition. 451, 452. 
 Bonnets for children, in cold weather, 408. 
 Borax, dry powdered, 251. 
 Borden's condensed milk, 132. 
 Boric acid, 251. 
 Boro-glyceride, ointment of, for the eyes, 
 
 393. 
 Bottle-feeding, 104, 124. 
 Bottle for a delicate babe, 128. 
 
 how to prepare, 119. 
 
 prepared, 138. 
 Bottle-food for child of four mouths, 156. 
 Bowditch, Prof. H. I., 190. 
 Bowel, catarrh of, 352. 
 Bowels, care of child after movement of, 
 336. 
 
 daily movements of, at six months, 
 337. 
 
 hemorrhage from, 268. 
 
 mother's knowledge of, 336. 
 
 movements of, up to three or four 
 months, 336. 
 
 normal condition of, in children, 336. 
 
 regulation of, 171. 
 
 Brain, care of, 94. 
 
 concussion of, 260. 
 
 irritability of, 184. 
 Bran a laxative, 143. 
 
 Bread jelly for children just after wean- 
 ing, 321. 
 
 how made, 321. 
 Breast, putting the child to the, 81, 87, 88. 
 Breast- and bottle-feeding, association of, 
 
 157. 
 Breast-binder, 49. 
 
 Breasts, care of, during pregnancy, 37, 38. 
 Breathing, artificial light spoils air for, 
 
 287. 
 British soldier's daily gymnastics, 218. 
 Broad-brimmed hats for children, 398. 
 Bromide of potassium in teething, 313, 
 
 314. 
 Bruises, 241. 
 
 Buchner on desk and seat, 202. 
 Burns, 261. 
 
 of the eye, 397. 
 
 with acids, 261. 
 
 with caustic alkalies, 262. 
 
 with hot pitch, 262. 
 Byers, Dr., on disinfection, 373, el seq. 
 
 Caill4, Dr., 112. 
 Calisthenics, 165, 214, 454, 4.55. 
 
 light, in second dentition, 454, 455, 
 Candy, pickles, etc., morbid appetite for, 
 
 12. 
 Cane-sugar, 132. 
 Canfield's condensed milk, 132. 
 Cap, baby's, 52. 
 
 under flannel, 408. 
 Carbolic-acid ointment, 252. 
 Carbonic-acid gas, 222. 
 Carbonic acid in air, how to get rid of, 
 
 287. 
 Carlsbad salt, 178. 
 Carmichael, 190. 
 
 Carpets, movable, for the nursery, 283. 
 Casein, 125. 
 
 Catarrh, age at which children show 
 symptoms of, 381,383. 
 
 cause of diarrhcea, 353. 
 
 Dr. Alexander MacCoy on treatment 
 of, 380, et seq. 
 
 earliest symptoms of, 381-383. 
 
 evidences of, 352, 353. 
 
 from wet feet, 427. 
 
n\DEX. 
 
 461 
 
 Catarrh, how hrought about, 353. 
 
 in children overclothed, 427. 
 
 nasal, acute and chronic, 380, et seq. 
 
 of the stomach and bowel, 352. 
 
 post-nasal, 382, 
 
 precautions for preventing, 383, 384. 
 
 produces diarrhcea, 353. 
 
 treatment for, 363, et seq. 
 Cats, bites of, 267. 
 Cereals, 141. 
 Chadwick, Edwin, 180. 
 Chafing of infant skin, prevention of, 55. 
 Chemical disinfectants, 376, et seq. 
 Chest, smallness of, 217. 
 Chicken-broth for children after wean- 
 ing, 322. , 
 Chicken-pox, 446, 447. 
 Child, appliances for the new-born, 50- 
 
 53. 
 Childbirth, antiseptics for use in, 49, 50. 
 Child's clothing warm and loose, 85. 
 Chimneys, construction of, for ventila- 
 tion, 287. 
 Chloride of lime, 377. 
 Chlorine, 377. 
 
 Cholera infantum, aggravation of simple 
 diarrhoea mistaken for, 353. 
 
 true, not very common, 353. 
 Chorea brought on by school-work, 184. 
 Clarke's, Dr., " Sex in Education," 188. 
 
 replies to, 188. 
 Clean cut, treatment of a, 243. 
 Cleanliness in pregnancy, 28. 
 Cleft palate, 76. 
 
 Climate, temperate and equable, for preg- 
 nancy, 41. 
 Clothing, child's, warm and loose, 85. 
 
 for period of second dentition, 454. 
 
 house, for the child, 52. 
 
 of the sick child, 371. 
 
 woman's, 17, 18. 
 Cod-liver oil, 453. 
 Cold cream, 252. 
 Cold, effects of, 263. 
 
 how to treat, for a child over six 
 months of age, 380. 
 
 in the head, 380. 
 
 should never be neglected, 380. 
 Colic in nursing babies, 100-102. 
 Collodion, 244. 
 
 Command, parent's, to be observed, 281. 
 Comrades, children sensitive to influence 
 of, 185. 
 
 Conception, conditions influencing, 19, 
 20. 
 periods of liability to, 20. 
 Concussion of the brain, 260. 
 Condensed milk, Borden's, 132. 
 Canfleld's, 132. 
 
 how to be used in weaning, 157. 
 Confinement, diet after, 64-69. 
 first few daj's after, 63. 
 getting up after, 71. 
 Congestion of the eyes, 211. 
 Consciousness, loss of, 259. 
 Constipation, agony of menstruation due 
 to, 175. 
 cause of, in infant at the breast, 337, 
 
 388. 
 diarrhcea of, 339. 
 Dr. C. A. Earle on, 344, 345. 
 Dr. A. Jacobi on, 345-347. 
 Dr. Walker's recommendation for, 
 
 343. 
 does not always mean faulty action 
 
 of the liver, 338. 
 due to derangement of digestion, 342. 
 to various causes, 339. 
 to want of propelling power in 
 the bowel, 340, 341. 
 enema in cases of, 340. 
 in infancy, 337, et seq. 
 tendency in the child to, 337. 
 water as a laxative in, 340. 
 Consumption, 189. 
 
 bad air causing. 189. 
 
 caused by school-influences, 189. 
 
 damp soil a predisposing agent to, 
 
 192. 
 hereditary tendencies to, 191. 
 incipient, disqualifies for bearing 
 
 children, 27, 28. 
 report on causes or antecedents of, 
 192. 
 Contagion at funerals, 240. 
 Contagious diseases in schools, 231. 
 
 preventing the spread of, 232. 
 Contusions, 264, 265. 
 Convulsions, 259. 
 
 Dr. A. Jacobi on treatment of, 314. 
 Cord, cutting the, 83. 
 Corporal punishment, 221. 
 Corsets for the ignorant and stupid, 17. 
 should not be worn by young women, 
 170. 
 Cotton, absorbent, 249. 
 
 39* 
 
462 
 
 INDEX. 
 
 Cormtry excursions for poor children, 355. 
 Cow's milk, advantages of, 109. 
 
 effect of, 88, 107, 128. 
 
 fresh, from the bottle, 351. 
 
 stale, 351. 
 Cradle, 53. 
 Cream, cold, 252. 
 
 Creeping in one position injurious, 309. 
 Croup, 414, et seq. 
 
 boys more apt than girls to have, 414. 
 
 child's diet in case of, 422. 
 
 cough during the day, 418-422. 
 
 croupy coughs all serious, 423. 
 
 emetic in suffocation from, 421. 
 
 fever mixture for croupy cough, 421. 
 
 how averted, 414. 
 
 lime in treatment of, 420. 
 
 membranous and diphtheritic, 416, 
 et seq. 
 of two varieties, 417. 
 
 obstruction of larynx in, 417, 418. 
 
 spasmodic, 415, 416. 
 
 treatment of mucou.s membrane in, 
 419, 420. 
 
 vapor of alkali in, 420. 
 Curd, predigesting the, 146. 
 Curvature, spinal, in schools, prevention 
 
 of, 195. 
 Curved spines, 169. 
 Cuts and other wounds, 242. 
 
 clean, treatment of, 243. 
 
 Dr. Howard Barrett's book on, 242. 
 Cutting teeth, lateness in, 309. 
 
 Damp soil predisposing to consumption, 
 
 192. 
 Darby, Dr. E. T., on care of the teeth, 
 
 333—33-5. 
 Davis, Dr. E. P., 116, 140. 
 Debility in early girlhood, 168. 
 Decayed meat, 274. 
 Decorum, misguided sense of, 196. 
 Deformities, spinal, 192. 
 Delayed menstruation, Dr. Mathews 
 
 Duncan on, 173, 174. 
 Delicate babe, bottle for, 128. 
 Dentifrices, their composition and use, 
 
 334. 
 Dentition, early, diet after, 317, el seq. 
 second, 447, et seq. 
 
 clothing for the period of, 454. 
 disorders of, 447-450. 
 
 Dentition, second, growing bones during. 
 451,462., 
 light calisthenics at the age of, 
 
 454, 455. 
 rickets a disease of, 452, 453. 
 Desks and seats, Buchner on, 202. 
 
 in school, 197. 
 Detention as a means of punishment, 
 
 221. 
 Diarrhoea, 348, et seq. 
 
 due to over-feeding, 349, 350. 
 
 enema for, 365. 
 
 from catarrh, 353. 
 
 immediate treatment of sudden cases 
 
 of, 356. 
 indigestion the common cause of, 348. 
 mother's duty in case of, 356. 
 of constipation, 339. 
 result of improper feeding, 324, 350, 
 
 351. 
 treatment of, 353, et seq. 
 Diet after confinement, 64-69. 
 
 after early dentition, 317, et seq. ' 
 
 Dr. S. S. Adams on, 320, et seq. 
 
 from the third to the fifth year, 327, 
 
 et seq. 
 greater variety in, 319, 320. 
 Digestion, 139. 
 
 constipation from deranged, 342. 
 of fat, 135. 
 Dilute alcohol, 252. 
 Dilution of milk, 135, 140. 
 Diphtheria, 231, 239. 
 
 chief suffferers from, 279. 
 nursing in, 368, 423. 
 Directions on medicine-bottle to be read 
 
 by mother or nurse, 372. 
 Discharges, disinfectants for, 368, 369. 
 Disinfectants, absorbent, 379. 
 
 bichloride of mercury (corrosive sub- 
 limate), 378. 
 carbolic acid, 378. 
 chemical, 376, et seq. 
 chlorine, 377. 
 
 for linen and discharges, 368, 369. 
 fumes of sulphur (sulphur dioxide), 
 
 376. 
 in the ntu^ery, 289. 
 Disinfection, Dr. Byers on, 373, et seq. 
 heat as an agent of, 374. 
 Labarraque's solution for personal, 
 
 373. 
 steam rapid and powerful for, 375. 
 
INDEX. 
 
 ' 463 
 
 Disordered, menses a symptom of over- 
 pressure, 187. 
 Disorders of second dentition, 447-450. 
 Dobell's solution in whooping-cough, 428. 
 Dogs, bites of, 267. 
 Douche bath, 371. 
 Drainage and sewerage, 228. 
 Draughts of cold air, protection of the 
 
 child from, 79. 
 Dress, infant's, hygienic essentials of, 290, 
 291 , et seq. 
 ordinary objectionable, 291. 
 of older children, 293, 294. 
 of the girl, 11. 
 Dressing-materials for wounds, 249, 250. 
 Drinking-water, pure, 279. 
 Drowning, 252. 
 Dulles, Dr. Charles W., on treatment of 
 
 wounds, 249-251. 
 Duncan, Dr. Mathews, on delayed men- 
 struation, 173, 174. 
 Dysentery and diarrhoea, 230. 
 Dysmenorrhcea, 172, 178. 
 Dyspepsia, national trait of Americans, 
 183. 
 school in some cases responsible for, 
 
 183.' 
 symptom of overwork at school, 183. 
 
 E. 
 
 Ear, diseases of the, 399, et seq. 
 
 aural disease due to nasal obstruc- 
 tion, 410. 
 
 child with running ear may go out 
 in the cold, 408. 
 
 cleansing discharging, 400, 401. 
 
 cotton not to be worn in the, 408. 
 
 discharges from the, 399, et seq. 
 
 foreign bodies in the, 258, 259, 407. 
 
 how the ears should be kept clean, 
 406, et seq. 
 
 inflating the middle ear,' 402. 
 
 John C. Saunders, M.D., on anatomy 
 of the, 404. 
 
 running ears in children under two 
 years of age, 405, 406. 
 
 soap and water poisonous to the, 
 400. 
 
 syringing the, 401. 
 
 wax in the, 406, 407. 
 Earache in a babe, 399, 400. 
 Earle, Dr. C. A., on constipation, 344, 345. 
 
 Eclampsia, or convulsions, occurring in 
 
 pregnancy, 27. -^ 
 
 Education and school-hygiene, 179-241. 
 
 m.eaning and scope of, 179. 
 Egg as substitute for infant food, 158. 
 Elixir cascara sagrada, 171. 
 Enema in cases of constipation, 340. 
 English school-boy described by A. Mac- 
 
 laren, 217. 
 Epilepsy from overwork in school, 180. 
 Epileptic fits, 259. 
 
 Eruptive diseases, treatment of, 369. 
 Evacuations, duty of nurse respecting, 
 
 366. 
 Evaporated milk, 133, 134. 
 Excessive use of eyes, 210. 
 Exhaustion from disease or inanition, 
 treatment of, 154 
 heat-, 263. 
 Eyes, diseases of the, 208, 388, et seq. 
 
 antiseptic wash for treatment of, 390. 
 baby's, how to be treated immediately 
 
 after birth, 388, et seq. 
 bleeding from the, 397, 398. 
 congestion of the, 211. 
 dilatation of the pupils of the, 389. 
 excessive use wearies the, 210. 
 foreign bodies in the, 257. 
 geometrical deformity of the, 212. 
 hereditary influence in defects of the, 
 
 212. 
 ointment of boro-glyceride for the, 
 
 393. 
 physiological laws of distance for 
 
 the, 211. 
 proper care of, 394. 
 swelling and inflammation of, 389, 
 
 390. 
 treatment of, night and day, 391. 
 
 F, 
 
 Fainting. 259. 
 
 Fairchild, Mr., on peptonizing food, 140- 
 
 150. 
 Fairehild's liquor pancreaticus, 154. 
 Family medicine-chest, 433. 
 Farinaceous foods, 141. 
 Fat, digestion of, 135. 
 Feeding-bottle a great offender, 367. 
 Fever, 429, et seq. 
 
 is a symptom, 429. 
 
 puerperal, antiseptics for, 61-63. 
 
464 
 
 INDEX. 
 
 Fever, what the mother should do for 
 
 the child with, 431, 432. 
 Filter, the Pasteur, 279. 
 First year, growth of child during, 308. 
 Fish-hooliS, how to remove, 266. 
 Fits, epileptic, 259. 
 Flooding after childbirth, 59. 
 Folding-bath, 80. 
 Folsom, Dx. C. F., 184. 
 Food as constituted by nature, 319. 
 
 choice of, for a child a matter of 
 experimient, 152. 
 
 test of, the thriving of the child, 152. 
 Foods, table of, 153. 
 Foreign bodies in the ear, 258, 259, 407. 
 
 in the eye, nose, and ear, 257. 
 Frankfort-on-the-Main, school gymnas- 
 tics of, 219. 
 Freezing, 263. ^ 
 
 Fresh air, 275. 
 Friedrichshall, 171, 178. 
 Funerals a source of contagion, 240. 
 Furnace, hot-air, 284. 
 Furniture of the nursery, 283. 
 
 G. 
 
 Gastric jiiice, 140. 
 
 Gauze, antiseptic, 249. 
 
 Geometrical deformity of the eye, 212. 
 
 Germany, excessive study iu the schools 
 
 of, 184. 
 Girlhood, debility in early, 168. 
 Girl's dress, 11. 
 
 life, hygiene of the, 9. 
 Glasses for long-sight, 213. 
 
 for near-sighted child, 213. 
 
 for remedy of astigmatism, 213, 214. 
 
 headache cured by, 184. 
 Gluten suppositories, 172. 
 Glycerin suppositories, 172. 
 Grape-sugar from cereals an aid in nutri- 
 tion, 151. 
 Growing girls, nourishment of, 11. 
 
 stimulants and narcotics should not 
 be given to, 12. 
 
 ten hours of sleep for, 12. 
 Growth of child during first year, 308. 
 Gum-arabic water as nourishment, 154 
 Gums in teething, 304, et seq. 
 
 when to be lanced, 313. 
 Gymnasium, apparatus of the, 216. 
 Gymnastics, light, Amherst College, 215. 
 
 H. 
 
 Hair, care of, in infancy, 289. 
 
 pillows, 396. 
 Harris, W. T., 182. 
 Harvard University, 216. 
 Hats, broad-brimmed, for children, 398. 
 Ha ward on backache, 187. 
 Head, cold in, 380. 
 Headache cured by suitable glasses, 184 
 
 various causes of, 184- 
 Heat an agent of disinfection, 374. 
 Heat-exhaustion, 263. 
 Heating, methods of, 277. 
 Hemorrhages, special, 267. 
 Hitchcock, Professor Edward, M.D., 215. 
 Hollow back, 216. 
 Holmes, Oliver Wendell, 61. 
 Hot-air furnace, 284. 
 House-clothing for child, 52. 
 House-service, benefits of, to lives and 
 health of women, 19. 
 
 need of properly-trained women for, 
 18, 19. 
 " Humanized milk," directions for, 130. 
 
 for infants with feeble digestion or 
 disordered stomach and. bowels, 
 130. 
 
 for the daily food of a healthy nurs- 
 ing infant, 130. 
 Hunyadi water, 178. 
 Hygiene of the girl's life, 9. 
 Hypermetropia, or long-sight, among 
 school-children, 213. 
 
 choice of glasses for, 218. 
 Hysterics, 259. 
 
 Impurities of air, 222. 
 Inanition, exhaustion from, 154. 
 Incipient consumption unfits for bearing 
 
 children, 27, 28. 
 Incised wound, treatment of an, 243. 
 Incubation of disease, 425. 
 
 of measles, 440. 
 Indigestion, causes of, 145. 
 
 child should be watched for symp- 
 toms of, 145. 
 
 great cause of diarrhoea, 348. 
 Infant's dress, 290, 291, et seq. 
 
 objectionable, 291. 
 
 softness of material for, 290. 
 Infection and spread of measles, 369. 
 
INDEX. 
 
 465 
 
 Inflammation of the eyes, 389, 390. 
 Inflating the middle ear, 402. 
 Injections, 357. 
 Insanity in pregnancy, 28. 
 Iodoform, 251. 
 
 J. 
 Jacobi, Dr., A., 91, 97, 104, 125, 132, 157, 161, 
 
 314, 345, 346, 347. 
 Jacokes's illustrations of ventilation, 226. 
 Jeffries's, Dr., article on best type for 
 
 clearness, quoting from Javal, 209. 
 Jenner, Sir William, 306. 
 Jute, 249. 
 
 K. 
 
 Keeping the nursery, 362. 
 
 Kindergarten, 179, 181. 
 
 Kissing, diseases carried by, 412, 418. 
 
 Knapp, Dr. H., 395. 
 
 Knitted garments, 290. 
 
 Labarraque's solution for personal disin- 
 fection, 373. 
 Labor, 56-60. 
 
 bed after, 59. 
 
 prepared for, 58. 
 
 care of patient during, 57-60. 
 
 rest after, 63. 
 
 three stages of, 56-59. 
 Lacerated wounds, 265. 
 Lactation, 74. 
 Lactopeptine, 154. 
 Lady Webster pills, 172. 
 Landolt on leading causes of myopia, 
 
 208. 
 Larynx, obstruction of, 417, 418. 
 Lateral curvature, 192. 
 Laudanum, 252. 
 
 Laws of distance for the eye, 211. 
 Laxatives, 171, 172. 
 
 bran, 143. 
 
 molasses, 344. 
 
 syrup, 344. 
 
 water, 145, 340. 
 Lead-water, 252. 
 Leconte, Dr. John L., 230. 
 Leeches for children, 365. 
 I^eeds, Professor Albert R., 116, 156. 
 Legs developed by sports, 217. 
 Lesson for children at different ages, 
 length of, 181. 
 ee 
 
 Letters, correct slant of, in writing, 207. 
 Liebig foods, 135, 151, 152, 153. 
 Liebreich's desk and seat, 203. 
 Light, 209. 
 
 artificial, spoils air for breathing, 287. 
 
 poor, cause of near-sight, 211. 
 Lighting, defective, 209. 
 Lightning-stroke, 262. 
 Lime, chloride of, 377. 
 
 in treatment of croup, 420. 
 Lime-water, preparation of, 122, 123. 
 Lincoln, Dr. D. P., 180, 224. 
 Linen, disinfectants for, 368, 369. 
 
 for outer garments, 290. 
 Lint, 249. 
 
 Liquid diet for weakly children, 325, 
 et seq. 
 
 how to prepare, 324. 
 
 recipes for, 324, 325. 
 
 when to confine children to, 324. 
 Liquids, bland, 274. 
 Liquor pancreaticus, Fairchild's, 154. 
 Little's soluble phenyle in scarlet fever, 
 
 438. 
 Long-sight among school-children, 213. 
 Loring on causes of near-sight, 208. 
 Lungs, brunt of measles borne by, 442. 
 
 hemorrhage from the, 267. 
 
 M. 
 
 MacCoy, Dr. Alexander W., on treatment 
 
 of nasal catarrh, 380, et seq. 
 Maclaren, Archibald, 217. 
 Maid, child's, ignorance and stupidity 
 
 of the average, 53. 
 Malt as an aid to digestion of starchy 
 
 food, 152. 
 Mammary glands, improvement of sub- 
 stance of, 92. 
 Manitou water, 135. 
 Map-drawing, best plan for, 209. 
 Massachusetts Board of Health Report, 
 
 1882-1883, 209. 
 Massage during mother's recovery, 71. 
 for girls at age of menstruation, 165. 
 in constipation, 345. 
 popularity of, 17. 
 Measles, 440-444. 
 
 danger of exposure after, 442. 
 incubation of, 440. 
 infection and spread of, 369. 
 lungs bear the brunt of, 442. 
 
466 
 
 INDEX. 
 
 Measles, nursing of, 443, 444. 
 symptoms of, 440. 
 very fatal among the poor, 442. 
 Meat, decayed, 274. 
 Meat-jnice press, 161. 
 Medicine-chest, family', 433. 
 Medicines to be kept out of child's reach, 
 
 372. 
 Meigs, Dr. A. V., on preparation of bottle, 
 
 121, 142. 
 Mellin's food, 151, 152. 
 Mendelson, Dr. Walter, article on Arnold 
 
 sterilizer by, 112-116. 
 Menorrhagia, 172. 
 Menses disordered from over-pressure, 
 
 187. 
 Menstrual irregularity, womb-troubles 
 
 from, 169. 
 Menstruation, age at which it appears, 165. 
 agony of, from constipation, 175. 
 attempts harmful and fatal to bring 
 
 on, 172. 
 delayed, Dr. Mathews Duncan on, 
 
 173, 174. 
 deviations from normal condition of, 
 
 167. 
 disordered varieties of, 172. 
 duration of the period of, 167. 
 duty of mother in, 166. 
 establishment of, 14. 
 false and true treatment of, 14-16. 
 remedies for, curse of house- 
 hold, 175. 
 general treatment during disturb- 
 ances of, 164, 165. 
 girl's understanding of, 166, 167. 
 home-influences during beginning 
 
 of, 16. 
 hysterical phenomena sometimes at- 
 tending, 167. 
 natural impulse of girls at beginning 
 
 of, 162. 
 normal, should be painless, 168. 
 pain during, 174-179. 
 painful, how to relieve, 176. 
 pernicious influences at period of, 
 
 162, 163. 
 phenomena of, 165. 
 preparation for, 14. 
 return of the period of, 167. 
 severest form of, 177. 
 signs of the advance of a period of, 
 167. 
 
 Menstruation, treatment in extreme cases 
 
 of, 177, 178. 
 Mental education of the girl, 12, 13. 
 Mercury, bichloride of, 378. 
 Middle ear, inflating the, 402. 
 Military drill, 217, 218. 
 Milk, adulteration of, 108. 
 advantages of boiling. 111. 
 
 of sterilizing by steam. 111, 112. 
 bad, causes of, 106, 107. 
 oere in selecting and preserving, 107. 
 condensed, 88, 131, 132. 
 dilution of, 108, 135, 140. 
 diseases carried by means of, 107. 
 evaporated, 133, 134. 
 excessive flow of, 75. 
 "humanized," directions for, 130. 
 laws against impure, 108. 
 mixed, 107. 
 mother's, 98, 104. 
 obtained from a single cow, 107. 
 peptonized, 151. 
 scanty supply of, 76. 
 sugar of, 132. 
 suspected of taint should be boiled, 
 
 107. 
 tablets for use in, 127. 
 tainted, fatality of, 104. 
 temperature of, for the child, 126. 
 Milking, directions for, 108, 109. 
 Mindererus, spirits of, in fever, 431. 
 Miscarriage, 25, 26. 
 causes of, 25. 
 
 dangers attending abortion and, 25. 
 disorders following, 26. 
 medical aid and treatment for, 25, 26. 
 Mixed milk, 107. 
 Modern surgery, marvels of, 117. 
 Moisture in air, 227. 
 Molars, sixth-year, 332. 
 
 twelfth-year, pressure of, 162. 
 Mother, appliances after childbirth for 
 
 the, 45-50. 
 Mother's milk, 98, 104. 
 
 substitute for, 119. 
 tuberculosis conveyed through, 
 28. 
 recovery in childbirth, 70. 
 Mouth at various stages of teething, 305. 
 Mouth-wash, formula for an excellent, 
 
 335. 
 Mucus, detaching, in whooping-cough, 
 428. 
 
INDEX. 
 
 467 
 
 Mumps, 444^46. 
 
 nature of, 444. 
 
 treatment of, 445, 446. 
 Muscular development in growing girls, 
 
 163. 
 Mustard poultices, 343. 
 Mutton-broth for children after weaning, 
 
 322. • 
 Myopia, Landolt on, 208. 
 
 leading causes of, 208. 
 
 N. 
 
 Narcotics and stimulants not to be given, 
 
 12. 
 Nasal catarrh. Dr. A. W. MacCoy on treat- 
 ment of, 880, et seq. 
 
 obstruction a cause of ear-disease, 410. 
 
 passages, 102. 
 Navel, 85. 
 Near-sight caused by poor light, 211. 
 
 Loring on causes of, 208. 
 Near-sighted child, glasses for the, 213. 
 Near-sightedness, 208. 
 Neglect of eyesight, Soldan on, 209. 
 Nervines, etc., no part in children's diet, 
 
 159. 
 Nervous system, care of, 33, et seq. 
 
 derangement of, 184. 
 Neurasthenia, .or break-down, 186. 
 
 common in young women, 186. 
 New-born child, appliances for, 50-53. 
 
 care of the, 79. 
 Nipple for nursing, care of the, 38, 81,99. 
 Nipple-shield, 55, 81. 
 Nose, bleeding from, 267. 
 
 best methods for stopping, 386-388. 
 
 blowing the, 384. 
 
 foreign bodies in the, 258. 
 
 germs of whooping-cough in secre- 
 tions from the, 426. 
 Nostrums to be avoided, 429. 
 Nourishment of growing girl, 11. 
 Nuisances of nursery, 288. 
 Nurse and room for infant, 105. 
 
 in confinement, 42^4. 
 Nursery, 276, et seq. 
 
 as a hospital, 282. 
 
 floor, ideal, 280. 
 
 how it should be kept, 362. 
 
 nuisances of, 288. 
 
 sunlight in the, 282. 
 
 temperature of, 278, 287. 
 
 Nursery, toys for the, 289. 
 
 turned into a sick-ward, 362, et seq. 
 
 walls, painted, 283. 
 
 windows, 288. 
 Nurses, care in selecting, 298. 
 
 carelessness of, 297. 
 
 mother and nature among wisest of, 
 16. 
 
 training-schools for, 358. 
 Nurses' directories, value of their cer- 
 tificates, 94. 
 Nursing at each breast alternately, 89, 97. 
 
 directions for, 97-103. 
 
 frequency of, 89, 97, 98. 
 
 good effect on mother's health, 155. 
 
 Miss Catherine Wood on, 358, et seq. 
 
 mother, care in her mode of life, 308. 
 
 of sick children, 357, et seq. 
 
 sleep for mother and child during 
 intermissions of, 89. 
 
 the infant, importance of, 73. 
 
 varicose veins in, 99, 100. 
 
 womb reduced to usual size by, 73. 
 
 womb-trouble from not, 156. 
 Nursing-bottles, number and size of, 105. 
 
 rules for using, 110. 
 
 success in use of, 106. 
 
 Oatmeal, cautions for the use of, 157. 
 Obstruction of larynx, 417, 418. 
 Ointments for the child's body, 79. 
 
 in simple surgery, 252. 
 Open air for infant, 52. 
 
 fireplace for the nursery, 277, 284. 
 Operation, preparing bed for, 372. 
 Ophthalmia, contagious, 240, 394. 
 
 in the new-born, 389, 393. 
 Out-door exercise, 275. 
 
 for girls, 9, 11. 
 Out of doors, at what age a child should 
 go, 296. 
 
 child not to be, on an empty stom- 
 ach, 300. 
 Overclothing, catarrh from, 427. 
 Overfeeding a cause of diarrhoea, 349, 
 350. 
 
 a cause of sleeplessness, 311, 312., 
 Overwork at school, dyspepsia a symp- 
 tom of, 183. 
 
 epilepsy from, 186. 
 Oxide-of-zinc ointment, 252. 
 
468 
 
 INDEX. 
 
 P. 
 
 Palate, cleft, 76. 
 
 Pancreas, extract of. 148, 150, 151. 
 
 secretion from the, 140. 
 Paper for nursery walls should be var- 
 nished, 283. 
 Paralysis of the upi)er eyelid, 398. 
 Parents, tactless, 168. 
 Parker, Dr., nipple recommended by, 109. 
 on American Indian women and in- 
 fants, 295. 
 Parsons, Dr., disinfecting solution recom- 
 mended by, 879. 
 Pasteurization, 131. 
 Patent sweeper for the nursery, 280. 
 Penmanship, '• systems" of, 206. 
 Pepsin, wine of, 130. 
 Peptogenie milk powder, 130. 
 Peptonized beef, 322. 
 
 milk, 151. 
 Peptonizing food, Mr. Fairchild on, 146- 
 
 150. 
 Perception, when beginning in the child, 
 
 94, 95. 
 Personal disinfection, Labarraque's solu- 
 tion for, 375. 
 Phenyle, Little's soluble, in scarlet ferer, 
 
 438. 
 Philadelphia Board of Health, regula- 
 tions for prevention and restriction of 
 scarlet fever, etc., 23.5-241. 
 Physical training, 214. 
 
 at Amherst College, 215, 216. 
 
 at Harvard University, 216. 
 
 how much school and coUege should 
 
 further, 214. 
 in primary work, 214. 
 moderate exercise sutficient in, 215. 
 Physiological laws of distance for the 
 
 eye, 211. 
 Pickles, morbid appetite for, 12. 
 Pigeon-breast, 217. 
 Pillows, hair, 396. 
 
 Avoven-wire, 396. 
 Plants for day -nursery, 280. 
 Plaster, adhesive, 250. 
 Play better than gymnastics, 217. 
 
 return to Euglish notions of, 182, 183. 
 Poisoned wounds, 266. 
 Poisoning, air- and water-, effects of, 228- 
 
 230. 
 Poisons, 268-274. 
 
 Poisons should be marked for safety, 268. 
 table of, and treatment for, 272-274. 
 to be kept out of reach of children, 
 
 268. 
 unknown, 268. 
 Pond's extract, 387. 
 Positions, faulty, 199, 206. 
 Post-nasal catarrh, 382. 
 Potassium, bromide of, in teething, 313, 
 314. 
 permanganate of, prevents putrefac- 
 tion in sewage, 380. 
 Powder, peptogenie, 130. 
 Pregnancy, bathing essential to healthy, 
 33,34. 
 blood-poisoning in, 28. 
 care of nervous system in, 34, K. 
 cleanliness essential during diseases 
 
 of, 28. 
 condition and duty of the mother 
 
 during, 23, 24. 
 constipation as affecting, 36. 
 diet suited to, 29-31. 
 diseases during, 26-29. 
 duration of, 2-24. 
 exercise and clothing necessary in, 
 
 32,33. 
 heart-disease sometimes relieved by 
 
 29. 
 hygiene of, 29-42. 
 importance of sleep during, 32. 
 insanity in, 28. 
 natural limit of, 23. 
 nervous diseases in, 28. 
 normal, 24. 
 
 Saint Vitus's dance in, 28. 
 sjTnptoms of, 21, 22. 
 temperate and equable climate for, 
 41. 
 Preparation of bottle, 121, 142. 
 Psychical contagion, 185. 
 Puberty, period of, 14-16. 
 
 dangers of, 14. 
 Public conveyances, care of infants in, 
 
 95,96. 
 Public schools, political management of, 
 
 179, 180. 
 Puerperal fever, 60. 
 
 antiseptics for, 61-63. 
 Punctured wounds, 246. 
 Pupils of the eyes, dilatation of, 389. 
 Purgatives, 70. 
 
INDEX. 
 
 469 
 
 Purgatives, powerful, should not be used 
 •without consulting a physician, 171. 
 
 Putrefaction, in sewage, prevented by- 
 permanganate of potassium, 380. 
 
 R. 
 
 Recovery of mother in childbirth, 70. 
 Regimen for child with the sixteen teeth, 
 
 322, et seq. 
 Regularity, importance of, in forming the 
 
 child's first habits, 95. 
 Respiration, obstructions to, 252. 
 
 secured while washing the child, 84. 
 Respiratory organs, child's requirements 
 in diseases of, 367. 
 power of, in the new-born child, 79. 
 Rickets, 306, et seq. 
 
 a disease of second dentition, 452, 
 
 453. 
 cod-liver oil for, 453. 
 tendency to, may be outgrown, 452. 
 treatment of, 453. 
 Rotch, Dr. T. M., on preparation of the 
 
 bottle, 122. 
 Running ears, 405, 406. 
 Ruptiure of varicose veins, 40. 
 
 Saint Vitus's dance a disease of bodily 
 development, 185. 
 
 child unfitted for school-work by, 
 185. 
 
 first step in treatment of, 185. 
 
 spread by psychical contagion among 
 children, 185. 
 
 symptoms of, 185. 
 Saliva, acidity of, cause of caries, 332. 
 
 free flow of, for teething child, 316. 
 Salivary calculus on the teeth, 333. 
 Sarco-peptones, Rudisch's, 161. 
 Sargent, Dr., his work at Harvard, 216. 
 Saunders, John C, M.D., on " The Anat- 
 omy of the Human Ear," 404. 
 Scalds, 261. 
 Scarlet fever, 233, 434, et seq. 
 
 dangers incident to, 438. 
 
 decline of, 438. 
 
 first symptoms of, 436. 
 
 how caused, 434-436. 
 
 scarlatina is, 434. 
 
 Scarlet fever, school-room distribution 
 of the poison of, 439. 
 what to do for, 436, et seq. 
 Schildbach, spirometric observations of, 
 
 196. 
 School-day, examples of the routine of a, 
 219, 220. 
 house windows, 210. 
 rooms, ventilation and heating of, 
 221. 
 Schools, contagious diseases in, 231. 
 
 old-fashioned, fault of, 181. 
 Scrofula during time of second dentition, 
 
 449. 
 Sea-shore and sea-bathing for children, 
 
 301-302. 
 Seat and desk, American model of, 204, 
 
 205. 
 Second dentition, 447, et seq. 
 disorders attending, 163, 164. 
 scrofula during, 449. 
 Secretions of the child, attention to the, 
 
 85. 
 Sensations, the child's first, 94. 
 Serpents, bites of, 267. 
 Sewage, 379. 
 
 perchloride of iron for disinfection 
 
 of, 380. 
 permanganate of potassium prevents 
 putrefaction in, 380. 
 Sewerage pipes, in the nursery, to be 
 
 avoided, 278. 
 Sick children. Dr. West on treatment of, 
 359. 
 nursing of, 357, et seq. 
 Sickness in a child, signs of, 358, 361. 
 Sixteen teeth, regimen for child with the, 
 
 322, et seq. 
 Skin, action of, essential to health, 302. 
 disorders of, during pregnancy, 37. 
 eruptions of, remedied by proper 
 
 bathing, 303. 
 grazes of the, 246. 
 infant, preventing chafing of, 55. 
 Sleep, child should be prepared for, 310. 
 for mother and child in intermis- 
 sions of nursing, 89. 
 ten hours of for girls, 12. 
 Sleeping-apartment of nursery. 276, et seq. 
 place, separate, for the infant, 35. 
 room, temperature of, 280. 
 Sleeplessness arising from pain, 313. 
 
 40 
 
470 
 
 INDEX. 
 
 Sleeplessness, bromide not to be glTen 
 for, 311. 
 caused by overfeeding, 311, 312. 
 comes from excitement before sleep- 
 time, 310. 
 from congestion of the gum and in- 
 flammation of the mucous mem- 
 brane of the mouth, 315. 
 hot foot-bath for, 311. 
 in teething, 310. 
 insufficient nourishment a cause of, 
 
 311. 
 warm Melliii's food and water in 
 certain cases of, 311. 
 Smith, Dr. J. Lewis, on propagation of 
 scarlet fever, 233-235. 
 preparation of infant's food recom- 
 mended by, 142. 
 Smith, Eustace, bottle-food for babes 
 
 used by, 129. 
 Snifaes, 102. 
 
 Soap and water poisonous to the ear, 400. 
 care to use pure, 303. 
 Castile, 298, 300. 
 Pears' non-scented, 298. 
 Social dissipation, girls' health mined by, 
 
 182. 
 Softness of material for infants' garments, 
 
 290. 
 Soil, damp, predisposing to consumption, 
 
 192. 
 Soldan on neglect of eyesight, 209. 
 Soluble phenyle in scarlet fever, 438. 
 Sore throat carefully treated, 412. 
 Soxhlet, Dr., steam sterilizing of milk 
 
 suggested by, 112. 
 Spectator, article in the, 455-457. 
 Spinal curvature in schools, prevention 
 of, 195. 
 deformities of, 192. 
 Spines, curved, 169. 
 Spirometric observations of Schildbach, 
 
 196. 
 Splinters, 266. 
 
 in the eye, 266. 
 of glass, 266. 
 Splints, 249. 
 Sponge-bathing, daily, 12, 
 
 effect of, on woman's beauty, 12. 
 Sponges dangerous in treatment of the 
 
 eyes, 390. 
 Sprains, 264. 
 
 Sputum, germs of whoopiag-cough in, 
 
 426. 
 Squint, or cross-eye, 398. 
 Starchy food alone starvation diet, 
 141. 
 
 how to be treated for using, 143. 
 
 malt as an aid to digestion of, 152. 
 Steam for disinfection, 375. 
 
 for moistening air of sick-room, 367, 
 368. 
 
 sterilizer, best form of, 112. 
 
 sterilizing of milk, 112. 
 Stenography and type-writing for women, 
 
 18. 
 Sterilization, meaning of, 120. 
 Sterilized milk, 96, 106, 108. 
 Sterilizer, Arnold steam, 112, 420. 
 
 article of Dr. Walter Mendelson on, 
 112-116. 
 Sterilizing and sterilizers, 110. 
 
 milk, 111. 
 Stimulants, 274. 
 
 and narcotics not to be given, 12. 
 
 frightful abuse of, in painful men- 
 struation, 176. 
 Stings, 266. 
 
 Stomach, hemorrhage from the, 268. 
 Stooping shoulders, 169. 
 Stoppage of tear-duct, 397. 
 Stoves arranged like portable furnaces, 
 225. 
 
 ventilating, of various patterns, 225. 
 Strangulation, 252. 
 Stroke of lightning, 262. 
 Study, injurious habits of, 169. 
 Suffocation, 252. 
 Sugar of milk. 132. 
 Sulphur dioxide, 376. 
 
 fumes of, 376. 
 Sunburn, 262. 
 
 Sunlight in the nursery, 282. 
 Sunstroke, 263. 
 
 Suppositories for constipation in chil- 
 dren, 343, 344. 
 
 glycerin, formula of, 347. 
 Surgery, modern, 117. 
 Surgical' emergencies, 241. 
 Sweeper, patent, for the nursery, 280. 
 Sweets, mistake to give them to a child 
 
 before eating, 318. 
 Swelling of the eyes, 389, 390. 
 Syringing the ear, 401. 
 
INDEX. 
 
 471 
 
 Tablets for use in milk, 127. 
 
 Tainted milk, 104. 
 
 Talcum, non-scented, best powder to 
 
 prevent chafing, 84. 
 Tarrant's aperient, 171. 
 Tea, excessive use of, injurious to women, 
 
 12. 
 Tear-duct, stoppage of, 397. 
 Teeth, acidity of saliva cause of caries 
 of, 332. 
 
 attention to decaying, 332. 
 
 care of, during pregnancy, 37. 
 
 care of, in infancy, 289. 
 
 Dr. E. T. Darby on care of, 333-335. 
 
 early, 304. 
 
 eye-, 304. 
 
 large back, 304. 
 
 lateness in cutting, 309. 
 
 premature removal of temporary, 
 331. 
 
 preservation of temporary, 331. 
 
 salivary calculus on the, 333. 
 
 sixth-year molar, largest of the per- 
 manent, 332. 
 
 structure of the deciduous, 331, 332. 
 
 two lower front, 304. 
 
 usually cut in pairs, 306. 
 Teething, 304. 
 
 appearance of mouth at various 
 stages of, 305. 
 
 gums in, 304, et seq. 
 
 nature's plan in, 306. 
 Temperature of milk, 126. 
 
 of nursery, 278, 287. 
 
 of school-room, 227, 228. 
 Test-types for near-sight, 212. 
 Thermometer, 430. 
 
 for the nursery, 278, 298. 
 Throat and air-passages, diseases of the, 
 411, et seq. 
 
 atomizers for sore, 413. 
 
 child with sore, not to go out, 413. 
 
 sore, should be carefully treated, 412. 
 Tongue-tie in infants, 76. 
 Tonsils, enlargement of, 449. 
 Torn wounds, 245. 
 Toys for the nursery, 289. 
 Training-schools for nurses, advantages 
 of, for women, 18. 
 
 noble work of, 358. 
 
 Tuberculosis conveyed through mother's 
 
 milk, 28. 
 Turnbull, Dr. Charles S., on diseases of 
 the ear, 399, et seq 
 on diseases of the eye, 388, et seq. 
 Twelfth-year molars, disturbances in 
 girls from pressure of, 162. 
 
 U. 
 
 Umbilical cord, stump of the, 85. 
 Under flannel cap for babies, 408. 
 United States Pharmacopoeia, 122. 
 
 on preparation of lime-water, 122, 123. 
 Urine, duty of nurse in measuring and 
 recording passage of, 366. 
 
 for testing, 366. 
 
 V. 
 
 Valentine's extract of beef, 161. 
 Vapor of an alkali in croup, 420. 
 Varicella, or chicken-pox, 446, 447. 
 Varicose veins, 39, 40. 
 
 in nursing, 99, 100. 
 
 support for, 39. 
 
 treatment of, in case of rupture, 40. 
 Varrentrapp, Dr. George, design for desk 
 
 and seat by, 203. 
 Vaseline, 252. 
 
 for the eyes, 390. 
 Veal-broth for children after weaning, 
 
 322. 
 Vegetables, decayed, 274. 
 
 when chUdren may begin to eat, 160. 
 Veil for baby's eyes, 52, 53. 
 Veins, varicose, 39, 40. 
 Ventilating stoves, 285. 
 Ventilation, 276, 2&5, et seq. 
 
 and heating of school-rooms, 221. 
 
 construction of chimneys for, 287. 
 
 fireplaces partial remedies for had, 
 224. 
 
 Jacokes's illustrations of, 226. 
 
 methods of, 224. 
 Viability, meaning of, 22. 
 Vichy water, 135. 
 
 in croup, 422. 
 Vitality, child's, lowered at night, 280, 
 Vomiting, how to provoke, 273. 
 
 hysterical, 167. 
 
 with diarrhoea, 357. 
 
472 
 
 INDEX. 
 
 "W. 
 
 Walls, painted, for the nursery, 283. 
 Wardrobe, child's, as it should be, 50. 
 
 elaborate, for new-born child use- 
 less, 50. 
 
 necessary changes of, 51. 
 
 various kinds of, among different 
 nations, 51. 
 Warren, Dr. J. C, 196. 
 Wash, antiseptic, for eyes, 390. 
 Water, acacia, 129. 
 
 as a laxative, 145, 340. 
 
 boiled, 349. 
 
 child's need for drinking, 157, 158. 
 
 cold, for bath, 202. 
 
 drinking-, pure, 279. 
 
 gum-arabic, as nourishment, 154. 
 
 Hunyadi, 178. 
 
 lead-, 252. 
 
 lime-, 122, 123. 
 
 Manitou, 135. 
 
 Vichy, 135. 
 Water-drinking, 69. 
 Wax in the ear, 406, 407. 
 Weakly children, liquid diet for, 325, et 
 
 seq. 
 Weaning, 103, 154-162. 
 
 addition of foods in, 159. 
 
 at what age to begin, 154, 155. 
 
 how child's food should be taken 
 during the process of, 156. 
 
 should be done by the child itself, 
 156. 
 
 too early, 309. 
 Well-fed baby, marks of a, 74. 
 West, Dr., on treatment of sick children, 
 
 359. 
 Wet feet, catarrh from, 427. 
 Wet-nurse and bottle compared, 92, 93. 
 
 diet of, 91, 92. 
 
 qualifications of, 89, 90. 
 
 selection of, 75, 89-91, 103. 
 Whey for the first few weeks of life, use 
 
 of, 128, 129. 
 Whooping-cough, 424, et seq. 
 
 aiding the child in detaching mu- 
 cus in , 428. 
 
 atomizer in treatment of, 428. 
 
 counter-irritation to the chest useful 
 in, 428. 
 
 course of, 426. 
 
 Whooping-cough, duty of the mother in 
 nursing, 426. 
 fatal in its complications, 424. 
 food for a child with, 427, 428. 
 germs of, in sputum and secretions 
 
 from the nose, 426. 
 good effect of sea-air upon, 426, 427. 
 its contagion in the breath, 425. 
 less contagious than other maladies, 
 
 425. 
 nostrums for, to be avoided, 429. 
 pure, fresh air essential in, 426. 
 to carry it among healthy children 
 almost criminal, 425, 426. 
 Windows for the nursery, 288. 
 for the school-house, 210. 
 Wine of pepsin, 130. 
 Wine-whey, 154. 
 Womanhood, beginning of, 17. 
 foundations of healthy, 9. 
 hygiene of, 17-19. 
 
 precaution for health and strength 
 of, 17. 
 Womb reduced to usual size by nursing, 
 
 73. 
 Womb-troubles from menstrual irregu- 
 larity, 168. 
 Wood, Miss Catherine, on nursing sick 
 
 children, 358, et seq. 
 Wool, fine carded, 249. 
 Wounded artery, 248. 
 Wounds, cleansing of, 250. 
 
 Dr. Charles W. Dulles on treatment 
 
 of, 249-251. 
 dressing of, 251. 
 dressing-materials for, 249, 250. 
 lacerated, 265. 
 of the eye, 397. 
 poisoned, 266. 
 punctured, 246. 
 torn or crushed, 245. 
 Woven-wire pillows, 396. 
 Writing, correct posture in, 206, 207. 
 correct slant of letters In, 207. 
 
 Y. 
 
 Yale, Dr. L. M., on " Nursery Hygiene," 
 281, et seq. 
 
 Z. 
 
 Zymotic disease, scarlet fever a, 435. 
 

 fU2>X S^Uft>2>>S^ 
 
 A LIST OF BOOKS 
 
 SELECTED FROM THE 
 
 Catalogue 
 
 J. B. LIPPINCOTT COMPANY 
 
 Complete Catalogue Sent on Application. 
 
New Medical Publications. 
 
 Complete Medical Pocket Formu lary, 
 
 And Physician's Vade-Mecum. Containing upwards of 2500 Pre- 
 scriptions, collected from the Practice of Physicians and Surgeons of 
 Experience, American and Foreign. Also a Special List of New 
 Drugs, with their Dosage, Solubilities, and Therapeutical Applica- 
 tion; and much other useful information. Collated for the Use of 
 Practitioners by J. C. WiLSON, A.M., M.D. 262 pages. Bound in 
 leather, pocket-book form. J2.00. (Size of book, 3^ x 8 inches.) 
 
 The Diseases of the Mouth in Children. 
 
 (Non-Surgical.) By F. Porchheimer, M.D. i2mo. Cloth. ^1.25. 
 
 " This book is the result of careful study, is practical — as the work 
 
 of a clinical teacher is apt to be — and is systematic. It will fill a 
 
 niche heretofore vacant in the library-." — Cleveland Medical Gazette. 
 
 Diseases of the Nervous Sys tem. 
 
 By Jerome K. Bauduy, M.D., LL.D. Second Edition. 8vo. 
 Cloth. ^3.00. 
 
 "This well-written work is a complete revision of a volume of 
 clinical lectures on diseases of the nervous system published in 1876, 
 and long out of print The author has succeeded in com- 
 pressing a wonderful amount of information into a volume of very 
 moderate s\z&." —Philadelphia Aledical Bulletin. 
 
 Nervous Diseases and their Diagnos is. 
 
 A Treatise upon the Phenomena Produced by Diseases of the Nervous 
 System, with Especial Reference to the Recognition of their Causes. 
 By H. C. Wood, M.D., LL.D., author of "Thermic Fever," "On 
 Fever," etc. 8vo. Extra Cloth, ^4.00; Sheep, ^4.50. 
 
 " As a text-book for students and practitioners we most cordially 
 recommend it."— 5/. Lonis Medical Joztrnal. 
 
 For sale by all Booksellers, or will be sent by the Publishers, post-paid, on receipt 
 of the price. 
 
 J. B. Lippincott Company, 
 
 715 and 717 Market Street, Philadelphia. 
 
New Medical Publications. 
 
 Diseases of the Kidneys and Bladder. 
 
 A Text-Book for Students of Medicine. By W. F. McXutt, M.D., 
 M.R.C S. Ed., L.R.C.P. Ed , Professor of the Principles and Practice 
 of Medicine, University of California, etc. Crown 8vo. Cloth. ^2.50. 
 There have been innumerablfe writers on special diseases of the 
 kidneys, and the subject necessarily forms a part of all comprehen- 
 sive works on pathology. But a single treatise devoted to this 
 theme in all its varv'ing phases, and prepared by an eminent spe- 
 cialist, is a work which ever}- owner of a medical librar\' will 
 consider essential to his collection, no matter how full his shelves 
 may be of the less complete material. 
 
 Nerves of the Human Body. 
 
 With Diagrams. By Alfred R. Hughes, Bachelor of Medicine and 
 Master in Surgerv' of the University of Edinburgh, etc. 4to. Cloth. 
 Thirt)--two pages. S3. 00. 
 
 The object of this work is to lighten the task of the students of 
 medicine in acquiring a knowledge of the ner\-es of the human 
 body. The diagrams are neatly and carefully drawn, and some of 
 the plates are printed in colors, so that the nen^es entering into the 
 formation of the plexuses may be distinguished. The letter-press 
 is concise, and purports to give a simple statement of the origins 
 and distributions of the various nerves. 
 
 Practical Pathology. 
 
 A ^Manual for Students and Practitioners. By G. SiMS AYoODHEAD, 
 M.D., F.R.C.P. Ed., etc. With 195 Colored Illustrations. Third 
 Ediiio7i. Greatly Enlarged and Revised. Svo. Cloth. 
 
 The Roller Bandage. 
 
 By William Barton Hopkins, i\I.D., Surgeon to the Out-Depart- 
 ments of the Pennsylvania, Episcopal, and University Hospitals; As- 
 sistant Demonstrator of Surgerj- in the University of Pennsylvania; 
 Fellow of the College of Physicians of Philadelphia, etc. With 73 
 Designs fully Illustrating the Process of Bandaging. i2mo. Cloth, 
 flexible. $1.25. 
 
 For sale by all Booksellers, or mil be sent by the Publishers, post-paid, on receipt 
 of the price. 
 
 J. B. Lippincott Company, 
 
 715 and 717 Market Street, Philadelphia. 
 
New Medical Publications. 
 
 Manual of H ypodermatic Medication. 
 
 The Treatment of Disease by the Hypodermatic or Subcutaneous 
 
 Method. By Roberts Bartholow, A.M., M.D., LL.D. Fifth 
 
 Edition. Revised and Enlarged. 542 pages. i2mo. Cloth. $3.00. 
 
 " The book has been enlarged and improved in every way, and 
 
 we cannot speak too highly either of the get-up or of the material 
 
 contained in it. Thoroughly up to date, we find in it directions as 
 
 to the dosage and mode of use of many of the new drugs, of which 
 
 the general practitioner has hardly had time to learn the names. 
 
 ... It would be presumptuous to say more about such a monument 
 
 of learning and research as this; it merits nothing but praise." — 
 
 Edinburgh Medical Journal. 
 
 Mother and Child. 
 
 Part I., Mother. By Edward P. Davis, A.M., M.D. Part II., 
 Child. By John M. Keating, M.D., LL.D. Crown 8vo. Cloth. 
 ;^2.oo. 
 
 " The aim of this instructive and readable manual has been not 
 to supplant the physician, but to supplement his advice and render 
 intelligible those matters that mothers and nurses find difficult to 
 understand. As the result of large experience, the views of the 
 authors are necessarily definite and positive ; but the experience of 
 others causes them to differ in many points of detail and manage- 
 ment, and, in order to make the book cover as large a field as pos- 
 sible, they have added much material from the writings of other 
 physicians whose opinions have great weight and whose advice is 
 of incalculable value." — Preface. 
 
 Hy datid Disease in its Clinical Aspects. 
 
 By James Graham, M.A., M.D., late Demonstrator of Anatomy, 
 Sydney University. Two hundred and four pages. With 34 Full- 
 Page Colored Plates from Original Drawings. 8vo. Cloth. ^50. 
 The author's description of the prophylaxis, propagation, and 
 mode of infection by the Tsenia echinococcus, as well as _ the 
 chapter on hydatid cysts, is remarkably terse, clear, and forcible. 
 Too much cannot be said in praise of the thirty-four colored plates 
 showing most of the organs affected with this disease. 
 
 For sale by all Booksellers, or will be sent by the Publishers, post-paid, on receipt 
 of the price. 
 
 J. B. Lippincott Company, 
 
 715 and 717 Market Street, Philadelphia. 
 
standard Medical Books. 
 
 Remington's Pharmacy. 
 
 Second Editioji. A Treatise on the Modes of Making and Dispensing 
 Officinal, Unofficinal, and Extemporaneous Preparations, with De- 
 scriptions of their Properties, Uses, and Doses. By Joseph P. Rem- 
 ington, Ph.M., F.C.S. 1300 pages and 630 Illustrations. 8vo. In 
 Cloth Binding, $6.00 ; Sheep, $6.50. 
 
 Garretson's Oral Surgery. 
 
 Fifth Edition. A Treatise on the Diseases and Sui-ger}" of the Mouth, 
 Jaws, Face, Teeth, and Associate Parts. By James E. Garretson, 
 A.M., M.D., D.D.S. Illustrated. Thoroughly Revised, with Im- 
 portant Additions. 8vo. In Cloth Binding, $9.00 ; Sheep, $10.00. 
 
 Practical Lessons in Nursing. 
 
 i2mo. Extra Cloth. $1.00 each. 
 
 I. The Nursing and Care of the Nervous and 
 the Insane. By Chas. k. mills, m.d. 
 
 II. Maternity, Infancy, Childhood. The Hygiene 
 
 of Pregnancy. The Nursing and Weaning of Infants. The 
 Care of Children in Health and Disease. By John M. 
 Keating, M.D. 
 
 III. Outlines for the Management of Diet ; 
 
 or. The Regulation of Food to the Requirements of Health 
 and the Treatment of Disease. By E. T. Bruen, ISI.D. 
 
 IV. Fever-Nursing. By J. C. Wilson, A.M., M.D. 
 
 V. Diseases and Injuries of the Ear: Their Pre- 
 vention and Cure. By Charles H. Burnett, A.M., M.D. 
 "The instructions contained in these books are applicable to 
 almost any form of disease, excepting surgical cases. They can be 
 recommended in the strongest terms to nurses and to physicians." — 
 Philadelphia Medical and Siu-gical Rep07'ter. 
 
 For sale by all Booksellers, or will be sent by the Publishers, post-paid, on receipt 
 of the price. 
 
 J. B. Lippincott Company, 
 
 715 and 717 Market Street, Philadelphia 
 
standard Medical Books. 
 
 Thomas's Medical Dictionary. 
 
 A Complete Pronouncing Medical Dictionary. By Joseph Thomas, 
 M.D., LL.D. 844 pages. Imperial 8vo. In Cloth Binding, $5.00; 
 Sheep, $6.00. 
 
 " It is just the book for a medical or any other student, and it 
 should be in the office of every physician. This dictionary supplies 
 a place that has never been filled. I have looked it through and 
 find all the new words that I have sought." — Prof. A. F. Patton, 
 College of Physicians and Surgeons, Boston, Mass. 
 
 United States Dispensatory. 
 
 New [Tdth] Edition. Illustrated. Carefully Revised and Rewritten 
 by H. C. Wood, M.D., LL.D., Joseph P. Remington, Ph.M., F.C.S., 
 Samuel P. Sadtler, Ph.D , F.C.S. Containing more than 800 pages 
 of new material. Green title label distinguishes the binding of the 
 Sixteenth Edition. Cloth, Extra, ^7.00 ; Best Leather Raised Bands, 
 $8.00; Half Russia, Raised Bands, $9.00. 
 
 Da Costa's Medical Diagnosis. 
 
 Seventh Edition. A Guide to the Knowledge and Discrimination of 
 Diseases. By J. M. Da Costa, M.D., LL.D. Revised and En- 
 larged. Illustrated. 8vo. In Cloth Binding, $6.00 ; Sheep, ^7.00. 
 
 Wood's Therapeutics. 
 
 Eighth Edition. Rearranged, Rewritten, and Enlarged. By H. C. 
 Wood, M.D., LL.D. A Work on Medical Agencies, Drugs, and 
 Poisons. 8vo. In Cloth Binding, 5600 ; Sheep, $6.50. 
 
 Agnew's Surgery. 
 
 Second Edition. A Treatise on Surgical Diseases and Injuries. By 
 D. Hayes Agnew, M.D., LL.D. Illustrated. Thoroughly Revised, 
 with Additions. Three Volumes. 8vo. Price, per Volume : In Cloth 
 Binding, $7.50; Sheep, ^8.50. 
 
 For sale by all Booksellers, or will be sent by the Publishers, post-paid, on receipt 
 of the p ice. 
 
 J. B. Lippincott Company, 
 
 715 and 717 Market Street, Philadelphia. 
 
International ^„„„,hiy. 
 
 71 /r J • « devoted to Medical 
 
 Medical * ^ * and surgical 
 
 _ _ , Science. 
 
 Magazine. * * 
 
 Edited by JUDSON DALAND, M.D. 
 
 Subscription, $4.00 per year. Single mt?nbers, jj cents. 
 
 UACH number of the magazine contains more than one hundred 
 pages, and is made up of original contributions, clinical lectures, 
 review of medicine, and book reviews. The enormous mass of con- 
 temporaneous medical literature is carefully read, and contributions 
 possessing real worth are reviewed in a crisp and concise manner. 
 
 All important articles appearing in German, French, Italian, and 
 Spanish medical periodicals, as well as in English, receive careful 
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 giene and Bacteriology, Climatology, and Forensic jSIedicine. 
 
 Each number is illustrated with reproductions from photographs or 
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 subject-matter. 
 
 The heart}- commendation accorded by physicians to the efforts 
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 For further particulars address the publishers, 
 
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COLUMBIA UNIVERSITY LIBRARIES 
 
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