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Title: The Eugenic Marriage, Volume 2 (of 4)

Author: W. Grant Hague

Release date: March 16, 2008 [eBook #24854]

Language: English

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*** START OF THE PROJECT GUTENBERG EBOOK THE EUGENIC
MARRIAGE, VOLUME 2 (OF 4) ***

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

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

By W. GRANT HAGUE, M. D.
College of Physicians and Surgeons (Columbia University), New York;
Member of County Medical Society, and of the American Medical
Association

In Four Volumes

VOLUME II

New York

THE REVIEW OF REVIEWS COMPANY

1914
Copyright, 1913, by
W. Grant Hague

Copyright, 1914, by
W. Grant Hague

TABLE OF CONTENTS
Sex Hygiene for the Boy

CHAPTER XII

BUILDING OUR BOYS

A word to parents—Interest in sex hygiene—The "Social Evil"—Ten
millions suffering with venereal diseases in the United States—Immorality
not confined to large cities—Venereal diseases common in country places—
What are the consequences of venereal disease to the boy?—Gonorrhea, or
clap—Symptoms of gonorrhea in the male—Complications of gonorrhea—
Syphilis, or the "pox"—How syphilis is acquired—Syphilis attacks every
organ in the body—Not possible to tell when cured—The chancre—
Systematic, or constitutional symptoms—Mucous patches and ulcers—
Syphilis of the blood vessels and lymphatic glands—The interior organs—
Brain and spinal cord—The nose, eye, ear, throat—Hair and nails—What
the boy with venereal disease may cause in others—The infected wife—A
girl's fate when she marries—Young wife rendered sterile—Young wife
made to miscarry—Is the husband to blame—Building the man—Age of
puberty—"Internal Secretion" Page 139

CHAPTER XIII

THE PARENTS AND THE BOY

Abuse of the procreative function—The continent life—Provide the
environment necessary to the clean life—The period of procreative power
—Self-abuse—Masturbation—Treatment of masturbation—Night losses or
wet dreams—Causes of night emissions—Sexual excesses—Treatment of
sexual excesses—What parents should know about the so-called "social
evil" before speaking with authority to the boy—The need of enlightenment

in sexual matters—"No one told me, I did not know"—Fake medical
treatment of venereal diseases—Sowing wild oats—Should circumcision be
advised Page 153

Sex Hygiene for the Girl

CHAPTER XIV

A MOTHER'S DUTY TO HER DAUGHTER

What a mother should tell her little girl—Where do babies come from—
How baby birds and fish come from eggs—How other animals have little
nests of their own—The duty of mothers to instruct and direct—What a
mother should tell her daughter—Every mother should regard this duty as
sacred—Every female child is a possible future mother—Motherhood the
highest function of the sex—Health the one necessary essential—
Symptoms of the first, or beginning menstruation—The period of puberty in
the female—Changes in the reproductive organs at puberty—The female
generative organs—The function of the reproductive organs—The age of
puberty in the female—The function of the ovary—The function of the
womb—Why menstruation occurs every twenty-eight days—The male or
papa egg—The function of the spermatozoa—"Tell the whole
story"—"How do these spermatozoa get there"—The union of the species
—"How can a baby live in there for such a long time"—How the baby gets
its nourishment in the womb—Girls must not become mothers Page 173

CHAPTER XV

PREPARING FOR MOTHERHOOD

Menstruation—Irregular menstruation—Changes in the quantity of the flow
—How the womb is held in place—Symptoms of menstruation—
Menstruation should not be accompanied with pain—Don't give your
daughters patent medicines, or "Female Regulators"—Take your daughter
to the doctor—Leucorrhea in girls—Bathing when menstruating—
Constipation and displaced wombs—Dress and menstruation—Absence of

menstruation, or amenorrhea—Treatment of amenorrhea—Painful
menstruation, or dysmenorrhea—Causes of dysmenorrhea—Treatment of
dysmenorrhea—Sterility in the female—Conditions which affect the
fertility of women—Climate, station in life, season of the year, age, the
tendency to miscarry—Causes of sterility in the female—Displacement of
womb—Diseases of womb, ovaries, or tubes—Malformations—Lacerations
—Tumors— Leucorrhea—Physical debility—Obesity—Special poisons
—"Knack of miscarrying"—Miscarriage—Cause of miscarriage—The
course and symptoms of miscarriage—What to do when a miscarriage is
threatened—Treatment of threatened miscarriage—Treatment of inevitable
miscarriage—After treatment of miscarriage—The tendency to miscarriage
Page 187

The Baby

CHAPTER XVI

HYGIENE AND DEVELOPMENT OF THE BABY

What to prepare for the coming baby—Care of the newly-born baby—The
first bath—Dressing the cord—Treatment after the cord falls off—A
pouting navel—Bathing baby—Clothing the baby—Baby's night clothes—
Care of the eyes—Care of the mouth and first teeth—Care of the skin—
Care of the genital organs—Amusing baby—Temperature in children—The
teeth—The permanent teeth—Care of the teeth—Dentition—Treatment of
teething—How to weigh the baby—Average weight of a male baby—
Average weight of a female baby—Average height of a male child—The
rate of growth of a child—Pulse rate in children—Infant records, why they
should be kept—"Growing pains" Page 209

CHAPTER XVII

BABY'S FEEDING HABITS

Overfeeding baby—Intervals of feeding—How long should a baby stay at
the breast—Vomiting between feedings—Regularity of feeding—Why is

regularity of feeding important—A baby never vomits—What is the
significance of so-called vomiting after feedings—Mother's milk that is
unfit for baby—Fresh air for baby—Air baths for baby Page 223

CHAPTER XVIII

BABY'S GOOD AND BAD HABITS—FOOD FORMULAS

Baby's bed—The proper way to lay baby in bed—Baby should sleep by
itself—How long should a baby sleep—Why a baby cries—The habitual
crier—The habit of feeding baby every time it cries—The habit of walking
the floor with baby every time it cries—Jouncing, or hobbling baby—Baby
needs water to drink—The evil habit of kissing baby—Establishing toilet
habits—Baby's comforter—What can be done to lessen the evil effects of
the comforter habit—Beef juice—Beef juice by the cold process—Mutton
broth—Mutton broth with cornstarch or arrowroot—Chicken, veal, and
beef broths—Scraped beef or meat pulp—Junket or curds and whey—
Whey—Barley water—Barley water gruel or barley jelly—Rice, wheat or
oat water—Imperial Granum—Albumen water—Dried bread—Coddled
egg Page 235

Artificial Feeding

CHAPTER XIX

ARTIFICIAL FEEDING

Elementary principles of milk modification—The secret of the efficiency of
mothers' milk—Two important factors in successful artificial feeding—
Every child is a problem in itself—Proprietary foods of little value as infant
foods—Their value is in the milk added to them—The credit belongs to the
cow—Difference between human and cow's milk—What "top-milk"
feeding means—Utensils necessary for home modification of milk—
Artificial feeding from birth to the twelfth month—How to measure "top-
milk"—Easy bottle-feeding method—Condensed milk feeding—Objections
to condensed milk feeding Page 249

CHAPTER XX

ARTIFICIAL FEEDING (continued)

How to prepare milk mixtures—Sterilizing the food for the day's feeding—
How to test the temperature of the food for baby—When to increase the
quality or quantity of food—Food allowable during the first year in addition
to milk—Beef-juice—White of egg—Orange juice—Peptonized milk—The
hot or immediate process—The cold process—Partially peptonized milk—
Completely peptonized milk—Uses of peptonized milk—Objections to
peptonized milk—What a mother should know about baby's feeding bottle
and nipple—Should a mother put her baby on artificial food if her supply of
milk during the first two weeks is not quite enough to satisfy it—Certain
conditions justify the adoption of artificial feeding from the beginning—
Mothers' mistakes in the preparation of artificial food—Feeding during the
second year—Sample meals for a child three years of age—The diet of
older children—Meats, vegetables, cereals, bread, desserts, fruits Page 259

What Mothers Should Know

CHAPTER XXI

THE EDUCATION OF THE MOTHER

What mothers should know about the care of children during illness—A
sick child should be in bed—The diet of the sick child—A child is the most
helpless living thing—The delicate child—How to feed the delicate child—
How to bathe the delicate child—Airing the delicate child—Habits of the
delicate child—Indiscriminate feeding—Poor appetite—Loss of appetite—
Treatment of loss of appetite—Overeating in infancy—What correct eating
means—Bran as a food—Breakfast for a child at school—Lunch for a child
at school—Bran muffins for school children—Bran muffins in constipation
—Hysterical children—What a mother should know about cathartics and
how to give a dose of castor oil—Castor oil—Calomel—Citrate of
Magnesium—When to use castor oil—When to use calomel—Vaccination

—Time for vaccination—Methods of vaccination—Symptoms of successful
vaccination Page 277

CHAPTER XXII

CONSTIPATION IN INFANTS AND CHILDREN

Constipation—Regularity of bowel function—The function of the stomach
—Fermentation—Incomplete constipation—Importance of a clean bowel—
A daily movement of the bowel necessary—Constipation in breast-fed
infants—Treatment of constipation in breast-fed infants—Constipation in
bottle-fed infants—Treatment of constipation in bottle-fed infants—
Constipation in children over two years of age—Diet list for constipation in
children—Bran muffins in constipation—Treatment of obstinate
constipation—Oil injections in constipation Page 303

CHAPTER XXIII

CONSTIPATION IN WOMEN

Chief cause of constipation in women—Constipation a cause of domestic
unhappiness—The requirements of good health—The cost of constipation
—Constipation and social exigencies—One of the important duties of
mothers—Constipation and diseases of women—Constipation is always
harmful—Constipation and pregnancy—Explanation of incomplete
constipation—Causes of constipation—Negligence—Lack of exercise—
Lack of water—Lack of bulk in the food taken—Abuse of cathartic drugs
and aperient waters—Overeating—Treatment of constipation in women
Page 315

SEX HYGIENE FOR THE BOY

CHAPTER XII
"The evil that men do lives after them. The good is often interred with
them."
"The pleasure in living is to meet temptation and not yield to it." Elmer Lee,
M. D.

BUILDING OUR BOYS

A Word to Parents—Interest in Sex Hygiene—The "Social Evil"—Ten
Millions Suffering with Venereal Diseases in the United States—Immorality
not Confined to Large Cities—Venereal Diseases Common in Country
Places—What Are the Consequences of Venereal Disease to the Boy?—
Gonorrhea, or Clap—Symptoms of Gonorrhea in the Male—Complications
of Gonorrhea—Syphilis, or the "Pox"—How Syphilis is Acquired—
Syphilis Attacks Every Organ in the Body—Not Possible to Tell When
Cured—The Chancre—Systematic or Constitutional Symptoms—Mucous
Patches and Ulcers—Syphilis of the Blood Vessels and Lymphatic Glands
—The Interior Organs—Brain and Spinal Cord—The Nose, Eye, Ear,
Throat—Hair and Nails—What the Boy with Venereal Disease May Cause
in Others—The Infected Wife—A Girl's Fate When She Marries—Young
Wife Rendered Sterile—Young Wife Made to Miscarry—Is the Husband to
Blame?—Building the Man—Age of Puberty—"Internal Secretion."
A Word to Parents.—Within recent times the subject of sex hygiene has
been freely discussed by members of the medical profession and through
them the general public has been made more or less acquainted with the
problem. It has therefore acquired a degree of genuine interest which speaks
well for the future of the eugenic ideal. Eugenics is based to a very large
extent upon the principles underlying sex hygiene.
As a result of this widespread interest and investigation, we have
discovered that the only method that promises actual progress, is to talk
plainly and to tell the actual truth. The day of the prude has passed. To

attempt to achieve results in the education of youth in sex problems,
without giving, facts, is wasted effort. To give facts we must explain each
problem so that its principles may be clearly understood and its meaning
grasped. To point out the duty of youth is not sufficient. They must be
shown why it is to their best interest to live the clean life. In every
department of education we are beginning to appreciate that to achieve
results it must be based upon the individual equation. This is why we have
found it necessary to assert that it is the duty of parents to make sex hygiene
a personal matter and to acquaint their children with the facts relating to this
problem. It has been discovered, however, that a very large percentage of
parents are inadequately informed on these subjects, in fact they know
practically nothing about the actual facts which they are supposed to teach.
I shall try to tell the story in a way which every parent will understand.
When a boy reaches the age of puberty he is susceptible to sexual desire. If
he has not been told the story of his growth from boyhood to man's estate
he will either begin to abuse himself, or he will be later enticed to commit
himself to intercourse with some unclean female and he will acquire a
disease as a result.
Inasmuch as it has been asserted that practically every boy has been
addicted to self-abuse at some time, and that eighty per cent. of all males,
between the ages of sixteen and thirty years, are victims of venereal disease,
it would seem justifiable to assume that the boys who are informed of the
facts in time are the boys who constitute the percentage who escape. This,
of course, may not be literally true, but it is a reasonable assumption.
While self-abuse is a pernicious habit and may be attended with serious
consequences, it is not a disease and, as will be explained later, it can be
cured. It is therefore a menace to the individual, not to the race, and
consequently need not concern us at the present time. On the other hand the
venereal diseases are not to be considered as individual problems since they
affect the welfare of the race. The venereal diseases which we will consider
are gonorrhea and syphilis.
The Social Evil.—It has been estimated that there are more than ten
millions of people in this country to-day suffering from the effects of
venereal diseases. In New York city alone, there are two million victims

suffering from the direct or indirect consequences of these diseases. It has
been authoritatively asserted that, out of every ten men between the ages of
sixteen and thirty, eight have, or have had, one or other of these diseases.
When it is remembered that these diseases are not merely temporary
incidents, but that they may be regarded as practically incurable in the vast
majority, because of antagonistic social conditions and ignorance, and that
they are highly infectious, we may begin to realize how important they are
from the standpoint of race regeneration.
Statistics of these conditions are never reliable because much of the evil is
hidden and lied about. It is quite probable,—if the estimates were based
upon absolute knowledge—that the extent of the prevalency of these
diseases would be greatly increased rather than reduced. It is however a
fact, that the combined ravages of the Great White Plague, leprosy, yellow
fever, and small-pox, are merely incidents compared to the effects which
the venereal diseases have had upon mankind. It is useless to think that
these diseases can be driven out of the land. Any hope of this nature is the
impression of the dreamer. By a propaganda of education, by the spread of
the eugenic idea and ideal, we may, however, reasonably hope to minimize
the evil and, at least, to protect the innocent.
The Sources of Immorality.—It is a fallacious idea to assume that the
sources of immorality are confined to the large cities. This is far from the
truth. In smaller towns and country places the diseases are quite common
and conditions there tend to the spread of the contagion in a more intimate
and a more harmful way. The individuals who are most likely to become
affected are those most liable to succumb to temptation and whose home
ties are of the best. There are many instances on record where one or two
loose women spread the infection all over the country communities,
infecting boys and men alike. No one can estimate what the final effect of
such an epidemic may mean or how many innocent individuals may have
their lives wrecked as a direct consequence. It is because these
consequences are the product of ignorance in a very large percentage of the
cases that there is such urgent need for enlightenment. It is at least our plain
duty to tell the boy the actual facts—to post him with reference to
consequences. The more thoroughly we instruct him in the elementary facts
relative to the venereal diseases, the safer he will be from temptation, and if

he possesses this knowledge and acquires disease, he will be more likely to
immediately seek competent aid and advice.

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

Gonorrhea or "Clap."—This is the most frequent of the venereal diseases.
It is also the most serious. It is an unfortunate fact, that in the past,—and
even to-day—boys have been told that gonorrhea is no worse than "a bad
cold." This lie has been responsible for much evil and a great amount of
unnecessary suffering and misery.
Gonorrhea is caused by a germ, obtained, as a rule, during intercourse with
an infected person. This germ is called gonococcus. It thrives on any
mucous membrane; it is not, therefore, limited to the sexual organs. For this
reason it may attack any part of the body where mucous membrane is. It is
particularly liable to damage, sometimes seriously and permanently, the
eye. It may be spread from one person to another, or from any infected
article to a person in numerous ways. The innocent may thus suffer as a
result of the carelessness of the vicious.
The Symptoms of Gonorrhea in the Male are slight itching and burning
of the mouth of the urethra. This is noticeable at any time from the third to
the fourteenth day after exposure. These symptoms become more
pronounced and a slight discharge appears. The patient is compelled to
urinate frequently and it is painful and difficult. The discharge increases, it
becomes thicker and looks like ordinary yellow pus. If the case is a severe
one, the discharge may be blood stained, and if this symptom is present
urination is more painful and more frequent.
In about ten days the disease reaches its height; it remains stationary for a
number of weeks and then slowly, seemingly, gets better. The discharge
grows thinner, less in quantity and lighter in color. It may refuse, despite the
most careful and efficient treatment, to stop altogether; it is then known as
"gleet." If the discharge stops completely the patient is apparently cured, as
far as any external manifestation of the disease is concerned. In seventy-five
per cent. of the cases, however, this apparent cure is no cure at all, as will
be seen later.

Certain complications are likely to arise in the course of gonorrhea. The
infection itself may be of such an acute or virulent type, that it invades the
deeper structures of its own accord and despite the most careful, competent
treatment; or if the treatment is not adequate or skillful it may be forced
backward; or through neglect in not beginning the right kind of treatment in
times, a simple infection may grow in degree into a serious disease, and
invade the more important structures. In this way are produced disease of
the bladder, prostate gland, seminal vesicles, testicles, and of the kidneys.
Gonorrheal rheumatism may follow, and even disease of the lining
membrane of the heart, and death.
When disease of the deeper parts occur the patient is frequently
incapacitated and compelled to go to bed. He may have chills, fever and
sweats, intense pain and the passage of bloody urine. He may have to be
operated upon, and his general health may be permanently wrecked. So
long as the germs are present there is danger despite the most scientific
treatment. It is not the quality of the treatment that is at fault, it is the
presence of the germs; and since it is impossible to pursue any certain
method of eradication, we must continue treatment—as long as the germs
are present—and hope for favorable results. The infection may last for
many years. The germs having found entrance into the small tubes in the
interior organs they can only be dislodged with difficulty, if at all. These
pockets of germs may be excited to renewed activity by sexual intercourse,
or by injury to the parts, and may reinfect the patient at any times. In a very
considerable number of these cases where the deeper structures are
involved, the patient may recover from the acute or painful period of the
disease, only to find that he is sterile. There are many such cases, and the
most vindictive individual who may believe that every who sins should be
punished will admit that sterility, as the price of a moment's forgetfulness, is
a terrible fee to pay.
Syphilis, or the "Pox," is an infectious, germ blood disease. It is most
frequently acquired through sexual intercourse.
It may be acquired by direct contact with a diseased person. In order to
render such contact effective, it is essential that the skin of the healthy
person be abraded, or the contact may be directly on a mucous membrane,
as the mouth in the act of kissing.

It may be acquired by using any article which has been used by a syphilitic,
as a drinking cup, or towel.
It may be acquired through hereditary transmission.
Surgeons frequently contract syphilis while operating on, or examining
patients who have the disease. Dentists may convey it by means of
instruments which have not been rendered aseptic, or thoroughly clean.
Using a towel which has been used by a syphilitic has many times conveyed
the infection to an innocent party. For this reason the roller towel has been
done away with, and some states have legislated against its use in hotels
and other public places. To use dishes, spoons, tobacco pipe, beer glasses,
etc., which have been used by one having the disease is an absolutely
certain way of being infected. Cigars which may have been made by a
syphilitic will infect whoever smokes them with the virus of the disease.
Syphilis has been known to have been caught from using the church
communion cup. The public drinking-cup has been a prolific source of
syphilitic dissemination to innocents. Legislators are just waking up to the
danger that lurks in this institution and it will no doubt be done away with,
not only in public places, but on all railroad and steamboat lines.
An infected mother can transmit syphilis to her child. If the father is
affected, but not the wife, the child may escape.
Syphilis attacks every organ in the human body. The actual degree of
infection has no relation to the size or character of the external
manifestations. The external evidence may be minute and insignificant,
while the internal extent and ravages of the disease may be tremendous and
of large proportions. Many men when asked regarding incidents of the long
ago, may state, "Oh, yes, I had a chancre twenty-five years ago, but it was a
very small affair and soon healed up and was cured." Yet that same little
chancre, that made only a mild impression on the man's mind, may, and
most probably will, be the direct cause of that man's death.
It is not possible to tell with absolute certainty that an individual is suffering
with syphilis by any known test. The most recent one—the Wassermann test
—is not absolute by any means.

The first symptoms, or what is known as the initial lesion of syphilis, is the
chancre.
The Chancre is a small, hard tumor, or it may be a small ulcer with a hard
base, or it may simply appear as a thin small patch on any mucous
membrane. It is not painful, it can be moved if taken between the fingers,
showing it is not attached to the deep structures, and when it is so moved it
is not tender or sore. Any little lump which ulcerates located on the genitals
must be regarded with suspicion. Boys and men should not be satisfied with
any offhand statement that, "it is nothing." It may be a chancre, and it may
be exceedingly serious if not properly diagnosed.
Systemic, or constitutional symptoms, begin to show themselves any time
from the sixth to the tenth week after the appearance of the chancre.
Eruptions of the Skin characterize every case of syphilis. They occur in all
degrees from the mild rash to the foul ulcer. The ulcerative process is very
often extensive and loathsome.
Mucous Patches and Ulcers affect the mucous membranes. The mouth and
throat are favorite locations for these lesions. They occur in the anus and
rectum, and may be mistaken in that region for other serious conditions.
Men who drink and smoke suffer as a rule severely from mucous patches in
the mouth and throat.
Syphilis attacks the blood vessels and the lymphatic glands. These cases
may have been unrecognized, and may have existed for many years. A man
may die from a rupture of a blood vessel in the brain during middle life as a
consequence of a forgotten, supposedly cured case of syphilis many years
before.
The Interior Organs may be attacked by syphilis. As a result we get
disease of the liver, heart, stomach, kidneys, lungs, and other parts. It has
been suggested that many diseases affecting these organs, for which
treatment proves unsatisfactory, may have had their origin in a former
syphilis.
The Brain and Spinal Cord are quite often the seat of syphilitic affections.
A tumor, known by the name of "gumma," is the result. The blood vessels

of the entire nervous system may be affected and, as a consequence, we
often see cases of paralysis, apoplexy, epilepsy, locomotor ataxia and death.
The Nose, Eye, Ear, Throat, are frequently very seriously compromised as
a result of the syphilitic poison. Deformity, caused by rotting of the bones
of these parts is not infrequent. Loss of voice, or smell, or hearing, or sight,
may result.
The Hair and Nails may fall out. The bones may ulcerate and rot. The
organs of procreation usually participate in the degenerative process.
Virility is destroyed, and impotence is quite common after a severe attack.

WHAT THE BOY WITH VENEREAL DISEASE MAY
CAUSE IN OTHERS

Gonorrhea.—When the average boy acquires gonorrhea he frequently does
not know, for many weeks, that he is the victim of a dangerous, infectious
disease. He appreciates probably, that it relates to the sexual indiscretion he
was guilty of, and feels that it is something to be ashamed of. He therefore
hides his condition, confides in no one, and blindly hopes it will get better
somehow or at some time. Meantime the disease, which may have been
mild at the beginning, is gradually gaining ground and strength, and his
neglect may eventuate in lifelong misery. No means are taken to guard
against spreading the infection, the discharge may lodge on his fingers and
he may infect his eyes and may lose his sight because he did not know that
the discharge is one of the most dangerous fluids known. It may get on
water-closet seats and infect others. Eventually he is compelled to seek aid,
and he may, after a long period, be freed from the immediate consequences
of his folly. At a later date he marries, and as previously explained, he
infects his wife. This is the beginning of much of the domestic infelicity
that is so prevalent to-day, and, inasmuch as it is a subject that should be
thoroughly understood by every woman and mother, I shall carefully and
clearly explain its significance and its consequences.
Let us first, however, briefly consider what may occur to others if the boy is
unfortunate enough to acquire syphilis. Again the boy fails to comprehend
the nature of his affliction. There is imminent danger of the members of his
household becoming infected. He uses the same dishes, spoons, towels, and

utensils, any one of which may convey the disease to his father, mother,
sister, or brother. He may use the common drinking glass in school, college,
or office, and spread the disease in this way. He may kiss any member of
his family, or a baby, and infect them. He may have his hair cut, or be
shaved, and the virus may be spread around in this way if the barber does
not sterilize the article used,—which he never does. He may drink at a soda
fountain, or at a saloon, and the next individual to use the same glass may
acquire the disease. He is a menace to the individual, to the community, and
to the race. Wives often acquire syphilis from their husbands.
The Infected Wife.—It has been previously stated that eight out of every
ten males between the ages of sixteen and thirty, have had or have,
gonorrhea or syphilis. Seventy-five per cent. of these cases have not been
cured. About thirty-five per cent. of these are destined to infect wife, or
wife and children, and in all probability many others.
If a young wife acquires infection from her husband, she is exactly in the
same condition as the diseased boy,—she does not know what ails her, so
she wastes precious time in unprofitable worry. Why should she know what
the trouble is? She came to the marriage bed pure, and clean, and healthy.
Her previous education did not include instruction which would even help
her to guess what the trouble might be. She is simply conscious of new
distressing conditions which she does not understand. She may try to
believe that these conditions are incidental to the change in her life. Shortly,
however, the discharge, which she has had for a number of weeks, and
which she thought was only a leucorrhea, or "the whites," becomes so
profuse and nasty that she begins douching. This procedure simply blinds
her to the true nature of the affection, and in the end she is driven, ashamed
and reluctant, to consult a physician. She may be informed that her
condition is bad, and that it will be necessary that she submit to a course of
treatment. After a time the physician may succeed in tiding her over the
immediate consequences of the gonorrheal infection she innocently
acquired. She may soon after become pregnant, and she may miscarry as a
result of the old trouble, or she may carry the child the full period. When
the child is born it may be blind and this defect is a consequence of the old
infection to the mother from the father. If the mother is syphilitic the child
most likely will inherit all the horrible possibilities of transmitted blood-
poison.

Pregnancy frequently "lights up" any old, gonorrheal infection in the
female, so this young wife fails to completely recover after the
confinement. She is able to be about, but her strength refuses to be restored.
It may be months later when she begins to suffer pain and to realize that she
is quite sick. She develops a fever and may have a chill. The physician
discovers that she has pus in her tubes and there is danger of peritonitis or
general blood poisoning. The old germs have been roused and are active.
Unfortunately they are located where it is impossible to dislodge them
without resorting to a serious operation. It is now a problem of saving her
life. She is taken to the hospital and her womb, tubes, and ovaries, are
removed—she is unsexed.
Young wives are being operated on every day, in every city in the civilized
world for just such causes. It is a notorious fact, that, in every city in the
world, the number of operations that are daily being performed on women,
is increasing appallingly. Every surgeon knows that eighty per cent. of these
operations are caused, directly or indirectly, by these diseases, and in almost
every case in married women, they are obtained innocently from their own
husbands. It is rare to find a married woman who is not suffering from some
ovarian or uterine trouble, or some obscure nervous condition, which is not
amenable to the ordinary remedies, and a very large percentage of these
cases are primarily caused by infection obtained in the same way.
When a girl marries she does not know what fate has in store for her, nor is
there any possible way of knowing, under the present marriage system. If
she begets a sickly, puny child,—assuming she herself has providentially
escaped immediate disease,—she devotes all her mother love and devotion
to her child, but she is fighting a hopeless fight as I previously explained
when I stated that one-half of the total effort of one-third of the race, is
expended in combating conditions against which no successful effort is
possible. Even her prayers are futile, because the wrong is implanted in the
constitution of the child and the remedy is beyond her power to find. These
are the tragedies of life, which no words may adequately describe, and
compared to which the incidental troubles of the world at large are as
nothing.
If the conditions are not as bad as those depicted above, the original
infection may have rendered her sterile. If the germs reached the womb and

tubes, the inflammatory process may close these tubes, with the result that
conception is impossible. In these cases the woman has to bear the stigma
and disgrace of a childless union, though she is not the guilty party. Many
husbands are sterile, however, as a result of venereal disease. It is claimed
that eighty per cent. of childless marriages are caused by sterility of the
male partner. Curiously and unfortunately these men never suspect
themselves. The wife is the delinquent member, in their estimation. She is
the victim of jest and suspicion, and later of jibes and insults. Many women
have had their lives rendered miserable and unhappy because of this
suspicion. They are compelled by their husbands to submit to examination
and unpleasant and painful treatment and operations with the intention of
rectifying a defective condition that does not exist. Many conscientious
physicians refuse to treat women patients against whom the charge of
sterility is made, before subjecting the husbands to thorough examination,
and, since eighty per cent. of childless marriages are due to sterility in the
male, this is a just and reasonable course to pursue.
During the course of all this domestic trouble and tragedy, the young wife's
health has suffered—she scarcely enjoys one day of good health. Her
mental condition is even worse. She submits to innuendo and insult under
the impression that she is the unwitting cause of all the domestic
wretchedness and often wishes she had never entered the marriage state. We
must remember that these conditions wreck ideals and homes, and that they
frequently render inefficient both husband and wife. The economic business
of marriage becomes a failure, ambition is crushed and hope dies in the
heart.
If the mother has been inoculated with the virus of syphilis her existence is
equally wretched; her health is ruined; her efficiency is forever mortgaged.
If she becomes pregnant she will most likely abort and she will go on
aborting for years, in the effort to bring children into the home, accusing
herself meantime and submitting to the reflections which are heaped upon
her, while the real culprit is the husband. He assumes an injured and
innocent attitude and behaves as if he had been imposed upon by marriage
with a woman who cannot carry out her marital contract.
If she gives birth to a child or children, they are syphilitic. They may be
deformed, or they may be feeble-minded or idiots. They may live at home

for years, always ailing, always sick. They may develop epilepsy, St. Vitus'
dance, skin disease, or mental vagaries, and they may have to be put into
institutions for the feeble-minded, or they may die by inches at home.
Is the Husband to Blame?—If a boy had gonorrhea a number of years
before entering the marriage state, was treated for it by a physician, until all
symptoms had disappeared and had enjoyed apparent good health in the
interim, and had never been told any of the facts regarding probable
consequences, is it just to blame him if he infects his wife? It is certain no
man would willingly subject his bride to the risk of infection, with all its
horrible consequences. These conditions exist as a result of the prudish
attitude of society in the past toward all questions affecting sex hygiene. We
have not told all the truth to the boy. Whatever knowledge he may have had
was gained from companions, or from individuals who knew the garbled
facts only. There is of course no excuse for the man who acquires disease
after marriage and conveys it to his wife or children. This is a very different
situation and one which should merit the severest condemnation and
punishment. We are, however, only interested in the boy at present and will
not take up the reader's time with a discussion of the "social evil" from this
standpoint.
Building a Man.—When the boy is about fifteen years of age certain
changes begin to manifest themselves. He grows more rapidly, a growth in
which his whole system participates. His bones grow bigger and stronger,
his muscles increase in size, even his heart, and lungs, and liver, and his
digestive system accommodate themselves to this transformation; the voice
changes and hair begins to grow on his face. The mental process also keeps
pace with the new order of things. He thinks differently and he sees from a
new viewpoint. Nature is making a man out of a boy.
These changes were not understood in the past, but we are beginning to
appreciate the reason for this evolutionary process. We have discovered that
the cause depends upon certain active changes which take place in the sex
organs. About this time the testicles begin to be active. For years these
glands have been preparing themselves for this work, so they first grow
rapidly, increasing in size until they are about eight times bigger than they
were before this time, then they begin to pour into the circulation a
secretion which stimulates changes in all other parts of the body and is

directly responsible for the wonderful change that is evident in the stature
of the boy's body.
This substance or "internal secretion" must not be confused with the semen.
The internal secretion is simply the substance which nature employs in the
developing process and is responsible for the degree of growth and quality
of manhood which the boy manifests. The semen, on the other hand, is the
procreative or fertilizing fluid which enables a man to beget offspring.
When a boy understands this process it aids him in appreciating the
importance of his sex organs and a little thought enables him to understand
that if he abuses these organs he will seriously interfere with his own
development. This process goes on for a number of years, until the boy
reaches maturity. Any act or habit which weakens the quality of this
secretion will deplete his powers and render him physically and mentally
inefficient. To make a man, nature must be permitted to work in her own
way. You cannot improve on her methods nor can you break her laws with
impunity.

CHAPTER XIII
THE PARENTS AND THE BOY

Abuse of the Procreative Function—The Continent Life—Provide the
Environment Necessary to the Clean Life—The Period of Procreative
Power—Self-abuse—Masturbation—Treatment of Masturbation—Night
Losses or Wet Dreams—Causes of Night Emissions—Sexual Excesses—
Treatment of Sexual Excesses—What Parents Should Know About the So-
called "Social Evil," Before Speaking with Authority to the Boy—The Need
of Enlightenment in Sexual Matters—"No One Told Me, I Did Not
Know"—Fake Medical Treatment of Venereal Diseases—Sowing Wild Oats
—Should Circumcision be Advised?
Abuse of the Procreative Function.—Breeders of animals have
discovered that to breed from very young stock is not good. The quality and
stamina of the progeny is lowered and the vitality of the parent stock is
reduced. It is not a good economic proposition.
Boys should therefore be taught that any form of sexual indulgence is
harmful before the period of full growth.
Nature did not intend that the procreative function should be exercised by
individuals who were not fully developed. The perpetuation of the species
must not depend upon the license of immaturity. The instinct of sex-
attraction must not be debased to serve a puerile, rather than a holy purpose.
Sexual indulgence in any form, and in any degree, at any age prior to full
maturity is a perversion of the primal instinct of race perpetuation. The
practice has a more intimate and a more personal association with growing
boys, however, than a merely altruistic reference. Any indulgence of this
character at this time is physically and mentally injurious. No boy can hope
ever to acquire the full measure of his possible development as an efficient
working or thinking machine if he wastes his vital forces in unnatural
liberties. He should be taught this truth in an emphatic manner by those
responsible for his education.

There is a false idea prevalent that a continent life is harmful. So far as
continence relates to immaturity, it may be strongly and justly asserted that
it is probably the most important factor in the conservation of health and
strength. The retention of the procreative fluids, at a time when nature is
opposed to their loss, enables the growing economy to utilize them in the
conservation of nervous energy and virility. If a boy dissipates these
energizing fluids, he deprives his body of the richest products which he is
capable of manufacturing at a time when he needs every aid in the building
up of a physically and mentally sound and vigorous constitution. There
cannot exist a normal development if the body is deprived of the essential
ingredients necessary to growth and mental vigor.
There was a time when young men were actually taught that sexual
intercourse was necessary to develop full manhood. This was followed by a
period of silence, which has practically extended to recent times. Both of
these systems are pernicious. We know that sexual intercourse is not
necessary to the development of mature normal manhood or womanhood.
On the contrary, we know that continence, not incontinence, is an absolute
essential to the growth of full sexual, virile maturity, as well as to the
growth of efficient and healthy manhood and womanhood.
We must appeal to a boy's reason and show him the personal side of clean
living. When he understands that to attain success in every department of
human effort,—on the baseball and football fields, in the ring, in gymnastic
contents, in examinations, in social intercourse, in trades and professions,—
a continent life is the only means possible that promises success, he will
give the appeal consideration.
We must employ all the safety devices possible to guard against the
inclination of youth to wander. Regular exercise is one of the very best
institutions in this respect. If we can instill into our boys a love of manly
sports and encourage every effort in this direction, we will be doing much
to minimize the growth of any tendency toward incontinence. We must
provide the environment necessary to right living. The home should be
attractive and we should permit the boy to have privileges even at the
expense of the housekeeping decorum. His companions should be made
welcome if they are the right kind of intimates, and the parents should enter
into the life of the boy and try to look at "things" from his standpoint.

The Period of Procreative Power.—The procreative ability begins at
puberty. There is no fixed period at which it may be said to end. From
puberty until the period of physical maturity, it grows in vigor and it
remains stationary until middle life, when it gradually declines. The
standard of virility is unquestionably an individual problem. It depends
upon the various factors that contribute to good health and longevity. It may
be stated that the boy who abused his procreative function, during the
period of immaturity, will not enjoy, during the mature period of his sexual
life, a normal standard of vigor, nor will he carry the ability into old age, to
the same relative degree, as he would, and as he had the innate promise to
do—if he had led a normal continent existence. It may also be stated here
that there is no effective remedial measures known, that will "bring back"
the procreative ability if it is lost as a result of disobeying natural laws.
Drugs and treatments by quacks to cure impotence are impositions and
fakes. Money and time spent in the pursuit of this dream is money and time
wasted.
Self-Abuse or Masturbation.—By self-abuse is meant the production of
the venereal orgasm, with or without emission, by any means other than the
natural union of the sexes.
It is a fact that the large majority of boys acquire the habit of self-abuse at
some time. This is a very serious reflection upon parent, teacher, and
physician, because it is through ignorance of the elementary principles of
sex hygiene that this condition continues to exist. If they were warned
against the possibility of self-abuse arising in innocent ways, as well as in
more reprehensible ways, they would exert their influence against its
acquirement. If however a boy discovers accidentally a condition of which
he was innocent, and of which he does not know the significance, it is
human nature that he should investigate the phenomenon and in the end
suffer as a consequence. In the effort to relieve some local irritation he may
handle himself and be led into a dangerous practice. He does not know that
the practice may have serious results—in fact he does not know he is doing
anything wrong. Many boys have practically ruined their physical health
and become morally irresponsible because no one—neither parent, teacher,
physician, nor friend—told them of their danger. This is unjust, but great
strides are being made in this direction and we may reasonably hope, that in

the not far distant future, every boy will be plainly told the true facts about
himself.
Most boys acquire this habit from other boys, but as we have intimated it is
possible to acquire it in what are termed innocent ways. Sometimes the
sensation which leads to it is discovered by sliding down banisters; or it
may be that climbing trees or poles first awakens the feeling. Very young
children are sometimes taught the vice by depraved nurses. Local irritation,
as has been stated, may necessitate itching and handling the parts and in this
way the vice is begun. The results are the same, no matter how the habit
may have originated.
If the habit is persisted in, the muscular system suffers,—the muscles
become weak and flabby; the patient develops weariness and languor and
loses his mental and physical vigor. He is no longer forceful or energetic,
his efficiency is impaired and as a consequence his nervous system begins
to show signs of depleted strength. He cannot concentrate his thoughts, he
falls behind in his studies, his mental effort is sluggish, he becomes
diffident and shy, shuns society, loses confidence in himself, is morbid and
emotional and may even think of suicide.
It is astonishing how indulgence in this habit may affect the moral nature of
a boy. First of all, he is no longer frank and open. He becomes shifty and
suspicious and will not look you squarely in the face. A boy cannot become
a slave to this habit without it affecting his mind. He invites debasing
thoughts,—the old pure and clean method of thought and living no longer
satisfy. His imagination even becomes corrupt and his moral nature and
moral sense is perverted until he no longer seems to be able to tell the
difference between right and wrong. He has little regard for the truth and if
occasion demands it he will lie without appreciating the dishonorable part
he is playing. In the end his will power is lost—even the effort to save
himself is too feeble to succeed—he is a slave to the habit, his health and
strength ruined.
If every boy could realize the possible end of this evil habit he would make
an effort to rid himself of it before he becomes its victim and its slave. It
may be easy to abandon the practice in the beginning. The longer he
continues it, however, the less chance he has of finally mastering it, until, if

he persists beyond a certain point, it is a matter of serious question whether
he will ever be able to free himself from its grip. If the boy has lost the will
power to carry out his resolves, no number of good desires or resolutions
will avail. And it is just this will power that the wasting of the semen saps
little by little away.
Treatment.—What can we do for these boys? Most of them can do much
for themselves by simply stopping the practice. There are, of course, others
who need careful management before the habit may be controlled and
health restored. It is well to always remember to be tactful and patient and
kind to these boys. Many of them are standing on the brink of despair, weak
in body and weak in mind. They do not know where to turn to look for a
friend—the right kind of a friend. It is a terrible thought that your own boy
may be abjectly miserable in his own home because he is harboring a secret
that is wrecking his health, and, though he may long for sympathy and a
helping hand, neither his father nor mother have invited his confidence or
spoken to him about these things. A watchful mother can usually tell when
her boy becomes addicted to this habit. He will show it in his manner, he
will not be free and open, he will want to be by himself. Later he will show
the effects of the abusive treatment he is subjecting himself to in his
appearance. He will be sunken-eyed, pimply-faced, pasty-skinned, shiftless,
sneaking, silent, unmanly. No mother can fail to note these signs and she
should suspect the cause and take steps to tactfully reach him before he has
ruined his health absolutely.
We would advise regular exercise of a vigorous kind. Tire out the body so
that sleep may be sound. Cold baths, followed by brisk rub-downs; no
intoxicants, light meals, plenty of drinking water morning and night. The
bowels should be regular every day. He should sleep alone on a hard bed in
a well-aired room with light covering. He should keep busy every minute of
the day and he should not think of himself at all.
The boy must realize that his salvation rests with himself. After he knows
the real danger which the habit carries with it, he must be on his guard
every moment to abstain. If he does not he may rest assured that the
practice will ruin his health, render him, a business failure and deprive him
of all happiness during the rest of his life.

Night Losses or "Wet-Dreams."—A so-called wet-dream is an
unconscious emission of semen during sleep. The discharge may or may not
be accompanied with an erotic dream.
After a certain age—which may be from the twelfth or fourteenth year—a
boy may discover that he has discharged some substance during his sleep.
He finds the discharge on his night clothes and it naturally puzzles him
greatly. He may be entirely unconscious of the whole proceeding, having
slept soundly during the night, or he may wake up to find the fluid actually
discharging.
If a boy has not been told of this phenomenon he may regard it as a form of
self-abuse of which he may have heard and as a consequence he may worry
himself sick, as the night emissions continue to occur from time to time.
Many pure-minded boys have been rendered miserable, and their efficiency
and health have suffered as a result of just such an experience. It is,
therefore, proper that they should fully understand the true significance of
these occurrences.
Causes of Night Emissions.—I have explained how nature makes a man
out of a boy. During this maturing process the testicles are very active
organs—their function is to manufacture or secrete the fertilizing fluid or
semen. This maturing process begins actively, as I stated, about the age of
fifteen, though in some boys it frequently occurs earlier, sometimes as early
as the twelfth year. When the testicle begins to grow at this time they
manufacture more semen than the little pockets can hold, so nature adopts
the method of permitting the surplus to escape during sleep. These night
emissions, therefore, are perfectly natural losses, and need cause absolutely
no distress of mind whatever. The frequency with which they may occur
depends altogether upon the temperament of the boy. If the boy is a strong,
active, athletic boy, they may not be so frequent in him as they may be in a
quiet, studious boy. The system of the athletic boy seems to utilize more of
this surplus than the quieter existence of the studious boy calls for. If the
discharge does not occur oftener than once every two weeks, it may be
regarded as normal and natural. Should they become more frequent than
this, the boy should inform his mother or father and the family physician
should be consulted. It may be that he is in need of a tonic, or special
instructions regarding his method of living and his mode of exercising.

Whatever the cause may be, it can be corrected, and the best plan is to give
it attention as soon as it is noted that the losses are too frequent.
Sexual Excesses.—It is well known to the medical profession that the
marital relation is frequently practiced to excess. The same indictment may
be passed on what may be termed extra-marital relations. No one has ever
formulated a general sexual standard which could be safely regarded as
normal. Too many individual conditions of temperament and health enter
into the proposition to permit of a standard being formulated. It must,
therefore, be regarded as an individual question to be adjusted, if necessary,
by the family physician. What may safely be regarded as normal and
harmless in one, constitutes, for many reasons, excess in another. When a
man performs hard physical or mental labor, his sexual aptitude or capacity
is limited, and this limitation cannot be exceeded without risk. Such a
limitation may not constitute an excess in a man whose occupation does not
call for a great expenditure of physical or mental energy. Any indulgence
which produces exhaustion is excessive.
The age of the individual has undoubtedly much to do with his sexual
endurance. A young, virile adult will tolerate a sexual expenditure which
would seriously affect the health and vigor of an older man.
Environment and inclination are factors in determining the standard of
some people. If the marital relations are participated in simply to preserve
peace and harmony in the home, they are productive of harm even if
indulged in moderately.
The symptoms of sexual excess are much the same as those of self-abuse.
To a certain extent, however, they are favorably influenced, because the
conditions under which the relationship is practiced are natural, because the
participants are matured physically, and because there is no element of
worry over the probable effects.
Sexual excess defeats its own purpose, because it engenders a lack of desire
and consequently it is to a certain extent a self-limiting process. We must
also remember that excess entails consequences just as the breaking of any
natural law is followed by retribution of some kind. In these cases we find
that discomfort follows excess. The parts become irritated and congested
and disease of the prostate gland always follows.

Treatment.—Stop the excess by self-control and self-restraint. Employ all
the aids dictated by an intelligent perusal of the laws of sex hygiene.
Preserve the general health. It may be necessary to resort to local treatment,
because, if the parts have been abused by excessive indulgence, there is
always more or less irritation and congestion present. This condition affects
the nerves, suggestive reflex sensations are produced by a congested
prostate and the patient becomes morbid. It is essential for such patients to
consult a physician whose local treatment will stop the sensitiveness in the
parts and relieve him so that he may carry out his programme of restoration
unhampered by conditions which are only amenable to local treatment.
What Parents Should Know About the So-Called "Social Evil" Before
Speaking With Authority to "The Boy."—To be qualified to speak with
authority, or convincingly, to a boy upon sex hygiene, the parents must be
familiar with, and well versed in the subject. The facts related in the
preceding pages must be thoroughly understood. No parent can study these
facts intelligently without being impressed with the importance of the
subject; without realizing that it is absolutely essential that the fundamental
principles of sex hygiene should be taught to the rising generation; without
acknowledging the tremendous part for evil which prudery and ignorance
play in the education of youth; and without being convinced that most of
the evil is the product of ignorance on the part of the boy, and that parents
are in a large sense to blame if they fail to impart the necessary knowledge
in time.
The need for enlightenment in sexual matters is a product of existing
conditions. Civilization and the social environment are developing along a
plane which subjects the youth to temptations that practically did not exist
in the past. There is a broader and looser code of ethics. Business
monopolizes the entire time of the father, and social and political unrest and
misdirected ambition distracts the mother. The son or daughter has a wider
latitude and a freer reign than they once had. The opportunities for
promiscuous intimacies are easier, and the public conveniences and utilities
lend themselves to the designs of evil-intentioned and loose-moraled
women. The ease of travel, the laxity of laws, the theater, with its unchaste
and indecent plays, the moving picture snows, the vaudeville resorts, whose
highest priced "talent" is some voluptuous female, who has cultivated the
art of draping nudity with suggestiveness and singing immoral songs, all

tend to give youth a false impression of the reality of life and to make the
path of the degenerate easy and profitable. The rich are growing richer, and
their children are pampered and overfed and underrestrained. Time hangs
heavily on their hands and their only mental effort is to devise new methods
and new ways of satisfying the lust of liberty and overstimulated desire.
The poor are growing poorer, and to "keep in the ring," to live and dress
beyond their means as many do, it is necessary to have an unexacting
standard of morals. In this way the promiscuous libertine is evolved,—the
most insidious and dangerous product of present day civilization, and the
most pernicious factor in the spread of immoral impulses and indecent
diseases.
Parents must accept these institutions and agencies as necessary instruments
of evil and adopt measures to nullify their attractiveness. Eternal vigilance
is the price of success, but the quality of the vigilance must be dictated by
love, not by suspicion and distrust.
When the parent can convince the boy that the knowledge is imparted, not
with the intention of depriving him of what he may construe as his natural
liberties and rights, but with the single intention of adding to the sum total
of his pleasure and success, he will look more kindly upon any proposition
that suggests a course of conduct that leads to clean living. Sex hygiene will
eventually find a natural place in the scheme of education. It will be taught
to male and female alike. In the meantime, however, we must begin by
educating the educators—the parents. In the beginning, their task will not
be easy. There will be much to overcome, much ignorance, prudery, false
modesty, hypocrisy; there will be much vicious teaching and evil example
to live down. But we cannot hope to achieve results in the noblest cause,
save by patient, intelligent, and persistent effort and by self-sacrifice and a
constant enthusiasm. The aim is to tell all,—all the truth,—so that we may
never be assailed by the cry, "No one told me, I did not know," from the
loved lips of son or daughter gone astray.
The Father and the Boy.—The right kind of father can always find the
time and the way to awaken in the heart of the boy the spirit of
companionship. No boy living will resent the fellowship of the right kind of
father. It depends upon the father! If the spirit of chumminess does not exist
between you and your boy, you are at fault, you have made a mistake, you

have missed your opportunity, you "did not go about it in the right way and
in the right spirit." Try again—it may not be too late.
The father who adopts the habit of taking his boys (and his girls too) out for
long walks, at least every Sunday, and who spends an hour with them every
evening—is the right kind of father. One who has never tested the merit of
walks with children cannot possibly appreciate the enjoyment and benefit
that can accrue from them. It is not only the physical good that results, nor
the inspiration which one may draw from nature, but the concrete
advantages that come from the fellowship with the children are a new and a
real experience—this is what counts. You will have opportunities of sewing
seeds in their minds that will grow into a harvest that will astonish you.
Children in the right mood—and they are in the right mood when they are
happy, and they are happy out in the open with an interesting companion—
are alert, and responsive, and eager to be told "things," and this mood can
be put to marvelous use by the "right kind of father." The father who
wanders forth with the fixed purpose of thinking out some business problem
during the walk and permits the children to find their own amusement is the
wrong kind of father. He must choose to be a child again, he must desire to
please them, he must make an effort to be in harmony with them, he must
draw on his experience to interest them, he must talk to them entertainingly
of every interesting problem which the walk itself suggests or he must
formulate a plan and select a subject with a definite educational scheme in
view. We can, in a most effective way, begin to build their characters, and,
by the right kind of talk and enthusiasm, he can determine their resolves to
be honest, truthful, just, clean, sympathetic. He can instill into them, in a
thousand different ways, the determination and inspiration to succeed. It is a
wonderful and a precious chance, and it will make the "right kind of father"
more just, more sympathetic, more optimistic, and it will make him young
again and more successful. Try it.
Implant in the hearts of your children a love of home, make the evening
meal and hour by the fireside a period of congenial fellowship, when all the
little irritable ruffles of the day may be ironed out and swept away. The
secret is to be intimate. Tell them the secret of success from your
standpoint, how happiness is gained only by being efficient and successful,
and that, to be efficient, one must be energetic and healthy. Drum into their
ears the truth that life is a battle, and only the brave "win out," and health is

the one essential necessity. It is astonishing how such talks will impress
young minds. They will remind you of things you said, that made a lasting
impression on them, long after you have forgotten the incident.
A father can, in this way, by talking of the future to his boy, convey to him
the high hopes he entertains of the great success the boy is going to achieve
—you establish a standard in the boy's mind, and he unconsciously hopes to
attain that standard. If you have impressed him with the necessity of
preserving his health and strength, as an essential to success, he will be
slow to yield to any temptation that may interfere with his plans. This
reasoning may sound quixotic to some people, but it is the truth. Many a
boy has been inspired to success by the knowledge that his mother or father
believed in him, and was confident he would be a leader. He strove to
justify the pride and confidence of those who held him dear, and he won
out.
To retain his health, therefore, is the first impulse to be conveyed to the boy.
When he recognizes this truth, it is an easy task to instill a love of exercise,
gymnastics, swimming, fresh air, cleanliness and temperance in him. If
these are attained, you will have tided him over the tendency to self-abuse,
and you will have rendered him less likely to yield to evil suggestion or
temptation. His confidence in you will be whole-hearted and implicit. You
can do anything with him at the psychological moment. It is now time to
talk of more intimate matters. Carefully and tactfully, the father approaches
the fundamental truths of sex hygiene.
The selection of a subject for a text as a means from which to advance
toward the real facts is sometimes of importance. It must not appear as
though the subject was designedly chosen. If it follows in a natural way it
will more thoroughly interest the boy and he will have swallowed a large
dose of truth before he is impressed with the personal viewpoint. A passing
trotting horse has served me a number of times for intimate talks with boys
on heredity and kindred subjects. I invite the boy to watch how the horse
uses his legs, and how rhythmically and beautifully he places his feet, and
how his whole attitude serves the end for which he is exerting himself—to
gain speed. Tell the boy the story of how professional breeders have
achieved such marvelous results; how for generations the "strain" has been
kept clean and pure, how any descendant of a great sire, who showed any

habit detrimental to the development of the highest racing qualities—no
matter how trivial the disability might be—was cast aside, experience
having taught that it does not pay to waste effort and time on any horse
whose physical or mental characteristics are not up to the highest standard.
Such a horse will not win, and it is only "wins" that count.
Change the subject to human beings. Tell him how the race maintains its
standard; but show him the difference between the methods employed. How
the horse has his mate selected because of the female's good qualities, so
that the offspring may possess like qualities, if not better, and that the
selection is made by men who know their business, and have had long
experience in the work. How, on the other hand, a young man with no
experience is permitted to choose any woman he may fancy irrespective of
her qualifications. As a consequence, we have all kinds of children, good
and bad, feeble and strong, honest and dishonest, some degenerates from
birth, some criminal, and many diseased and inefficient, few of them
"winners." It is an easy matter to preach a little sermon from this text. Show
him how essential it is to select the mother of one's children wisely, to know
if there is disease in the future wife's blood, if her family history is good, if
her temperament is suited to his, if her domestic qualities are satisfactory, if
her principles are moral and normal, and if she understands and appreciates
the true object and function of marriage. Show him also the element of
justice involved in the marriage contract; that he must give what he exacts,
that if he expects a healthy and normal wife, he must be healthy and normal
himself; if he expects purity and cleanliness he must give purity and
cleanliness; if he expects to mate with a fit female he must be an efficient
and fit male. Remember that every act, deed, thought, and aspiration is
regulated by laws which one cannot fool with, or disobey, without reaping a
harvest which will conquer, crush and ruin you, no matter how clever or
smart you may think yourself.
Show him the wisdom of the breeders' habit of never permitting sexual
liberties in a too young stallion. For the same reason the boy must conserve
his strength and virility for the marriage state and for the function of
procreation.
In a further talk, the father may extend this subject and gradually lead up to
the "consequences" of the unclean life. The boy will be ready for this talk

and will evince an interest in it that will be encouraging and promising.
The talk about the science of mating the horses he will understand readily
and thoroughly, and he will not fail to see the point when you switch to man
and apply the same principles. Then when you show how mismating is
responsible for poor children quality and how disease accounts for feeble-
minded and degenerate offspring, he will be fairly well posted, and he will
be ready to imbibe more details, and you will have done much of your duty.
His curiosity will be quickened and his interest is awakened. It depends
upon the father. If your boy is honest and clean, open and decent, he will
not fall without a fight, and while he is fighting he is maturing. If your
picture of the consequences of the venereal diseases has been effective and
vivid, he will grow up with a healthy horror of them. If your conduct as a
father has been wise and exemplary, and if your home has the right kind of
environment, and the right kind of mother in it, you have done all a father
can do to help the boy over the rough spots. The proper kind of
encouragement and the right kind of vigilance, and books which will satisfy
the boy's craving for more knowledge along this line is all that is needed to
help the boy to "win out."
Fake Medical Treatment for Venereal Diseases.—Parents should in every
possible way discourage the use of patent medicines and fake medical
methods of curing these diseases. Untold harm has been done to boys and to
women by these nostrums.
In every instance the motive underlying the methods of people selling these
things is to frighten the patients into the belief that their condition is more
serious than it is in order to justify a long and expensive course of
treatment.
Their work is carelessly performed, and frequently they are directly
responsible for the development of complication and dangerous sequelæ.
The promises of speedy cures are false, and, not infrequently, methods of
black-mailing have been known to follow an expensive and unsuccessful
course of treatment.
There is no class of disease in which the help and honesty of the legitimate
medical profession is needed more than in the treatment of the venereal
diseases. Parents should see to it that the family physician is prescribing any

strange medicine that may appear in the boy's room, and not some unknown
individual who may be an impostor and a blackmailer.
Sowing Wild Oats.—Writers of fiction and others of a more serious trend
of thought have recognized the sowing of wild oats as an institution which,
if it does not merit the full approval of society's moral code, is, at least,
tolerated. No serious consequences befall the offender. On the contrary, the
libertine is the type of hero who receives the commendatory quips of erotic
dames and the questionable interest of hysterical maidens.
Women of easy morals are always willing to espouse the cause of the "black
sheep," and to further the matrimonial success of the penitent roué. Many
mothers are willing to marry their daughters to the polished villain of
society, who is known as a rake and debauchee, if his family connections
are desirable. It has been even held that a youth who did not "sow his wild
oats" was of doubtful stamina.
That many able men have sown wild oats is indisputable, and that many
men who are respectful husbands, have also gone "through the mill" is also
true, but this need not blind us to the fact that thousands upon thousands,
who could have been successful men of affairs and creditable husbands and
fathers, have been utterly ruined, as a result of having sown wild oats. No
man is a better man because of a past record of licentious habits. The man
who sows and escapes the harvest is lucky. The man who reaps, reaps in
abundance. Most men regret the lapses of youth. Most of these lapses
would never have occurred if the impulse could have been governed by the
reasoning of maturity. These acts are the promptings of an impetuosity
which may be entirely foreign to the individual's innate character, but
brought out by promiscuous circumstances and the ignorance and license of
youth. If we can protect youth, by an adequate knowledge of the
consequences, we will furnish the means to tide over the impressionable
period. Until a healthy maturity of judgment will assume the task unaided.
The effects of the wild oats' theory are too tragically evident to need any
argumentative refutation. The statistics of the prevalency of venereal
diseases alone is sufficient; the results of these diseases are more than
enough.

Study the records of the jails and prisons, courts and asylums, hospitals and
health resorts, think of the hundreds of thousands of diseased and deformed
and mentally inferior children, of the multitude of paretics, melancholies,
ataxics, maniacs, syphilitics,—all the products of "wild oats,"—and ask if
the wild oats' theory is justifiable.
Think of the ruined homes, the wretched lives of fallen women, the
hopeless prayers of abandoned wives, the loneliness and misery of parents
neglected and forgotten, the "bastards" and fatherless children, the
drunkards and criminals and tramps—all weeds of the wild oats' harvest.
Then reflect upon the tragedies, the suicides of the betrayed and of the
diseased, the bank thief, the broken hearts of deserted and hungry children,
the army of inefficients—around whose necks hang wild oats' medals, the
men of big business, who constantly fight the effects of early incontinence
and abuse, and the thousands who go to early graves, and then ask, in all
justice, if the sowing of wild oats needs justification.
Who supports the thousands of prostitutes? Who made them? Wherever you
find pauperism, crime, drunkenness, insanity, idleness, immorality, vice and
disease, you will find that the sower of wild oats has traveled the path and
left his stain and his footprints there.
Should Circumcision be Advised?—The answer to the above question is
"Yes," in every instance. If circumcision is done early,—during the first two
weeks of life,—the operation is without danger and practically without
pain. In quite a considerable percentage of all males, circumcision is an
absolute necessity. For excellent medical reasons, about which your family
physician can inform you, every boy should be circumcised.

CHAPTER XIV
A MOTHER'S DUTY TO HER DAUGHTER

What a Mother Should Tell Her Little Girl—Where Do Babies Come From
—How Baby Birds and Fish Come from Eggs—How Other Animals Have
Little Nests of Their Own—The Duty of Mothers to Instruct and Direct—
What a Mother Should Tell Her Daughter—Every Mother Should Regard
This Duty as Sacred—Every Female Child is a Possible Future Mother—
Motherhood the Highest Function of the Sex—Health the One Necessary
Essential—Symptoms of the First, or Beginning Menstruation—The Period
of Puberty in the Female—Changes in the Reproductive Organs at Puberty
—The Female Generative Organs—The Function of the Reproductive
Organs—The Age of Puberty in the Female—The Function of the Ovary—
The Function of the Womb—Why Menstruation Occurs Every Twenty-
eight Days—The Male or Papa Egg—The Function of the Spermatozoa
—"Tell the Whole Story"—"How do These Spermatozoa Get There"—The
Union of the Species—"How Can a Baby Live in There for Such a Long
Time"—How the Baby Gets its Nourishment in the Womb—Girls Must Not
Become Mothers.
What a Mother Should Tell Her Little Girl.—Every little girl should be
told the Story of Life by her mother. It should be told in simple language, so
that the little girl will understand. Very early in life the little girl will be
prompted to inquire of her mother "Where do babies come from?" It is
wrong to give an evasive reply to this natural inquiry or to postpone telling
the story, because they will be told it by playmates and will receive very
wrong and very crude impressions of this wonderful subject.
Every mother knows enough of life to tell her little girl its story in a way
that will impress her with the sacredness of God's beautiful reproductive
plan. She should begin by telling her a story about how the birds live. How
at a certain season of the year they choose a mate and go housekeeping.
They build a nest, and when it is all nicely finished, the mother bird lays her
eggs. Then the papa and mamma bird take turns and sit on the eggs to keep

them warm, and after a time the egg breaks and a little bird is born into the
world. They feed the little baby birds until their feathers grow, and when
they are old enough they fly away from their home and begin life by
themselves.
Many questions will be asked as the mother tells the story in her own
words, and the correct answers to these questions will fill in all the difficult-
to-understand points. The story of how the fish lay eggs in shallow water so
that the sun may keep them warm and hatch them out will interest also. Be
careful to impress upon them that there is always a mamma and a papa, a
male and a female bird and fish,—that this is necessary because God made
it so, and we must obey His wish. When the little girl fully understands the
story of the egg bird, and egg fish, the mother can tell how the Creator
thought out a different plan for other animals like the dog, horse, lion,
elephant, and cow. He knew that it would neither be safe nor possible for
these animals to stay at home long enough to sit on eggs and hatch their
babies, so he made a nest for them inside of their bodies. There they would
be warm and would always be with their mammas no matter what they were
doing. So we come to the answer to their question: "Where do babies come
from?"
These interesting stories, according to the intelligence and sincerity of the
mother, can be taken advantage of, to impress the little girl with the
importance of many of the lessons of life. For example, her attention can be
drawn to the fact that man and woman are the highest types of living things
that God made. No other living thing, animal, or fish, or bird, or tree, or
flower, can talk, and think, and reason as man and woman can. Because of
this faculty—to think and reason—the human family are always trying to
find out what can be done with all the other things God made. We try to find
out what the different rocks are good for; what the different trees are good
for, and the different kinds of earth, and animals, and birds, and fishes, and
everything in the world. We study these, and we learn much, and we are
made happier and more comfortable by what we learn. For example, by
studying horses, and feeding and breeding them carefully, and training
them, and caring for them, we can make stronger horses and better and
faster horses; by studying trees, and planting them in soil best suited to
them, and giving them plenty of water to drink, we can compel these trees
to grow better apples and pears and peaches. In the same way we can

produce better strawberries, and oranges, and grapes, and we can grow
flowers with sweeter smells and prettier colors. We do all this by training
these animals and trees to grow a certain way, to eat certain food, to drink
pure water, and we protect them from the cold and sometimes from the sun
if it is too hot. Our faculty to think and reason has taught us just what is
good for them, and we compel them to obey our laws. As a result they
become strong and more healthy. Now show the little girl how important
she is; how much more precious she is than a tree, or animal, or flower, and
how much more necessary it is that we, mammas and papas, should use our
ability to think and reason in her interest. Show her how we have found out
all about babies and little girls and how we know just what to do to make
strong and healthy, and pure, and good, and clean men and women of all the
little boys and girls in the world. Tell her that this is what mother is doing
now, training her and compelling her to do the things that will make her a
strong and a good mother when she grows older. Let her distinctly
understand that it is the duty of mothers to instruct and to correct their little
daughters when they do any wrong. Mothers know, because they have had
experience in these matters, and they know just how a little girl must live,
and dress, and eat, and behave, in order to be strong and pure, and good. So
when mother reproves and corrects, it is because she knows that what you
are doing to merit a correction is not for your ultimate good. Show them
that all young things, and young animals, and young babies, and young
girls, must be compelled to obey certain rules and laws, otherwise they
would not grow up to be strong and healthy. Sometimes a rose bush grows
up among stones and weeds, but it never thrives, it is always more or less
sick. It does not grow strong, its flowers are poor little sickly things
compared to the roses on a bush that is planted in proper soil, and carefully
tended and pruned, and watered. So would the little girl turn out if she grew
up in bad company and did not have a mother to guard and guide her,—to
prune her when she was growing careless. Everything in this world has a
meaning, and when mother tells you that you must not do a certain thing
you very much want to do, she has a very good reason for telling you not to
do it. You may not know the reason, but you should have confidence in your
mother, you should believe that she knows what is best, and that she would
not inflict pain or cause you suffering unless she knew it was for your good.
The young horse does not understand why a halter is put around its neck
and is made to run around in a circle until it is tired. It would much rather

enjoy itself in its own care-free, and happy way. And when finally a full set
of harness is put on, and it is put into the shafts of a wagon and tied there,
and made to pull it and its driver many weary miles the horse does not like
it, and he rebels strenuously. He is, however, compelled to obey in the end,
and he finally consents to become a useful horse.
It is exactly the same way with every little boy and girl. We are put into this
world for a certain purpose, and we must all work. Now parents know this,
and they know just how to prepare little girls and boys for this work. They
therefore ask them to do many things that are not pleasant or agreeable but
which must be done in order to prepare them for the work ahead.

WHAT A MOTHER SHOULD TELL HER DAUGHTER

Your daughter is now about fourteen years of age. She is about to pass from
girlhood to womanhood and she should know more of life's story. The
mother will now tell her the complete story in the form of little talks, based
upon the following facts as texts. Each mother will doubtless add to the
story as conditions justify and as the education of the mother and daughter
may dictate. A multitude of little side talks can be wisely indulged in to
make clear any uncertain or doubtful explanation, and every one of these
incidental excursions can be made exceedingly interesting if wisely and
opportunely chosen. Always remember, however, to emphasize the
sacredness of the story. Do not permit your daughter to get the impression
that you are telling her something that simply has to be told, just as you told
her the correct way to boil an egg. Let her realize and get the impression
that this is the most serious and most wonderfully interesting story in
existence, the most important story she will ever hear. Let her understand
that motherhood, for which she is now preparing, is the duty God assigned
her in this world: that that duty must be carried out, and that she must do
nothing, nor leave anything undone, to interfere with its accomplishment.
Do not only impress her with the story itself, but let your own explanation
be so emphatically serious, that she will deeply appreciate its momentous
significance—an occasion to be remembered all her life.
If she gets the proper impression from you at this time she will never treat
the subject lightly, or permit it to be promiscuously discussed within her
hearing.

Begin by telling her that she is about to enter the most important period of
her life. Explain why this is so in the following way, in your own words. If
we admit every female child to be a future mother, and motherhood the
highest function possible to the sex, then the awakening of the sex organs
and the mother instinct, must be the most important developmental episode
in the life story of every woman. If this is so, then it follows that every girl
should enter this period in the very best physical health possible, in order to
reap the best results incident to this evolutionary period. We impress and
warn her, therefore, that, as her system is about to undergo important
changes, she must be particularly careful of her health. A little mistake at
this time may be followed by more serious consequences than if made at
any other time in her life. If a girl is to become a mother, certain changes
must occur in her body before the nest, of which we previously wrote, can
be made ready. God did not overlook anything when He peopled the earth;
He therefore wisely planned that these changes in the female should occur
at a time when the girl is strong and healthy.
The Period of Puberty in the Female. Symptoms of Beginning
Menstruation.—At about the age of fourteen these changes begin to give
evidence of existence. They affect the girl's whole system and the mother
must be especially patient and sympathetic. Her disposition may change,
she may want to be alone, and she may be more or less melancholy. She
will be dissatisfied with the things that previously interested her. She will
tire easily, and she may have many spasmodic pains from time to time. The
wise mother will tactfully see that she takes plenty of nourishing food and
systematic exercise, and that she gets enough sleep in a well-aired room.
There are other physical changes which are observable at this age. The girl
grows taller, the figure broadens out, the hips widen, the bust enlarges, and
the waist line increases in size. These are all part of the great change from
girlhood to womanhood.
Changes in the Reproductive Organs.—The principal change takes place
in the reproductive organs themselves, and it is very essential that she
should have a clear mental picture of just what is meant by "reproductive"
organs and their location in her body. We mean by this term the group of
organs which are concerned in creating and nourishing a child until it is old
enough to be born into the world.

The Female Generative Organs.—These organs are the womb or uterus,
two ovaries, two fallopian tubes and the vagina. The womb or uterus is the
"nest." It is about the size of and is shaped like a pear. It is hollow, however,
though its walls are quite thick. The ovaries are about the size of a peach
stone and lie at the side of the womb,—one on either side. The fallopian
tubes connect the ovaries with the womb. The vagina connects the womb
with the outside world,—it is sometimes known as the birth canal. In the
very lowest part of the abdomen, or belly, in front, is the bladder, which
collects the urine until it is necessary to pass it out. In the back part of this
region is the rectum; it collects all the undigested food, etc., from the
intestinal canal. Between these two,—the bladder and rectum,—we find the
reproductive organs, the womb, ovaries and vagina, described above.
The Function of the Reproductive Organs.—It will be difficult, even for
mothers, to acquire a clear understanding of the function of the reproductive
or generative organs. It is an exceedingly interesting process, however, and
it is well worth a patient, attentive study to clearly understand the brief
description we give of it. If you acquire a distinct mental picture of the
problem you will be able to tell your daughter a story that will be of intense
interest to her, and a tale that is interesting is impressive and is productive
of thought and reflection. That is the condition of mind we want daughters
to be in when they hear this story.
The human ovaries begin to prepare themselves for their life work when the
girl is about eight years of age. When they are ripe, or ready to perform this
duty, the girl menstruates for the first time. This is known as the age of
"puberty," which implies that she has developed, passed from girlhood into
womanhood. After having reached the age of puberty it is possible to
become a mother.
The Age of Puberty.—There is no fixed age at which the first menstruation
takes place. Some girls develop quicker than others,—a condition that
depends upon the health and type of girl. A strong, robust, full-blooded girl
will menstruate at an earlier age, than will a sickly anemic girl. The average
age is fourteen years, though there is no reason to worry if a girl does not
menstruate for a number of years later. In warm climates the age of puberty
is from two to four years earlier than in more temperate climates.

The Function of the Ovary.—Just what takes place in each ovary when it
is ripe is best explained by likening an ovary to an orange,—though of
course the ovary is very much smaller than an orange, as was previously
noted. If you make a cut in an orange and squeeze it, you express some of
its juice and most likely you will also express one or more seeds. The seeds
of the ovaries are called "ovules," and the process by which it expresses
them is called "ovulation." Of course there is no actual squeezing of the
ovary,—the ovules grow in the ovary, and as they ripen they come to the
surface, and when actually ripe, the part of the surface of the ovary to which
they come, opens up (like a flower unfolding when in bloom), and they fall
out. The ovule we may regard as the human female egg, and one ripens and
falls out every twenty-eight days.
When the egg falls out of the ovary it falls into the tube which carries it into
the womb. This tube you will remember is called the fallopian tube. The
ovule or egg is now in the cavity of the womb where we will leave it for the
present.
The Function of the Womb.—While these changes are going on in the
ovary, the womb is also preparing itself for its share of the work. The lining
or internal surface of the womb is composed of mucous membrane, much
the same as the interior lining of the mouth and throat. This lining becomes
congested with blood, and is so intensely swollen at the time when the
ovule or egg reaches the womb, that it is ready to rupture and bleed all over
its surface. Just whether it will rupture and bleed, depends upon whether the
egg is going to grow into a child or not. If it is not going to grow into a
child, it immediately bleeds freely, and continues to bleed, until the whole
lining of the womb and egg is passed out into the outer world. This takes
four or five days and constitutes "menstruation." After menstruation is over,
the womb begins again to prepare itself for the coming of the next ovule or
egg, and as this occurs every twenty-eight days, menstruation is commonly
termed the "monthly periods."
Why Menstruation Occurs Every Twenty-Eight Days.—The reason why
the womb does this every twenty-eight days is because it is impossible to
tell just when the womb will be called upon to nourish and support a child.
If it did not get rid of the old blood, it would not be in a healthy condition to
nourish and take care of a baby, nor would its interior be ready to supply

new fresh blood for the growth of the infant. Hence nature constructs and
builds a new "nest" in the interior of the womb each month. It very much
resembles the new home into which the bride and groom, go to begin
housekeeping.
When you told your little girl the story of life, you particularly drew her
attention to the important fact that every living thing is created by the union
of a male and female principle, and, therefore, has a mamma and papa. This
applies to trees, flowers, vegetables, fish, animals, birds, insects,—every
living thing, including human beings. We have seen that the ovule from the
ovary is the female egg, or principle. It is the part the female contributes
toward the future child. Before a child is possible, however, the ovule must
meet the egg from the male.
The Male or Papa Egg.—The male or papa egg is called a "spermatozoa."
It reaches the interior of the womb through the lower opening, which you
will remember opens into the vagina. Emphasize to your daughter that the
female ovule or egg, and the male egg, or spermatozoa, are minute objects,
so microscopically small that a hundred million of them could comfortably
lie upon a ten-cent piece.
The Function of the Spermatozoa.—God gave the male spermatozoa the
power to move. To watch them under the microscope you would imagine
you were looking into a bowl of water, in which there were hundreds of
little fish all squirming around. But the most wonderful thing about them is,
they can only move in an upward direction,—they seemingly cannot move
downward, or sideways. If you think for a moment you will understand why
God gave them this marvelous property. When the male semen is deposited
in the female vagina, there are thousands of these minute, living, moving
spermatozoa in it. The womb is above the vagina, and the female egg is in
the womb, consequently, to reach this egg, the spermatozoa must travel
upward. To travel in any other direction would be fruitless energy. There is
only one female egg, but there are thousands of male eggs, or spermatozoa;
it is easy, therefore, to comprehend how one of these spermatozoa should
exactly be in line with the female egg in its upward path, since there are so
many of them. It is only necessary that one should meet the female egg in
order to impregnate it.

The shape of the male principle, or spermatozoa, is exactly like a little
tadpole, and you no doubt recall that a tadpole has a minute tail, the
movement of which enables it to swim around. So has the spermatozoa, and
by the incessant movement of this microscopic tail they all move upward as
soon as discharged by the male. I told you that God gave the male-germ
life. It is necessary now to explain the character of this life. It is very brief;
it is estimated that they are active for two hours, and then become inactive,
or die. The best way to explain the brief activity to your daughter, is to liken
the spermatozoa, to a mechanical toy, which is wound up to go for a certain
time. After it runs out it becomes inactive; this is exactly what happens to
the little human tadpole. If during this brief life none of them has happened
to reach the female egg, pregnancy does not take place and menstruation
occurs. On the other hand, if this were not so,—if these spermatozoa were
active for a longer period, pregnancy would almost be certain to take place
every time the womb was not already occupied with a pregnancy.
Tell the Whole Story.—When a mother reaches this stage of the wondrous
tale she will be asked by an innocent girl,—"How do these spermatozoa get
there?" or, "You have not told me where these tadpoles came from" or, "I
don't understand how these spermatozoa got into the vagina" or, "I don't
know why you call these the male egg when they are in mamma." It does
not matter how it is expressed, the intent is plain enough. I have said, that
an innocent girl will ask this question, the implication being that one who is
not innocent will refrain from asking this question. A girl who knows the
answer will not ask, because, if she is familiar with this subject before her
mother thinks it wise and proper to tell her, she obtained her information
from a source which, most likely, insinuated a suggestive, or evil, meaning
into the explanation, consequently she would be afraid, or ashamed, to ask
the question. An innocent girl, on the other hand, would rightly ask for
information which is obviously kept back, and which she has a right to
know, since a complete, and intelligent understanding of the story depends
upon the elucidation asked. If it is proper to tell part of the story, it is
essential to tell all of it. Tell it in your own words in this way:
When God conceived the human race He ensured its perpetuation by
designing a method whereby this would be rendered possible: He did more;
He wisely decided that the function, involving the very existence of the
human race, should be attended with a sentient gratification. He further

instilled into the fundamental economy of mankind, sex attraction, which is
involuntary, undeniable, and unquenchable. If God conceived the means
and the method, no human mind in possession of its faculties should see
evil where it does not exist. It was by Him designed that the male organ of
reproduction should deposit its germinating fluid in the vagina of the
female, and this is accomplished by a union of species.
The one set of reproductive organs is a complement of the other, and
essential to the other. It is by this act that the male spermatozoa is enabled
to complete the function of fecundation.
If now we assume the male and female element to have met and united,
menstruation does not take place. The egg or embryo (the future child)
begins to grow, and it remains in the womb for two hundred and eighty days
from the day when the male and female egg met. It is quite natural for an
intelligent girl to ask her mother to explain, "How a baby can live in there
for such a long time," or "What makes it grow if it does not get anything to
eat or drink."
How the Baby Gets its Nourishment in the Womb.—These questions can
be answered in this way. While the baby is in its little comfortable home it
gets everything it needs. You are in your home now. If you wanted a drink,
what would you do? Wouldn't you go to the water faucet and draw a glass
of water? The water comes to you through a pipe, right into your home, you
don't have to go out of the house to get it. And if you wanted light when it is
dark you would turn on the gas and light it. It, too, comes into your home
through a pipe. Now baby gets its air; and food, and all it needs to drink in
just that way. There are two little pipes which go into its nest or home, and
then into the baby's body at the navel, and through these pipes fresh blood
runs in and out. When mother breathes, her blood sucks up oxygen from the
air in her lungs, and the blood carries oxygen to every part of her body. In
this way, all parts are supplied with the proper quantity of air. Now the baby
is simply a new part of mamma as long as it is in its nest in her body, so it
too gets air in this way. When mother eats, the food is taken into her
stomach and it is there changed into liquid and so prepared, that when it
passes into the intestines, the part of the food that is good for her, is sucked
up into the blood, and the blood carries it to every part of her body. It
distributes whatever is needed to all parts, and as the baby is a part, it gets

its share. The other pipe carries the blood back again, out of the baby for
new supplies, and as this is going on all the time, there is no danger of the
baby starving in any way, or at any time.
When your daughter understands this, show her how important it is that
mothers should be in good health, otherwise the baby will not get good
food, it will not be properly nourished and will be born a poor, little sickly
child. Little girls, consequently, should try to eat properly, exercise
regularly, and do everything their mothers tell them, so that when they
become mothers, they will be able to nourish their babies and not bring into
the world poor little starved infants.
Girls Must not Become Mothers.—We have previously stated that girls
can become mothers when they have reached the age of puberty. God did
not intend, however, that girls at the age of twelve or fourteen should
become mothers, because their bodies are not strong enough, nor are they
fully grown, nor have they the experience, to undertake the physical task
and responsibility of bringing a baby into the world. We know this from
experience, because we have seen the sickly babies such girls have, and we
have seen how much these girl mothers suffer, and how they ruin their
health, by trying to do what God did not intend they should do. Even the
trees teach us this lesson. An orange tree will bring out buds, which would
develop into oranges, when it is two years old. The experienced farmer,
however, will pluck these buds off, and will do so every year, till the tree is
five years old. If he allowed the tree to bear fruit during its young years, the
oranges would not be good, or sweet, or large; so he waits until the tree has
grown and is strong and healthy, when its fruit will be large and sweet. An
orange tree of this type will have better fruit, and will continue to produce
this good variety for many years. A tree allowed to bear fruit when two
years old will never have first class oranges, nor will it continue to have,
even poor oranges, as long as the other.

CHAPTER XV
PREPARING FOR MOTHERHOOD

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

MENSTRUATION

We have explained in the previous chapter what menstruation is, its
frequency, its significance and its origin. There are a number of its common
characteristics with which the mother and daughter should be acquainted.
Irregular Menstruation.—Menstruation may occur once (the first time)
and fail to recur the following month or for a number of months. This need
cause no alarm as long as the general health remains good. It will come
again in its own time. Nervousness may cause a suspension of
menstruation. This is quite common in school girls who are driven too hard

at school, whose sleep is interfered with, whose appetite is poor and who
are allowed too many social indiscretions, as parties, dances, etc., where
late hours are observed, all of which should be put aside until school life is
over. Sometimes menstruation will temporarily stop if the girl goes away
from home on a visit.
Sometimes the quantity will be greater than at other times, and a very scant
flow, after it has been free and regular may cause apprehension. Various
causes may be responsible for a decrease, catching cold, sitting on cold
steps or cold ground, wearing damp clothes, nervousness, mental worry,
physical exhaustion, insufficient food and exercise, and anemia, may cause
it. For these reasons a girl should be exceedingly careful of her health, she
should guard against catching cold. Do not change the underwear until
certain that the weather is far enough advanced in season to justify such a
change. She should not become exhausted or worry. In all cases of
suppression, or of increased flow, a physician should be consulted at once,
and girls should be instructed to tell their mothers of any change in the
character of the "periods," as soon as it occurs. Mothers should instruct their
daughters to rest the first day of their monthly flow, and all during the
menstruation they should refrain from any unusual activity. Even play
should be moderated and abstained from entirely if there is any pain. In
order that the girl fully appreciates why these rules are laid down, it is
advisable to explain just how the womb is held in place in her body.
This appears to the writer as being a particular important point. A girl must
not be expected to give these matters the serious consideration they merit
unless she thoroughly understands the reasons why. An explanation, in the
form of even an intelligent talk, will soon be forgotten. If, however, a
definite, concrete picture, is impressed upon her; if she actually sees in her
mind the process that is going on, she will understand why it is necessary to
do as she is told. If the mother will therefore assure herself that the daughter
actually knows what is being accomplished in her womb at the menstrual
period, she will carry out the instructions more faithfully.
How the Womb is Held in Place.—The human uterus, or womb, is held in
its proper place in much the same way as a clothes pin sits on a clothes line.
The heavier part is the upper part, and that part is held in place partly by
resting on the rectum behind, and the bladder in front. When menstruation

occurs, the body of the womb becomes much heavier because of the
increased amount of blood in its interior. This added weight increases its
liability to tip over, and if any extra strain or effort is made at this time it
will become tipped, or as the physician calls it, displaced. If a womb
becomes displaced, every menstruation afterward will be painful and
prolonged,—sometimes excessively so. A displaced womb becomes
congested and unhealthy. It causes leucorrhea or a chronic discharge, makes
a nervous wreck of the woman, results in sterility and frequently in a
dangerous operation. There are, therefore, ample reasons for watchfulness
and care on the part of the growing girl.
Symptoms of Menstruation.—After menstruation is established there
should be no actual pain at each period. There are, however, certain
undefined feelings,—premonitory symptoms,—which may be explained in
the following terms:—A day or two before the date on which the
menstruation is expected, the girl will appreciate that "her sickness" is
coming. She will not, or should not, complain of pain, but will state that she
has a bearing down feeling, is a little more nervous than usual, has no desire
to go into company, and wants to be more or less her own entertainer. The
"sick" period usually lasts four or five days. The second day is the most
important.
Menstruation Should Not be Accompanied With Pain.—If any actual
pain accompanies menstruation, either before or after it is established, the
mother should at once take the daughter to the family physician.
Menstruation is a natural, physiological act and should not be accompanied
with actual distress or pain. It is astonishing how many mothers will allow
their daughters to suffer needlessly, for months and years, because of the
mistaken idea that "since the pain is there, it must be," or because she—the
mother—suffered, so also must the daughter suffer. There is no more
unfortunate mistake, and many a girl's health and happiness has been
blasted because of this misbelief. The cause of the pain is, in a vast majority
of the cases, a very simple one, and can be removed in a very brief time.
Should the menstrual period last too long, be too frequent, or be in any way
not what it should be, consult your physician. If you are not sure of "what it
should be," or if you have any doubt, ask your doctor. Don't let any false
pride or feeling of modesty on your part, or on the part of your daughter,

dictate your policy under such circumstances. Don't take the advice of your
friends or neighbors in a matter so vital. It is too important, and they are not
qualified to "guess" any more than you are. Don't, if you have any respect
for yourself, or love for your child, begin dosing her with the advertised
patent medicines and "Female Regulators" for which so much is claimed,
and which seem to "just suit" your daughter's case at this particular time.
Take her to the doctor, whose advice you value (or you should not have him
as a family physician), who has no interest at stake except to help you and
your child, and whose fee is no more than the price of one of these bottles
of advertised poison. He is the only one qualified to speak with authority on
such a momentous subject, and you will never spend a dollar to better
advantage. Warn your daughter not to speak about "her sickness" to other
girls.
Especial attention should be paid to cleanliness during this period. The
mistaken idea that bathing of any kind at this time may have disastrous
consequences is responsible for much of this neglect. If proper care is taken
warm sponge baths, in a warm room, will not cause any trouble. Unpleasant
odors can be avoided by sponging the parts with a warm solution, into
which a mild antiseptic is put, upon changing the cloths.
Leucorrhea in Girls.—It has been stated above that a displaced womb may
cause leucorrhea or a discharge. It must be remembered that leucorrhea, or
"whites," may occur in girls as well as in married women. It can also result
from catching cold during the menstrual period. Another mistaken idea is
that girls should not take douches for fear of injuring the hymen. This is
erroneous, and while they are entirely unnecessary in a vast majority of
cases it is sometimes absolutely essential to douche in order to cure
leucorrhea. When they are given, it is advisable to use the small nozzle that
comes with every douche bag set.
Constipation and Displaced Wombs.—When the picture is fresh in the
mind of the girl, of how the womb is held upright in her body, the mother
should speak to her about the serious results that may occur from
constipation. If the rectum is full of hardened feces the womb will be
pushed out of place, and if under these circumstances straining is necessary
to empty the bowel, and if this condition is habitual, constipation may be
the actual cause of displacement of the womb.

Dress and Menstruation.—It is also an opportune time to demonstrate to
what extent serious results may follow mistakes in dressing. The habit of
permitting growing girls to constrict the waist, to bind and pull the abdomen
by too tight garters, or too tight corset, is wrong, and no mother should
permit it. In another part of the book, this matter is taken up more fully, but
if it is explained to the girl while she is considering the subject of
menstruation, she may more quickly and more fully appreciate its
significance.
Absence of Menstruation—Amenorrhea.—The absence of menstruation
after it has been established, does not, as a rule, indicate any disease of the
womb or female sexual organs. It is to be regarded merely as a symptom
and can be, as previously stated, safely ignored if the general health is good.
If the general condition is poor, and the quantity and quality of the blood
deficient, it is a provision of nature to suppress menstruation in the interest
of the general health. For this reason it is safe to disregard the amenorrhea
and build up the bodily strength. This explains why some girls pass the
usual age of puberty and show no signs of menstruating. They are poorly
developed sexually, through deficiency of blood. If, on the other hand, a girl
should have all the symptoms of menstruation every month, but no flow,
she should be examined by a physician to determine if there is any
obstruction to the escape of blood. Total absence of any symptoms of
menstruation extending into adult life, may indicate an absence of the
sexual organs. During the first year after puberty it is quite natural for
menstruation to be irregular; after the function is thoroughly established
there are many causes that may be responsible for its temporary absence.
Causes of Amenorrhea.—Any condition or circumstance which reduces
the general health or impoverishes the quality or quantity of the blood and
weakens the nervous system, will result in a stoppage of the monthly
periods. Among these are insufficient food and exercise, overwork,
overstudy, exposure to cold, sitting on cold steps or gold ground, wearing
damp clothes, bathing in cold water at the beginning of menstruation,
powerful emotions, as great fright, anger, anxiety; acute diseases, such as
typhoid fever, cholera, the infectious skin diseases; chronic diseases such as
Bright's disease, heart disease, consumption; anemia and chlorosis are very
common causes. Obesity or an overfat condition will cause an early
suppression of the menses which may result in a fruitless marriage.

Displacement of the womb and other local disorders frequently result in
scanty or delayed menstruation. Anxiety lest pregnancy may occur in the
newly married may cause a delay in the periods. A radical change of climate
or sometimes a visit to the country, or changed circumstances may stop the
flow for the time being.
Treatment.—The treatment of amenorrhea, or absence of menstruation,
will depend on the underlying cause. A careful investigation should be
made into the mode of life and the hygienic surroundings of the patient. Her
general health and her mental condition should be inquired into. If the
patient is not in good health, or is not obtaining exercise in the open air, or
if she is a victim of mental worry or of domestic unhappiness, or if any
sufficient cause exists for the amenorrhea it must be removed before any
treatment may be expected to relieve the condition. If the patient is a
married woman the possibility of pregnancy should always be borne in
mind, and no radical treatment instituted until this has been excluded. If the
absence of menstruation is dependent upon defective development of the
sexual organs we cannot expect much from any treatment. The amenorrhea
from exhaustive diseases will usually correct itself with, or soon after, the
establishment of convalescence. In diseases which tend to death, as in
consumption, heart disease, etc., the function is never reestablished. A very
common habit of most people is to regard the absence of the monthly
periods as the cause of their ill health. It is not, it is the result of the ill
health. Get rid of the bad health and the menses will take care of
themselves. That form of amenorrhea which is the result of change of
climate or surroundings will regulate itself as soon as the victim becomes
acclimated or reconciled to the change, or returns home if the visit is of
brief duration.
As a general routine treatment, good wholesome food, regular hours, fresh
air, sunlight, and judicious exercise, with such other measures as may be
suggested by the condition of the blood and nervous system, are the
indications in the way of treatment. Anemia and chlorosis (poor blood)
should be treated by the administration of iron in some form. Obesity
should be reduced by diet, exercise, and such other treatment as may be
found efficient and not detrimental to health. Overwork, mental and
physical, should be stopped, and sedentary habits changed to a more active
out-door life. The acute suppression from exposure to cold, wearing of

damp clothes, sitting on cold stones or cold or damp ground, sea bathing in
very cold water, is very often associated with an acute inflammation of the
womb itself and calls for rest in bed, laxatives to open the bowel, hot
application to the lower part of the abdomen and a teaspoonful of Hayden's
Viburnum in a glass of hot water every four hours until relieved. The use of
the sitz bath is frequently successful if taken at night followed by a laxative
and a hot drink.
Painful Menstruation—Dysmenorrhea.—Most, if not all, victims of
painful menstruation are of a nervous temperament. Dysmenorrhea is
simply one symptom of the general nervous condition. The nervousness
may be acquired or it may be the result of heredity. In girls it has been
found to be an accompaniment of the overwork and worry of school and
student life. Girls who suffer greatly from it while in school are entirely free
during vacation from school.
There is a type of painful menstruation known as neuralgic dysmenorrhea.
This is simply a local expression of a general neuralgic tendency. It comes
under conditions which favor neuralgias in other parts of the body. Girls
and women affected with this type of dysmenorrhea are often anemic,
hysterical, and not infrequently the victims of malaria, rheumatism, or other
diseases which tend to impoverish the blood and reduce nerve vitality. The
pain resembles neuralgia elsewhere. It comes and goes, it may last a brief
time or a long time, it may be very mild or very severe. The pain bears no
fixed relation to the flow, it may proceed, accompany or follow it.
Mechanical dysmenorrhea is that form in which a mechanical impediment
exists to the escape of the menstrual fluid. The internal canal may be too
small, displacement, growths, either inside or out of the womb, faulty
development, or frequently simple congestion will act as an obstruction and
cause pain from tension. The pain accompanying mechanical dysmenorrhea
is very different from the neuralgic type. It comes on gradually, increases
slowly until it is very severe and stops suddenly. A gush of blood from the
womb announces the fact that the obstruction has been overcome and the
womb has emptied itself; as soon as this occurs the pain ceases.
In the mechanical variety there are frequently clots in the menstrual flow.
Inasmuch as this type may be caused by imperfect development of the

womb, it is common to find that pain has characterized the monthly periods
from the time of the first menstruation. It may, however, as stated above, be
caused by growths which had their beginning at a later period.
Treatment.—For the neuralgic variety the treatment should be general. The
whole object is to build up the general health. Fresh air, sunlight, out-door
exercise, plain, substantial food, regular hours, pleasant surroundings, and
such medication as may be indicated, should be the course to follow. The
bowels should be kept regular and digestion aided in every way possible, if
necessary by rest from school, or work, or by a change of air and scene. If
the patient is inclined to malaria she must take quinine and live in a locality
free from that tendency. If rheumatic she should take the remedies advised
in that disease and avoid colds, wet clothes, or sitting in cold, badly
ventilated rooms, churches or theatres. If there are no distinct evidences of
special tendencies, general tonics may be given to advantage. These should
consist chiefly of iron, arsenic, phosphous, nux vomica, cod liver oil, etc.
The treatment of mechanical dysmenorrhea of course implies removal of
the cause. As this necessitates operative procedure, or at least an
examination by a physician, it is best left in his hands.

STERILITY

Sterility means the inability to become a parent. A woman who is sterile
cannot become a mother. She is for some reason unable to have a baby.
A childless union is frequently the cause of much unhappiness. There is
something lacking in the expression "a childless home." It seems a paradox,
as home is inherently associated with children and happiness. It has been
stated that one out of every eight marriages is barren. The average time
which elapses after marriage and the birth of the first child is seventeen
months. Physicians agree that if a woman goes over three years after
marriage without having a baby her chances of having one are small. If
children are desired, and they usually are by childless parents, every effort
should be made within the first three years to ascertain the cause of the
sterility, and if it can be rectified. The barrenness may be dependent upon
some physical defect which will quickly respond to the proper medical
treatment. It is well to remember, however, that the defect is not always the

woman's. In every six childless marriages about one is due to sterility in the
husband. The age of the greatest fertility in women is between twenty and
twenty-four years. It is rare to find a barren woman between these years.
Nature evidently intended that the duties of maternity should be assumed
between the twenty and twenty-fourth year. If married before the age of
twenty the statistics prove that barrenness exists in one woman in every
twelve. If married after the twenty-fourth year the chances of having
children decreases with the age of the woman.
If a mother goes for three consecutive years without becoming pregnant the
chances are that she will have no more children. Consequently if other
children are desired it is unsafe to rest upon the assumption that a woman
will again be a mother simply because she has been one in the past. Many
conditions could, and may, have occurred since the last pregnancy (and may
be as a result of that pregnancy) to change her natural fertility into a
condition of temporary sterility. An examination should therefore be made
before too long an interval elapses and the facts learned. It will usually be
found in such cases that a displacement or laceration, or at most, some
cause easily remedied is immediately responsible for the apparent
barrenness.

CONDITIONS WHICH AFFECT THE FERTILITY OF
WOMEN

Climate.—It is a well-known fact that more children are born in southern
regions than in northern countries. It may be asserted, therefore, that
climate affects the fertility of the race.
Station in Life.—Children are more numerous among the poor than among
those who are wealthy and enjoy the luxury of riches. This condition
cannot, however, be construed as a true expression of fertile efficiency. It is
more a comparison of ethics, and when we express it thus we are giving it
its most charitable name.
Season of the Year.—The spring of the year, being more favorable to
fecundity, exerts an influence over the increase of population. Nursing
mothers are as a rule sterile until after weaning time. This is not always so
however, and the possibility of pregnancy taking place while nursing a

baby, and before menstruation is reestablished must be reckoned with as it
occurs quite frequently.
Age.—Age may be said to affect the fertility of women inasmuch as
sterility is the natural and proper condition before menstruation is
established and after menstruation ceases.
The Tendency to Miscarry.—Because a woman has never given birth to a
living child is no proof that she is sterile. Many women have the ability to
conceive but for some reason they have acquired the misfortune, or the
"knack," of miscarrying. This is a condition of the gravest significance and
will be considered at length in its proper place.
The influence of a temporary separation has had excellent results in a great
many historical cases. Where the married couple seem to be lacking in
some one or other of the emotional or temperamental qualifications, it is
advisable to suggest a temporary separation. When this period has expired
and they resume marital relationship the element of novelty, acting as a
stimulus, quite frequently reestablishes a fertility that was seemingly
suspended, or awakens it if conception has never previously taken place.
There are a great many cases on record where, conditions having remained
the same, women have become fertile after years of seeming barrenness. It
is impossible to explain, or to satisfactorily understand these cases. It is
quite common to note cases in which women have never become pregnant
until a number of years after marriage, even when the desire to have
children existed. There is one case on record of a woman married at
eighteen, but although both herself and her husband enjoyed habitual good
health, conception did not take place until she was forty-eight years of age
when she bore a healthy child. Women should not, therefore, become easily
discouraged in the hope of having a baby, especially when they have a clean
history, and a healthy body. The conditions may change and may become
favorable when hope is about to die.

CAUSES OF STERILITY IN WOMEN

Inasmuch as it is necessary to consult a competent physician in all cases of
sterility, it is not necessary to go into detail regarding each possible cause,

other than to explain how each may produce barrenness. It will be observed
that a competent physician is specified and advised in these cases. This is
very important because many advertising, or "quack" doctors, particularly
solicit these kind of cases. They are not competent to be trusted with such
cases and will likely effect more harm than good. A woman should not
hesitate to consult the best available medical authority if she is a victim of
sterility. There is nothing to be ashamed of. It is a perfectly proper medical
situation and should receive the best medical advice and investigation. The
following are the more frequent causes of absolute sterility.
(A) Displacement of womb.
(B) Diseases of womb, ovaries or fallopian tubes.
(C) Malformations.
(D) Lacerations or tears of mouth of womb.
(E) Tumor.
(F) Leucorrhea.
(G) Physical debility.
(H) Special blood poisons.
(I) Great obesity.
(J) Anemia.
(K) Self-abuse.
(L) Habitual alcoholism.
(M) Lack of moderation in the marital relations.
(N) Certain diseases may be associated with barrenness: cancer, diabetes,
consumption, Bright's disease, etc.
(O) Certain temperamental conditions may be associated with barrenness:
lack of affinity, frigidity.

THE KNACK OF MISCARRYING

Displacement of Womb.—In many instances the primary cause of the
displaced womb was some energetic, muscular effort, made while the
victim was yet a girl,—probably before menstruation began. Whatever act
first caused a slight tilting of the womb, must necessarily have been an
unusual physical effort, and as girls are getting more and more strenuous we
may look for more trouble in this direction in the future. Inasmuch as a
slight tilting of the womb gradually gets worse it is a reasonable expectation
to believe that sterility is a natural sequence to displacement. The girl may
have been the victim of painful menstruation which was neglected, because
not quite painful enough to compel medical relief, which is sought for only
as a last resource unfortunately under the circumstances. Intercourse may
also have been more or less painful,—a condition which again is mistakenly
and imprudently borne in silence and left to take care of itself. But when
persistent sterility faces her, the woman seeks medical assistance and her
trouble is discovered. As the displacement is found to be the cause of her
sterility, its correction, which is a comparatively easy medical problem, not
only cures the barrenness but happily relieves her of the menstrual distress
and all other pain.
The treatment for displacement consist of placing medicated pieces of wool
or cotton, called tampons, in the vagina in such a position as to hold the
womb, as nearly in its proper place as is possible. After a time nature will
so strengthen the ligaments that they will hold the womb and a cure is,
therefore, affected. The length of time necessary to cure depends upon the
length of time the displacement has existed. It may take, from two to four
months. When the displacement is of long standing and is accompanied
with more or less inflammation, adhesions sometimes grow between the
womb and the adjacent organs. It is necessary to resort to surgery in such
cases, but the result is always good and the danger practically nothing.
Disease of the Womb, Ovaries or Fallopian Tubes.—Disease of the
womb, ovaries, and fallopian tubes, which renders the victim sterile, is as a
rule the direct result of infection. Such infection is conveyed by the husband
to the wife. This is quite a common condition. The simple fact that such
conditions exist leads us to hope that the time is not far distant when it will
be compulsory for all participants in the marriage ceremony to submit to a

thorough physical examination. By this means, and by this means only, will
the innocent be protected. No one can conceive, unless he has been
identified, as a physician, with one of the large metropolitan hospital
clinics, of the extent of this class of disease, and of the frightful suffering
caused, and innocent lives ruined, by infection conveyed in this way. It is a
tragic corollary to the marriage vow "for better or for worse."
If a woman is fortunate enough to fall into the hands of an honorable
physician, who will tactfully explain to her the serious significance of her
condition and obtain her consent to treat her until she is cured, which in all
probability will include a surgical operation, and will do so with diligence,
without regard to the size of the bill, she will indeed be a lucky woman. It is
from women who are suffering with such diseases,—most of them without
the slightest idea of what ails them,—that the venders of advertised
nostrums reap their fortunes, and it is from the same victims that most of
the advertised medical "quacks" look for their blood-money. The great
difficulty, however, lies in the failure of the woman to appreciate the
seriousness of her condition, and as a consequence she fails to understands
why it should take so long to cure her. She loses confidence in her
physician, she buys certain "cures" recommended to her by Mrs. Busybody
and later tries other physicians and ends by losing faith in herself.
Meantime she grows worse and worse. There are thousands such. It may be
here stated without fear of contradiction that if the public in general would
repose more confidence in the medical profession, there would be much
less suffering, much less sorrow, fewer regrets, fewer irresponsible "isms,"
and cults, because there would be fewer disappointed individuals to support
them. If the medical profession would condescend to employ the tactics and
devices of those questionable, fashionable agencies that claim the power to
cure human suffering, it could quickly reap the profit and the laudation that
it now escapes because it keeps the faith.
The way to be cured of any disease, if it is curable, is to engage a reputable
physician and follow his instructions implicitly. Let him understand you
expect him to see you through your trouble and let him know you have
confidence in him. There isn't one physician in a thousand who will cheat
you under these circumstances.

Malformation.—Under this heading are all those cases of sterility resulting
from imperfect generative organs. These are products of a failure on the part
of nature to furnish or develop the structures participating in the
propagation of the species. The entire generative organs are sometimes
wanting. The womb may have failed for some reason to grow with the rest
of the body, it remains (as it is known) as an "infantile womb."
Occasionally the womb grows together, that is, it is solid instead of being a
hollow organ. The mouth of the womb may be too small, representing what
is called "a pin head opening." The natural opening is large enough to admit
a lead pencil, a "pin head opening" would not be larger than the lead in the
pencil. The latter condition is quite a common cause of sterility and is
readily amenable to treatment. Most of the malformations which produce
sterility are impossible to cure.
Lacerations or Tears in Mouth of Womb.—This subject is fully discussed
on another page of this volume.
Tumor.—A tumor may be so situated as to prevent conception, or it may
involve the body of the womb constituting a reason in itself for sterility.
Leucorrhea.—Leucorrhea or "the whites" may be of such an acid character
as to kill the spermatozoa in the vagina, or it may be of such volume as to
render impregnation impossible. The treatment of this condition is
discussed elsewhere.
Physical Debility.—When the general health is bad, no matter from what
cause, sterility usually exists. This lack of vitality may be due to chronic
disease, or it may have been caused by a very severe acute illness, such as
typhoid fever. One's mode of living, if unhygienic, may be responsible for
continued bad health and a consequent sterility.
Obesity.—Very fat women are usually barren. If a woman rapidly
accumulates fat after marriage she as a rule does not have more than one or
two children. Women often become stout immediately after the child
bearing age ceases.
Special Poisons.—Certain special poisons in the blood cause sterility by
producing miscarriage.

MISCARRIAGE

By the term "miscarriage" we mean that for some reason the progress of
pregnancy has been interrupted and the fetus is expelled from the womb. A
miscarriage or abortion (both terms meaning the same—the difference
between the two terms is a technical one and need not concern us here) can
occur any time after conception up to approximately the seventh month,
when, if labor takes place, the child may be born alive. The condition would
then be termed a premature labor. A miscarriage or abortion is an immature
labor and implies an immature or dead child.
The condition is a serious one no matter whether it is attended with grave
symptoms or apparently no symptoms. If it occurs shortly after conception,
during the first few months of married life it is serious, if not in its physical
consequences, it is in its significance, because it establishes the tendency to
miscarry,—a tendency that may result in great mental distress because of
the worry and fear it engenders, and of sorrow and heartache because it may
blast the hope of parentage. Such a miscarriage may take place at once after
conception. If so, the following menstruation may be delayed for a week or
so and is then a little more profuse than is customary. This will be the only
indication that a life has been sacrificed that the young wife may have, and
frequently the significance of such an occurrence is never understood, yet
the tendency to miscarry is nevertheless established, and a seeming sterility
is apparently the fate of the woman. It is, therefore, of the greatest
importance that extreme care should be taken to bring the first pregnancy to
a successful consummation. A young wife should realize that she is apt to
become pregnant at any time. Her conduct therefore should be such at least
as not to harm the life principle with which she has been entrusted. To this
end any excessive sexual activity should be strictly avoided.
Causes of Miscarriage.—Any strenuous physical effort must be guarded
against. Included in such efforts may be the following: dancing, running,
jumping, surf-bathing, sewing on a machine, sweeping, washing, house-
cleaning, moving furniture, etc. Sometimes the primary cause of a
miscarriage is to be found in some hygienic act, such as a hot bath, too
prolonged or too many hot douches near the menstrual periods. A blow or a
fall, even a fright or shock may cause a miscarriage. Anything that violently
shakes or agitates the womb, which may at this time be irritable because of

its condition, will be sufficient to excite it to contract and miscarry. Hence
violent coughing or vomiting should be avoided if possible; horseback
riding, jolting in a carriage, convulsions, hysterical crying, may also be the
causative factors. Displacement of the womb by limiting its tendency to
grow when pregnant, may cause it to miscarry. Very severe general diseases
such as small-pox, pneumonia, etc., will cause the womb to empty itself.
Disease of the fetus or the presence of syphilis in either of the parents will
also have the same result.
The Course and Symptoms of Miscarriage.—The cause of a miscarriage
or abortion is much the same as an ordinary labor at term. Whatever
interrupts the pregnancy causes the death of the fetus. The dead fetus acts as
a foreign body and excites the womb to contract as it does during an
ordinary confinement. The contractions open up the mouth of the womb and
the fetus is expelled together with its membranes and after-birth. The
significant and the most important symptom of a miscarriage or abortion is
hemorrhage or bleeding from the privates. The flow of blood may not
amount to much or it may be excessive and alarming; it may not be
constant, it may come from time to time in the form of clots.
The next significant and important symptom of miscarriage or abortion is
pain. The pain, like the flow of blood, may be only slight or it may be very
severe, sometimes it is absent in very early miscarriage. As a rule the pain is
severe when the miscarriage occurs after pregnancy has lasted for a number
of months.
A miscarriage or abortion is said to be "complete" when the fetus with its
membranes and after-birth is expelled clean and whole, or in other words
when the womb empties itself completely. A miscarriage or abortion is said
to be "incomplete" when some part of the embryo is left in the womb.
What to Do When a Miscarriage is Threatened.—When a woman, who
is pregnant, begins to flow she should at once go to bed and keep perfectly
quiet and send for a physician. A miscarriage is a treacherous condition and
is so regarded by all medical men. It may not amount to much or it may, on
the other hand, develop into a serious situation. The immediate danger is
from hemorrhage; the ultimate or remote danger is sepsis or blood
poisoning. The condition is one that can only be taken in charge by a

qualified physician in whose hands we can safely leave the conduct of the
case.
As a general rule it is quite safe to assert that a woman will not bleed
enough at the beginning of a miscarriage to do any permanent harm.
Consequently there is no occasion for unnecessary alarm. She must,
however, as stated above, heed the warning and go to bed, keep perfectly
quiet and send for a physician. If she fails to follow this advice it is quite
possible that she may have a hemorrhage during the course of the
miscarriage of a sufficiently serious character to endanger her life or from
the effects of which she may suffer for the remainder of her life.
There is practically no danger during the course of or after a "complete"
miscarriage. The danger which may ensue from an "incomplete"
miscarriage is hemorrhage and a form of poisoning caused by the
absorption into the system of putrifying products of the part of the dead
embryo left in the womb.
There are a large number of cases of criminal abortion in which septic
poisoning occurs caused by the utensils or instruments used in inducing the
abortion. All of these cases are operative cases which must be attended to
promptly to save life.
Treatment of Threatened Miscarriage.—Not all of the cases of beginning
miscarriage end in miscarriage. If the physician is sent for in time he can
very frequently give directions that will, if carried out faithfully, avert the
disaster. Success is more likely to attend those cases in which the trouble
has been caused by some accidental injury, as a fall, or blow, or extra
exertion. This is more especially the case if the woman has previously
borne children, is healthy and in good condition and whose womb is known
not to be diseased. In these cases there is a partial separation of the fetus
from the wall of the womb, which causes the bleeding. The physician will
direct that the woman be put to bed, in a quiet, darkened room. He will
instruct the nurse to sterilize the external genital region: a sterile gauze
dressing is then left in place. Some form of prescription will be given to
diminish the patient's nervous fear and to allay any tendency on the part of
the womb to contract. It is always essential and very important to save
everything that passes from the womb during the course of a threatened

miscarriage in order that the physician may know exactly just what the
condition is. Each cloth, each clot of blood will have to be examined before
the proper treatment can be pursued in safety.
When the miscarriage cannot be prevented it is called an "Inevitable
miscarriage."
Treatment of an Inevitable Miscarriage.—In these cases every precaution
is taken, just as in a normal confinement, to avert blood poisoning. The
hands, instruments, dressings, etc., are carefully rendered sterile and the
whole field must be surgically clean. The physician will conduct the case as
conditions justify and as the situation develops.
After Treatment of a Miscarriage.—It is one of the many thankless tasks
of a physician's life to insist on each patient staying in bed at least ten days
after a miscarriage. The average woman and frequently the intelligent
woman fails to appreciate the absolute necessity for this procedure. It is
necessary and it is the physician's duty to insist on it being done in the
interest of the woman. Many of the multitude of diseases of women are
caused by disregarding advice on such occasions.
The Tendency to Miscarry.—If a woman, for any reason, has had a
miscarriage, her womb will tend to miscarry at the same period during a
subsequent pregnancy. If the miscarriage should occur during her first
pregnancy the tendency to miscarry will be greater than if acquired after she
has had a baby.
This is one of the reasons why young wives often fail to have children.
They "get rid" of the first one or two, because they are not ready to have
children, or because they want some enjoyment themselves before they are
tied down with a family. Having established the habit their womb has been
educated to abort, and it will keep this habit up, much to their astonishment
and chagrin.
Young wives should therefore faithfully follow out all the rules of the
Hygiene of Pregnancy laid down by their physician, and which are given in
detail in this book.

Courtesy of New York World At Work with the
Calipers
Watching carefully the physical development of the child month by month is one of those many
little things which may result in disaster if neglected.
Abnormal development, or lack of development, should be promptly reported to the physician, as
it may be a warning of serious trouble.
For the table of standards, mental and physical, adopted by the American Medical Society see
page 271.

THE BABY

CHAPTER XVI
HYGIENE AND DEVELOPMENT OF THE BABY

What to Prepare for the Coming Baby—Care of the Newly-born Baby—The First Bath—
Dressing the Cord—Treatment After the Cord Falls off—A Pouting Navel—Bathing Baby—
Clothing the Baby—Baby's Night Clothes—Care of the Eyes—Care of the Mouth and First Teeth
—Care of the Skin—Care of the Genital Organs—Amusing Baby—Temperature in Children—
The Teeth—The Permanent Teeth—Care of the Teeth—Dentition—Treatment of Teething—How
to Weigh the Baby—Average Weight of a Male Baby—Average Weight of a Female Baby—
Average Height of a Male Child—The Rate of Growth of a Child—Pulse Rate in Children—
Infant Records, Why They Should be Kept—"Growing Pains."
What to Prepare For the Coming Baby.—The physician should instruct the young wife just
what to provide for the coming baby. The following list will be found useful as a general guide.
An ordinary clothes basket, padded and lined, is quite sufficient for the first month; or, a baby
crib, which may be cheap or expensive as the individual taste dictates. The Taylor crib is probably
the handiest and best one on the market.
Pin cushion;
Puff-box and puff;
Soap box containing pure castile soap;
Hair brush and fine comb;
Two wash cloths;
Four ounces of crystal boracic acid, a saturated solution of which is used for cleansing baby's
eyes and mouth;
One pound of good absorbent cotton;
A flexible tube of white vaseline;
A bath thermometer;
A package of sterile gauze;
A half dozen baby towels, good quality;
A soft, white, good blanket,—one and one-half yards square;
One pair small blunt pointed scissors;
A package of the best safety pins;
Three or four dozen bird's-eye cotton diapers. First size, eighteen inches square. Second size,
twenty-five inches square;

One yard of soft white flannel for belly bands; each band should be five inches wide, by twenty-
four inches long.
Two silk and wool shirts;
Three flannel shirts (all shirts should be high necked, long sleeved, and open down the front);
Three Eiderdown wrappers;
Three Cashmere sacques;
Three pads for crib;
Six dresses;
Six petticoats (they should be thirty-three inches long from neck to hem; they should be turned up
at the bottom for about four inches and should button there to keep the feet warm; if it is desired
to use pinning blankets for the first two months in place of the petticoats, they should be made of
soft white flannel with cotton bands);
Six night slips;
Six pair socks;
Two cloaks;
Two hoods;
One dozen bibs.
Simplicity, warmth, and freedom are the essentials in latter-day baby clothes. It is cheaper to
make the clothes than to buy them. Excellent and accurate paper patterns can be obtained, giving
the quantity of material necessary and suggesting the kind and quality best suited for the purpose.
These patterns may be obtained from the Butterick Publishing Company in New York City.
Care of the Newly-Born Baby.—After the nurse has completed her duties with the mother after
the confinement, she will prepare to give baby its first bath.
The bath should be given in a warm room. This is a matter that should receive more consideration
than has been given it. Nurses do not as a rule attach much importance to this duty, while in
reality it is a most important one. I have seen trained nurses make ready to give baby its first bath
in rooms, during the night, that were not heated adequately. I am convinced that many babies
have been victims of this careless habit to the extent of grafting on them the tendency to catarrhal
colds and bronchitis because of undue exposure at this critical period. If one will remember that a
baby has just been removed from an environment where the temperature was suitable and
constant, to one in which it needs a large degree of artificial heat until such time as it may
become accustomed to the change, one may appreciate the risk taken in exposing the child for
even a short time. The mother should therefore warn the nurse not to undertake the baby's first
bath until the temperature and other conditions are favorable. Many nurses and other individuals
have the impression, without knowing why, that the baby should be cleansed and bathed
immediately after birth. This is not at all necessary. If the conditions are not favorable, it would
be far better to wrap the baby snugly in a warm blanket—first having put a diaper on—and place
it in its crib with a hot water bottle near it and defer the bathing until the following forenoon. By

that time the baby will be adapted to its new surroundings; its lungs will have become
accustomed to the air which it is breathing for the first time; the mother will have been rendered
comfortable; in other words, the conditions and the environment will be favorable for the baby
and for a better performance of the duty.
The next important feature of the first bath is that it should be done in the quickest time consistent
with efficient service. Only the necessary exposure should be indulged in. It is not necessary that
the baby should be exposed to the admiring inspection of every member of the household—there
will be plenty of time for that without risking the health of the child. A pan of water at a
temperature of 100° F. should be placed on a stool in front of the nurse. The nurse should have on
a rubber apron, and on top of this, an ordinary apron and a warm bath towel laid over her knees.
The child should be gently rubbed with warm sweet oil to remove the vernix caseosa (the greasy
substance which is on all babies when born to a lesser or greater extent). Particular attention is to
be given to all folds of the skin, as under the arms, in the fold of the neck, in the groin, behind the
ears, etc., because in these parts the substance is thickest and if not carefully removed it will cake,
and cause painful eruptions and sores, which may bleed and render the infant extremely
uncomfortable. It is not necessary to expose the whole body at one time while applying the oil.
The lower half may be covered with a warm soft towel while the nurse is oiling the upper part,
and vice versa. After the body has been thoroughly oiled it should be cleansed with water at the
proper temperature, in which pure castile soap has been dissolved. Absorbent cotton only should
be used to wash the baby. All the washing is done with the baby on the nurse's knee; it is not put
into the water.
The baby should be mopped dry with sterile gauze, or with a soft sterile towel, the cord dressed
and the flannel band adjusted. It should then be completely dressed and put to the nipple and later
to sleep.
Dressing the Cord.—The cord should be covered with powder and sterile gauze. The powder to
use should be plain subnitrate of bismuth. If there is any reason to use another powder the
physician will write a prescription for it according to indications. The subnitrate of bismuth will
be found much better than any ordinary talcum or toilet powder, many of which do not make
good dressing powders.
Very few nurses know how to dress the cord. It seems to be impossible to impress them with the
need of frequent attention to the cord. Fresh powder should be put on every time the diaper is
removed, every time the infant urinates, and at other times during the day. The cord should be
kept absolutely dry. Putting on powder twice daily will not keep the cord dry and many nurses are
too lazy to bother to do it oftener. You cannot make a mistake in putting on too much powder, you
can make a serious mistake by not putting on enough. Every time the cord is powdered it should
be lifted up, away from the skin of the abdomen, and the powder put below it. The cord should be
slightly drawn out and the powder applied round its base where it meets the skin. Many nurses
are afraid to touch or handle the cord—they find it easier to neglect it. The mother should see that
the nurse dresses the cord at least five times every day.
Applying the Sterile Gauze to the Cord.—A piece of gauze, six inches square is taken, a hole is
cut the size of a ten-cent piece out of the center, the cord is drawn through the hole, the gauze
folded lengthwise over the cord and then sidewise, and this is held in place by the binder. This
piece of gauze will adhere to the cord and will most likely be removed with the cord on the fifth
day. If it should fall off, another piece may be put on in the same way.

If the cord does not fall off until very late it is because it has not been attended to rightly or
because it was a very thick cord.
Treatment After the Cord Falls Off.—The stump of the cord should be powdered with the same
powder used on the cord; a pad two inches square of sterile gauze and quite thick should be held
over the stump for a number of days by the abdominal binder. This is used to prevent a possible
rupture. After a week the size of the pad may be reduced, but a small pad should be used over the
stump of the cord for a month or more.
A Pouting Navel.—If the stump of the cord should protrude, a piece of strong pasteboard, the
size of a fifty-cent piece, should be wrapped in soft gauze and placed over the navel, over this a
gauze pad, and if necessary this should be held in place by a strip of adhesive plaster, though the
binder is usually sufficient if it is put on carefully. If this pad is held properly and worn for a
month the tendency to protrusion or rupture will have passed away. These pads may of course, be
removed when the baby is being bathed and put back again before the binder is applied.
Bathing Baby.—A baby should not be put into water for a bath until after the cord has been off
for forty-eight hours.
During the first few months the temperature of the water should be 98° F. The temperature of the
water should be taken with a bath thermometer; it should not be guessed at. A bath thermometer
is an inexpensive commodity and it will be in daily use in many ways in a home where there is a
baby—it should therefore be procured wherever possible. The room should be warm; there
should be no draughts. The mother or nurse should cultivate the habit of bathing baby quickly and
with system. Everything should be ready and at hand. A little salt in the water will tend to
strengthen the skin; it will also relieve any superficial rashes or excoriations which may be on the
skin. Four tablespoonfuls to a gallon of water will be sufficient. The sea salt sold in the stores
may be used in lesser quantities.
By the end of the fifth month the temperature of the water may be reduced to 95° F., and by the
end of the first year to 90° F. After the first year the mother should accustom the child to a quick
sponge with cool water on the chest and spine immediately after the bath. This simple means, if
kept up, will often prevent the development of colds and bronchial troubles so common to
children in temperate latitudes.
The best time to give the warm bath is at night. In the morning a cold sponge bath is desirable.
This should be given as described in the chapter on cold sponge or shower baths.
In certain children bathing seems to depress their entire system. They do not react well even to a
warm bath. They remain blue or pale around the mouth and eyes; bathing should therefore be
carefully undertaken with these children until such time as they acquire strength.
Clothing of Baby.—The baby should wear a woolen shirt, with a high neck and long sleeves.
The abdominal binder may be worn for the first three months. It is not necessary after that time. If
worn longer the habit is acquired and chronic indigestion may ensue when it is ultimately taken
off. If the baby is very thin it may be wise to leave it on, simply for its warming effect, for a few
months longer. If the child is normal and healthy the binder should be left off permanently after
three months. The band for the first four weeks should be made of plain flannel; after this period
a knitted band with shoulder straps is the better article. All petticoats and skirts should be

supported from the shoulders. Stockinet is a good material for diapers; it is soft, warm, and
pliable.
Baby's feet should be warm always. Cold feet are frequently responsible for colic and gastro-
intestinal troubles. A hot water bottle should be placed in the carriage if the weather is cold, but
care should be taken to see that it does not touch the feet, otherwise it may burn them. The same
measure may be adopted in the baby's crib if the feet are cold.
During the summer the outer clothing should be made of the thinnest quality of material possible,
and the underclothing of the finest flannel or gauze. Body heat may be maintained during changes
of temperature by extra outer wraps—not by dressing the baby in clothes that keep it too hot and
uncomfortable all the time.
The main object to be attained in clothing the baby is to ensure a sufficient protection, but the
clothing must be light, warm, loose, and non-irritating. Don't bundle up the arms and legs so that
they cannot be moved; don't pin them so tight that the child cannot breathe properly and don't put
the band on so that the child is in torture all the time from inability to move the abdomen.
Baby's Night Clothes.—The night clothing should be the same as that worn during the day, but it
should be loose and of the lightest flannel material. For older children a thin woolen shirt (not the
one worn during the day) and a suit of union clothing with feet is best.
The mistake must not be made to cover children too warmly at night. They can do with relatively
less than adults. Too much covering will render the sleep restless, will encourage nightmare, and
in older children will engender bad habits. Delicate children especially must not be over-covered
at night.
For the first few months children should sleep in a darkened room.
Care of the Eyes.—The eyes should be cleansed for the first few days with a saturated solution
of boracic acid. They should be protected from the direct light for two or three weeks after birth.
Care of the Mouth and First Teeth.—Boiled cooled water should be used to cleanse the mouth
every morning after the bath. A soft piece of sterile gauze should used for this purpose. The
mother must guard against using too much force in cleaning the mouth of an infant.
The milk teeth should receive attention. If they are allowed to become dirty they will become
carious and cause bad breath and neuralgia. Teeth of this character are a menace to health because
they harbor germs and in this way infect the mouth and cause stomach troubles. Teeth that are
carious should be filled or removed.
Care of the Skin.—The skin of a baby, because of its delicate character, is susceptible to the
slightest changes in the weather or to the condition of the digestive organs. Babies are frequently
subject to rashes, intertrigo, excoriations, eczema, and other skin affections. It is much easier to
prevent these conditions than to cure them. Cleanliness, not only in giving a daily efficient bath,
but in every other respect, is essential. Castile soap only should be used, and no rubbing indulged
in, simply mopping the parts with gauze well saturated with soapy water. All napkins should be
removed as soon as soiled. If the skin is easily chafed the child should be bathed in salt water or
water in which bran is mixed as explained in the chapter on bran baths.

The baby should be well powdered with a good quality of toilet powder. Ordinary starch, or
talcum, or the stearate of zinc is suitable. Fat infants should be powdered in all the skin folds;
otherwise they are sure to chafe.
Care of the Genital Organs.—The mother should make it a habit to remove any dirt from the
genitals of the baby during the morning bath. Fecal matter sometimes gets into the folds of the
female baby; this should be removed promptly. In older female children, dirt and dust get into the
genitals which often has to be removed carefully with a soft piece of cloth. An exceedingly
chronic form of inflammation is often seen in poor children because of neglect of these parts.
In male babies the mother must daily push back the foreskin and clean under it. If this is not done
the natural secretion will gather there and cause much trouble. If the foreskin is long, the child
should be circumcised; if it is not long it must be pushed back daily for a number of weeks;
otherwise it will contract and it may be necessary to operate on it at a later date. If this is not
faithfully attended to the prepuce will become adherent, the child becomes nervous and irritable,
and it may become addicted to self-abuse at a very early date—simply because the mother is
derelict in the performance of her duty. If you are afraid to do your duty, don't neglect it, ask the
doctor to show you just what has to be done and just how it should be done. You will find it to be
a simple matter when you know how, as most things are.
Amusing Baby.—Mothers should understand that it is not necessary to amuse a baby under one
year of age. Their nervous systems are not ready for any such sport. To excite a baby to laughter
is to subject it to a shock which may injure it. The healthy development of the brain of a child
demands quiet and restful surroundings. It should sleep, eat, and be allowed to amuse itself in a
natural way.
Temperature in Children.—The normal temperature in a child varies more than it does in an
adult. The rectal range may be between 98° and 99.5° F. and may be normal to that particular
child. A rectal temperature of 97.5° F. or of 100.5° F. is of no importance unless it continues.
The best place to take the temperature in a child is the rectum and the next best place is in the
groin. The temperature will always be from a half to a full degree higher in the rectum than in the
groin. The thermometer should be left in the rectum for two minutes, and in the groin for five
minutes.
The temperature in a child is a very fair guide as to the severity of the disease. It must be
remembered, however, that a child will develop a temperature of two or three degrees from a very
slight cause. It is not the height of the fever that is significant, but rather the duration of the fever
that is important. A fever of 102° F. in a child may only mean a slight indigestion which will
wholly disappear after a laxative is given, while the same degree of temperature in an adult
usually means something much more serious. The degree of the temperature therefore should not
occasion unnecessary worry; if, however, it continues and if the child shows other signs of illness,
it may be regarded as indicating an abnormal condition which should be immediately found out.
A temperature of 100° F. to 102° F. usually means a mild illness, and one of 104° F. or over, a
serious sickness.
It is not advisable that the ordinary mother should possess a clinical thermometer. There are many
occasions when a child will have a fever which should not cause any worry; if the mother gets the
thermometer habit, she will many times occasion unnecessary calls of the physician only to learn
that they are false fears.

The Teeth.—There is no definite time at which the first teeth appear. They usually come between
the sixth and eighth months. They may not, however, come until much later; or they may come
earlier than the sixth month; and yet the child may be perfectly healthy. They come as a rule in
the following order:

1. The two lower middle teeth, 6 to 8 months.
2. The four upper middle teeth, 8 to 10 months.
3. One on each side of two lower middle teeth, 8 to 12 months.
12 to 15
4. One on each side, above and below, back of above teeth (four in all),
months.
5. The next one on each side, above and below, back of those already in (four in 18 to 24
all), months.
24 to 30
6. The four back teeth on each side, above and below,
months.
At 1 year a child should have 6 teeth
At 1-1-2 years a child should have 12 teeth
At 2 years a child should have 16 teeth
At 2-1-2 years a child should have 20 teeth

They may not come in the above regular order even in well children. The upper front teeth may
come first. If the child is sickly there may be marked irregularity in the order in which they
appear. Twenty teeth comprise the first set.
The Permanent Teeth.—This set consists of thirty-two teeth. They begin about the sixth year
and they are usually not complete until the twentieth year. They appear in the following order:

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

Care of the Teeth.—The teeth should be given attention as soon as they appear. It is an excellent
custom to wash the teeth and gums twice daily with a piece of clean absorbent cotton rolled
round the finger of the mother and dipped in a saturated solution of boracic acid. This should be
done up to the second year. After the second year a soft brush should be used and the teeth
thoroughly cleaned morning and night with pure castile soap or a powder. The teeth of every
child should be examined by a dentist every six months. All cavities should be filled with a soft
filling. The milk teeth should not decay, but should fall out, or be forced out by the second set. A
child should be taught to gargle early and a mouth wash should be used morning and night.
Dentition.—As a general rule the process of teething is accompanied by some symptoms. There
may be fever, restlessness, and loss of appetite; though in many cases there are absolutely no
symptoms. Some children seem to teethe hard, others easily. The same child may have some teeth
without pain, and with others it may suffer severely. The condition of the child at the time, its age,

and the season of the year undoubtedly have an influence. Children who are sickly and puny may
have much difficulty while teething.
The degree of sickness varies quite considerably. There may only be, as stated above, slight fever,
restlessness, with loss of appetite; or there may be, in addition to these symptoms, a pronounced
fermentative diarrhea, which may lead to serious intestinal diseases; frequently there is a cough.
This is more apt to be the case if the child is teething during the hot season.
Treatment.—When dentition affects the child's disposition it is a good plan to reduce the feeding
in quantity and quality for the time being. If the child is bottle-fed, two ounces can be taken out
of each bottle and one ounce of boiled water added. If the child is breast-fed, he should be given
two ounces of warm, boiled water before each feeding, and the actual feeding time at the breast
shortened.
Rubbing the gum over the erupting tooth with a clean cloth may aid in helping it through. If the
child is very restless and has lost sleep, the cloth may be moistened with brandy and water.
Lancing the gum, though it is seldom done now-a-days, is justified in a few cases. Teething is not
the cause of actual disease as was once thought, but it must be remembered that a child whose
vitality is reduced by fever, restlessness, loss of appetite, loss of sleep, and irregular bowels, is
more susceptible to disease than when enjoying robust health.
Sometimes a child will have a fever for one or two weeks during a hard dentition. There is apt to
be more or less intestinal indigestion and fermentation at this time and as a consequence actual
intestinal disease may develop. To avoid such a possibility it is an excellent plan to give an
occasional dose of castor oil to clean thoroughly the whole intestinal canal. This should be done
irrespective of the condition of the bowel, because frequently a diarrhea is caused by retained
fermenting products.
Mothers must not acquire the habit of attributing all symptoms to the teething process simply
because the child is teething. It must be remembered that a child may get a disease, or an ailment,
while teething, that has nothing to do with teething. If this is neglected, serious consequences
may result. Many children have lost their lives by a mother's carelessness in this way. Be on the
safe side, consult your doctor; let him assume the responsibility.
How to Weigh the Baby.—The test of weight is one of the most satisfactory we possess as an
indication of physical progress and health. It is not an absolute test, but it may safely be relied
upon. The fattest baby is not necessarily the healthiest. A gradual and a uniform increase is a
satisfactory growth. At birth a baby weighs, on an average, from seven to eight pounds, though
some babies weighing less are equally healthy. The normal and customary gain is from four to six
ounces every week after birth.
The baby should be weighed about the same time of the day each week, and before a meal.
The average weight of a male child at different ages is as follows:

Birth 7-1/2 lbs.
3 weeks 8 lbs.
1 month 8-1/2 lbs.
3 months 12 lbs.
4 months 13-1/2 lbs.

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

A female child weighs about one-fifteenth less than a male child, as a rule.
Table showing the average height of a male child, at different ages:

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

The Rate of Growth of a Child.—A child grows most rapidly during its first year—six to seven
inches; from fourth to sixteenth, about two inches annually; thence to twentieth, one inch.
Commonly, a child at two and a half years has attained half of its ultimate adult stature. The
diseases of youth always accelerate growth.
Pulse Rate in Children and Adults.—Normal Pulse,—of new born, 130 to 140, per minute; first
year, 105 to 115; second year, 106 to 115; third year, 95 to 105; fifth to twelfth year, 80 to 90;
thirteenth to twenty-first year, 75 to 80; twenty-first to sixtieth year, 70 to 75; in old age, 75 to 85.
Infant Records.—A record should be kept by the mother of every child which would embrace
exact data as to weight, diet, size, development of mental power, teeth, ailments, sickness, pains,
etc., with dates and any information which would aid in recalling exact conditions. Such records
are of the utmost value in a number of ways. They help in giving suggestions as to diet, general
health, and mental qualities of the child in question, and they aid in furnishing what physicians

call "past history," which past history has a very valuable significance in estimating the character
and importance of sickness during later years.
Such a record is also of importance in comparing a child's development with what is regarded as
standard development, and also with the growth and development of other children in or out of
the family.
If a child should thus be found to fall seriously below the standard and yet not appear actually
sick, a very thorough and routine investigation should be instituted to discover if possible the
cause. Some error might thus be detected which might seriously affect the child's future growth
and well-being.
The date of the closing of the soft spot on the baby's head should be noted, and if it is still open,
when it should be closed, it might mean that the child has a serious brain condition. The soft spot
should close between the eighteenth and twenty-fourth months. The family physician should be
notified if the soft spot is open later than the second year, as he may want to investigate the cause.
Should the child be unusually backward in walking, and when it does so should limp and feel
pain in the knees, it should be examined for any symptom of hip joint disease, of which these are
the earliest signs.
If the child complains of so-called "growing pains," keep in mind that these are rheumatic and
may need attention. There are no such pains as actual "growing pains," that is, pains caused by
the child growing.

CHAPTER XVII
BABY'S FEEDING HABITS

Overfeeding Baby—Intervals of Feeding—How Long Should a Baby Stay at the Breast—
Vomiting Between Feedings—Regularity of Feeding—Why is Regularity of Feeding Important
—"A Baby Never Vomits"—What is the Significance of So-called Vomiting After Feedings—
Mothers Milk That is Unfit for Baby—Fresh Air for Baby—Air Baths for Baby.
Overfeeding Baby.—Every nursing mother should have printed and hung up, so she may read it
every time she nurses her child, the following motto: "DON'T OVERFEED BABY." Few, if any,
babies die of willful starvation: many die as a result of overfeeding. Mistaken kindness and lack
of judgment are responsible for one-half of all the troubles of infancy. Babies require much less
than is constantly given them. The stomach of a baby at birth will not hold more than one ounce,
which is two tablespoonfuls; and at two months it will not hold more than three tablespoonfuls;
and at six months, six or seven tablespoonfuls. Read these quantities once again carefully and try
to realize the significance of the smallness of them. A baby is just like a little pig; it will go on
feeding as long as it is allowed. The baby does not reason; it has no judgment; it depends upon its
mother's judgment. If the mother is false to the trust the baby overloads its stomach. A swollen,
distended, overloaded stomach causes indigestion. A baby with indigestion is a colicky, fretty,
sick baby. Overfeeding, therefore, is the beginning of lots of trouble to the mother, and needless
pain and suffering and sickness to the baby. A simple matter, but it is one of the most difficult
lessons nursing mothers have to learn.
Overfeeding is most apt to occur at night. Many mothers put the child to the nipple for its regular
feeding and fall asleep; the child keeps on nursing at intervals until twice the proper quantity is
taken; or she gives it the nipple or the bottle if it cries, without regard to whether it is the proper
feeding time or not. The habit of overfeeding is very common in infants who are suffering from
indigestion. They cry frequently, and are irritable most of the time; nothing seems to satisfy them
but the nipple. Taking the warm milk into the stomach seems to allay the distress for the time
being, so mothers get into the habit of quieting them in this way. The cry of the drinking man,
whom we try to sober up, is: "Just one more drink and I'll quit." You give the drink and in a little
while the demand is repeated. If the mother understood the seriousness of this practice of giving
the child the nipple or bottle at irregular times, she would not do it.
Overfeeding an infant may lay the foundation for a lifelong ailment. The excess of food remains
in the stomach or bowels undigested. If you remember that this mass of undigested matter is
confined in a small space which is both warm and damp, it will be easily understood that
putrefaction is the inevitable outcome. As a result of this putrefaction there are produced certain
ptomaines and leucomaines. These poisons are carried through the body, causing "auto-
intoxication" which upsets and irritates the child's nervous system and may cause very serious
consequences, as it frequently produces sudden death from apoplexy and "heart failure" in the
adult. These children are always restless, fretful, continually uncomfortable, sleepless and
colicky. They lose weight, the stomach becomes distended and a gastritis or inflammation of the
stomach results.

Frequently a mother with such a fretful baby, seeing her child getting thinner and thinner, will
think that it is not getting enough to eat, and will proceed to add to the trouble by giving the child
more to eat.
Mothers must therefore learn not to overfeed their infants; not to imagine that a failure to gain
weight means the need of more food (if the quality of the food being given is wrong, will
increasing the quantity of bad food do any good?); not to feed irregularly, no matter how insistent
the child may be.
Intervals of Feeding.—The physician will give instructions regarding the feeding of the newly
born baby for the first few days. After the first few days and up to the beginning of the third
month, it should be fed every two hours from 7 a. m. until 9 p. m., and twice during the night
between 9 p. m. and 7 a. m., when the regular two-hours' interval again begins for the following
day. The two night feedings should be about 1 and 4:30 a. m.
After the third month, and up to the sixth month, feed every three hours and once during the
night. From the sixth month until weaned, every three and one-half or four hours, and not at all
during the night.
While it has been pointed out that regularity of feeding is absolutely essential, the above schedule
is not to be regarded as an absolute guide. It is a general guide,—approximately it will be found
correct in a large majority of cases. Each baby is a rule unto itself. The quantity of the mother's
milk will dictate the interval after the first month and for each month as the baby grows. If a
mother with no milk to spare, is nursing a big, strong, husky baby, the three-hour interval during
the day may have to be shortened to two and one-half hours. As a rule, however, these exceptions
are better regulated by attention to the time the baby is given at each nursing to fill its stomach.
How Long Should a Baby Stay at the Breast?—Babies differ as to their method of feeding;
some of them seem to like to nurse a moment or two and then look around; others seem to regard
nursing as a serious business, and resent any effort to take the nipple away until they have
finished. A baby should be taught to nurse methodically; it should not be allowed to play the
nipple. Let it fill its stomach and put it down as quickly as possible. A mother will very soon
know just how long it takes the baby to fill its little stomach, and when she finds this out she
should time it by the clock. When the supply of milk is sufficient, and the child is strong, and
nurses freely, eight to twelve minutes are sufficient. After it is taken away from the breast it must
be left quiet till the next feeding.
Other babies, according to the ability they evince to nurse, even when the milk runs freely,
require a longer time,—from twelve to fifteen minutes. The rule, however, is never to allow them
to nurse so long that when they are taken away the milk runs out of the mouth. If this occurs, cut
down the length of time they are at the breast, and always time the length of feeding by the clock,
—don't guess at it.
Children Who "Vomit" Between Feedings.—When a child habitually brings up food between
feedings it is usually a symptom of gastric indigestion. In these cases it is advisable to add lime-
water to each feeding, and to remove some of the fat in each feeding. If improvement does not
follow remove more of the fat by removing some of the cream from the top of the bottle before
shaking it.

Remove from the bottle four ounces of cream and shake before preparing the food from what is
left. If the child improves after a few days remove only three ounces, then in a few days remove
two ounces and later one ounce. After a time, sufficiently long to permit the stomach to become
accustomed to the graded amounts of fat, the former diet of whole milk can be again resumed.
Never decrease the interval of feeding of a baby who is bringing up parts of its meal between
feedings; it is frequently advisable to increase the interval. If a child is colicky and is bringing up
lots of gas in addition to some food, one-half grain of benzoate of soda may be added to each
ounce of food given and continued for a number of weeks if necessary. When the gas is located in
the intestines and is not brought up, it must be made to pass downward. Attention to the bowels is
of great importance in these cases and it may be necessary to peptonize the milk for some time. A
reduction of the sugar and starch in the feeding frequently cures this condition. (See "Colic.")
There are children who continue to have symptoms of indigestion and who do not thrive despite
various changes in the quantity and quality of the feedings. It may be necessary to obtain a wet
nurse for them, as it is with "the delicate child." If a wet nurse cannot be obtained, or if the age
will permit, a substitute may be tried. Borden's Eagle brand of condensed milk, canned, is
probably the best substitute under these circumstances. Condensed milk should never be used as a
continuous food; as a substitute, however, for a few weeks it is often invaluable. With an infant of
three or four months it should be used at the beginning in the proportion of one ounce of the milk
to sixteen ounces of plain boiled water or barley water. The proper quantity, whatever the child is
taking (four or six ounces according to the age) at the time, can be taken from the sixteen ounces
and fed to the child. As the symptoms improve the milk should be diluted less and less, 1 to 14, 1
to 10, and so on until the proper strength is reached. After the child has been on the condensed
milk for a month it should be changed back to cow's milk, using of course a diluted formula until
the child becomes accustomed to the change. Condensed milk, if used as a permanent food, will
fatten babies, but their vitality is very deficient, the muscles flabby, and the resistance to disease
exceedingly poor. They are apt to develop rickets and sometimes scurvy.
Regularity of Feeding.—One of the very first, and one of the most important factors in
contributing to the good health and the comfort of a baby is absolute regularity in feeding. A
regular interval of feeding is particularly essential during the first month of a baby's life.
Despite the explicit way in which young mothers are instructed in this respect, it is one of the
disappointing incidents of the practice of medicine to observe how many of these mothers fail to
heed the advice. We have personally tried to find an explanation for this astonishing carelessness,
and have come to the conclusion that it is not due to intentional forgetfulness, but rather to an
inexplicable failure to appreciate that the physician means exactly what he says.
If, for example, specific instructions are given to feed, or nurse, the child every two hours (and by
"specific instructions" it is meant, that the physician takes time to explain in detail the
instructions he gives—that the instructions are not incidental to the call, but part of the call;—that
the advice is given not as a choice of what is desirable, but as an absolute rule to follow; and
carefully explains why it is imperative to do as he says; and is satisfied the mother understands
what he means) it would seem that there could be no possible reason why the directions should
not be faithfully carried out. Yet such is not the case in many instances, and the excuses given by
mothers for failure are so trivial and annoying that they show a failure to appreciate that they are
dealing with a serious problem—a problem affecting human life. They fail to understand that
fatal consequences may follow their negligence. They treat the baby problem exactly as they

would a household incident, and as they do not consider it important whether the breakfast dishes
are washed at 9 a. m. or at twelve noon, neither do they consider it important whether the baby is
fed at 9 a. m. or an hour later. When mothers learn that the attention they must give their babies is
essentially different from the attention they give ordinary household duties, the problem of
raising children with success and comfort will be greatly simplified.
If the instructions are to feed the baby at certain intervals, do so at all hazards. To offer the foolish
excuse that the baby was asleep when feeding time came, is no excuse at all; as a matter of fact
the baby should be asleep at each feeding time, if it is healthy. Wake it and feed it, for, as will be
shown later, it is the constant regularity that counts. It will be more difficult to institute regular
feeding intervals during the first month, because a healthy baby is very difficult to wake up, even
to be fed, during the first few weeks of life. It is absolutely essential, however, that it should be
wakened: otherwise the tendency to overfill the stomach at the next feeding will lead to
indigestion and colic.
Why is Regularity of Feeding Important?—Because a baby's stomach holds a very small
quantity, and experience has taught us that a baby will thrive better on small quantities given
frequently, rather than large quantities at longer intervals. The smaller the baby, the smaller the
quantity to begin with. Some babies weigh from five to seven pounds at birth, while others weigh
from nine to twelve pounds. It would be unreasonable to expect a very small baby to be able to
hold and digest as much as a very large baby. Considerable common sense and the exercise of
some judgment is therefore necessary on the part of the uninstructed mother, as to just the right
quantity to give. Fortunately, a little experience will enable the observant mother quickly to solve
this important problem. Nature promptly furnishes the symptoms which will correctly guide her.
Before considering the significance of these symptoms let us appreciate certain facts common to
all babies, and we will more easily interpret the meaning of the special symptoms the baby will
furnish.
First of all the baby never vomits. The ejection of food, therefore, is dependent upon a condition,
not a disease. If milk runs out of its mouth immediately, or within a few moments, after a feeding,
the explanation is that it was fed too much; it does not vomit, the stomach simply overflows. It is
exactly like trying to put more milk into a cup after it is full,—it will not hold more, it overflows.
The significance of this symptom, therefore, is that the quantity of the feeding is wrong (it is not
the baby's stomach that is at fault,—it is the mother's judgment). Reduce the quantity of each
feeding and you will quickly cure it. If the milk does not overflow soon after a feeding, the baby
will appear satisfied and will go to sleep, and will sleep until it is time for the next feeding. It may
not do this, however. In half an hour, or a little longer, after the feeding, it wakes, it begins to fret
and cry, and very soon it suddenly belches gas and ejects a mouthful of milk, after which it will
rest quietly for a few moments, when it will begin fretting all over again. It may keep up this
performance for an hour, or until the next feeding, and if so it is exhausted and unfit to carry on
the digestive process. It is in these cases where most mothers make serious mistakes. This is the
beginning of real trouble, and the family physician is the only one qualified to give advice under
such circumstances. Remember the warning given regarding heeding the advice of every
busybody just at this time. Your baby's health is at stake; maybe its life depends upon what you
choose to do.
What is the Significance of "Vomiting" After Feedings in Babies?—Let us examine the
difference between the milk which overflowed immediately after the feeding and the milk which

the baby ejects one-half hour or so later, and which is now being considered.
The first milk looks like ordinary milk (breast milk), or if the baby is being fed from the bottle, it
looks just like the mixture in the bottle. It not only looks like what it took, but it smells just like it.
Now examine the other; we find it looks like curdled milk, it is lumpy, and we immediately can
tell that it is sour, because it smells sour and looks sour.
The explanation of the first overflow (immediately after the feeding) was the too great quantity;
the explanation of the second overflow (one-half hour or so after the feeding), is the wrong
quality of milk. The quantity was right because none overflowed right after the feeding, but the
quality was wrong. Again, it is not the baby's stomach that is at fault,—it is the quality of the
milk.
How do we know this? Because of what takes place in the baby's stomach during the one-half
hour between the feeding and the time of the overflow of the sour milk. The quantity being right,
why should the baby have any trouble if the quality is correct? It should not. Therefore by
changing the quality (not the quantity as in the former case) we cure the trouble, thus proving the
quality of the milk to be at fault.
What took place in the baby's stomach in the intervening half hour? The quality being wrong, the
little stomach could not digest the mixture quick enough. Fermentation set in, gas was evolved,
and as the stomach was full before the gas was manufactured (and as more and more gas is
manufactured when food ferments), the stomach overflowed and out of the baby's mouth comes
gas, and sour, fermenting, curdled milk. This process goes on until fermentation stops, or until the
little stomach has just enough left to fill it and no more. But think what this is,—a sour mass of
rotting, indigestible, curdled milk,—and that is what this baby is expected to live and thrive on.
Some babies seem to have trouble from the very first day of life. Either they will not retain the
food, or the food fails to agree with them. If the baby is put upon artificial food at once, these
troubles are, of course, not unexpected (because the right artificial food may not be first chosen
for the particular baby), but it is not always the artificially fed baby that gives us trouble, and it is
sometimes difficult to find the cause for such trouble in a baby who has had nothing but its
mother's milk since it was born.
The cause of stomach trouble in a baby a few days old, fed exclusively on mother's milk, is
invariably to be found in the quality of the milk.
The quality of the mother's milk may be affected in a number of ways which will render it unfit
for the baby. For example, if the mother for any reason becomes sick, and has a high fever shortly
after confinement, it will affect her milk and render it unfit temporarily.
If the mother worries or becomes highly nervous during the first few days of her baby's life, she
will so affect her milk as to render it unfit for baby. If a baby is fed for a number of days after its
birth by its mother, and it should prove afterward that she has not enough milk to continue
feeding it, and has finally to put it on artificial food, the baby will most likely have acquired
slight stomach ailments that may be troublesome for some time, because in this case both the
quality and the quantity were no doubt wrong. Constipation in the mother will also cause trouble.
The child will develop colic and extreme irritability until the mother's condition is relieved.
Each of these conditions affecting the milk of the nursing mother usually demands a change of
food for the baby, and the substitution of the proper artificial food will invariably immediately

correct the trouble. In some cases, however, the quality of the mother's milk is not dependent
upon a temporary temperamental condition, but is caused by errors in diet, or conduct, or both.
The milk of a physically tired, worn-out mother, is not good, no matter whether the exhaustion is
caused by actual physical labor or by the exactions of a strenuous social programme. The milk of
a mother who persists in eating irregularly, or who willfully caters to an appetite which craves the
rich, highly seasoned articles of diet, or who attempts to satisfy a legitimate hunger by drinking
large quantities of stale tea or coffee and eating bread, is unfit for her baby.
These cases are amenable to the proper treatment, which of course means, that the mother must
change her conduct if at fault, and live strictly upon the diet prescribed elsewhere for nursing
mothers.
If these troubles occur in babies who have been fed exclusively upon artificial food, an entire
change of food is frequently necessary.

FRESH AIR FOR BABY

Baby's first journey out of doors depends upon so many contingencies that no specific age can be
given when it would be perfectly safe to take it.
First, the weather and season of the year should be considered. The baby should not be taken out
at all when it is wet, or foggy, or very humid; nor when it is extremely cold.
Second, the vigor or vitality of the individual child must be considered. Some children can safely
be taken out if the weather is propitious when two weeks old, others cannot be taken out without
risk until they are two months old, regardless of the weather conditions. If a child is robust at
birth, and nurses well, and increases in weight from the beginning, he can be taken out when he is
two weeks old while the sun shines during the middle of the day. If a child is small and puny
when born, and begins to have nursing troubles from the beginning, does not increase in weight,
is fretting, and crying, and sleeps spasmodically, it would be unsafe to take it out before the sixth
week unless it is at a season of the year which would justify exposure to the sunshine.
The question of suitable clothing will be important, and will decide the advisability as to when
the baby should go out. Every baby should be dressed in wool weather is not too distinctly bad.
Remember always to [Transcriber's note: words missing in text] from neck to ankles. Its head
should be warmly clad. Dressed thus and well wrapped in blankets, a healthy child is ready for an
out-door trip at any time, if the [Transcriber's note: words missing in text] have plenty of blankets
below the child as well as above it, if it is in a baby carriage. In very cold weather the child
should be buried in blankets, and a hot water bottle can be wrapped in near his feet. Great care
must be taken that the water in the bottle is not too hot, and that it does not actually touch the
skin. No matter how many or how few blankets are used, the face should be exposed directly to
the fresh air. When the air is very gusty, or high, a light veil can be laid over the face, but never at
any other time.
Air Baths for Babies.—Babies necessarily require plenty of exercise and plenty of fresh air, as
has been pointed out. It is a splendid custom to allow the baby to lie naked after his bath for half
an hour. If the room is comfortably warm, select a spot that is free from draughts, and lay the
baby on a pillow or two and let him kick and coo. In the sun by the window, his head and
especially the eyes shaded from the direct rays of the sun, is an excellent place in the summer

time. The influence of the direct sun rays on the little naked body is conducive to good sturdy
health, good nerves, and sound sleep.

CHAPTER XVIII
BABY'S GOOD AND BAD HABITS. FOOD FORMULAS

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

BABY'S BED

The Proper Way to Lay Baby in Its Bed.—The baby should be accustomed to sleep by itself
from the day of its birth. Mothers have been known to smother their babies during sleep. The
mother may pull the bed-clothing over the baby's head during the night and thus deprive it fresh
air. A mother is much more apt to nurse her baby regularly and to do it more efficiently, if she is
compelled to get up to do it. If she occupies the same bed with baby, she may fall asleep while
nursing him; the baby consequently nurses too long, fills his stomach too full, and soon develops
indigestion and colic in addition to acquiring a very bad habit.
For the first few weeks an ordinary basket arrangement is all that is necessary. As soon as the
baby begins to move around it should have a regular baby crib, so that possible accidents may be
avoided.
When the baby is placed in bed after a feeding, it should be laid upon its back, being tilted
slightly toward its right side. By placing a soft, small pillow, under its left side, the baby will rest
more on its right side, which is the proper position. The reason of this is because the liver of a
child grows quicker and larger than any other organ, and it is on the right side. By placing the
child on this side, it prevents the heavy liver from sagging over on the little full stomach. If the
child were laid on its left side, the liver would crowd the full stomach and embarrass the heart,
and cause pain and restlessness. Frequently a change of position fully to the right side, when a
child has been restless or crying, and especially if it has been lying on its back, will at once
relieve it and allow it to go to sleep again. It is the knowledge of these little things that count in
babyhood.
How Long Should a Baby Sleep?—A perfectly healthy baby should sleep, while very young,
eighteen or twenty hours out of the twenty-four. As it grows older it will sleep less. It should
have, and nothing should interfere with its having, two sound naps every day,—one in the
forenoon after its bath, and the other in the afternoon. When four or five months old, it should
also sleep from 7 p. m. until 10 p. m., then it should be fed and allowed to sleep until morning. It
has been aptly said, that, "a child might easily overeat, but he practically never oversleeps."
During the second year a child should sleep twelve hours at night, and about two hours during the

day. The twelve-hour night rest should be continued until the child is six years of age. The
practice of taking a nap at noon is a very good one, and it should be encouraged as long as
possible. It can usually be kept up until the child begins school life. The strenuous activity of
childhood, makes some such rest highly desirable, and the result will necessarily be a stronger
body, a better disposition, and firmer nerves than otherwise. The practice of retiring early should
be strictly enforced during childhood. Children of two years of age, should retire at 6:30 p. m., or
at latest at 7 p. m., those from three to five years, may remain up an additional hour. At thirteen or
fourteen the regular bedtime should be at 8:30 p. m. There is no justification for the late hours
which growing children are allowed to keep, especially in large cities.
Regular sleep is largely a matter of habit, and if the infant is started right, with suitable feedings,
given at definite times, followed by the proper periods of sleep, but little trouble will be
experienced with sleeplessness. When sleep is disturbed and broken, it means bad habits,
unsuitable food, minor forms of indigestion, or positive illness of some kind. Sleep is absolutely
essential in infancy and all through childhood for purposes of growth. It is wrong to permit a
child to sleep too much during the day; it will become a habit, and it will not sleep well during
the night as a consequence. In order to prevent or break this habit, the child should be kept in a
well-lighted room and should be amused and entertained so as to keep it awake. The nap during
the middle of the day is an exceedingly important factor in keeping the average child in good
physical condition. It is a valuable adjunct in preventing, and in treating, nervousness in children.
Children who are anemic should be encouraged to sleep long and freely in well-aired rooms.
Why a Baby Cries.—As has been stated, every healthy baby should cry for half an hour each
day. Nature suggests, demands this as an essential exercise. Muscular movements involving a
greater part of the whole body accompany the act of crying and furnish this necessary exercise. It
is of great importance to an adequate and uniform development of the lungs; deep breathing is
necessary to lusty crying, hence the lungs are expanded and the blood renewed and oxygenated.
Crying is also of material aid in moving the baby's bowels. Babies in perfect health will, however,
cry under any of the following circumstances, and doubtless under circumstances of lesser
importance and frequency when frightened or uncomfortable from hunger or position, soiled
napkins, inflamed buttocks, earache, pain, from heat or cold, unsuitable clothing, and during
difficult bowel movement, when displeased or angry. Children slightly but painfully ill may cry
incessantly for an hour or two. Thus, with intestinal colic, when the cry is loud and continuous
until the child is relieved or until he falls asleep from exhaustion.
The healthy, well trained child seldom causes trouble; it is the rule for it to be happy and good
natured in its own way.
The Habitual Crier.—If a child becomes a habitual crier, it is because it is uncomfortable and
unhappy. There are restless, often vigorous, crying, whining infants, and the trouble, as a rule, is
in the intestinal tract. Badly managed, "spoiled babies" cry from inattention, and when left alone.
If they are taken up and talked to, the crying ceases, thus proving that it was not pain or
discomfort that was causing the crying. In the case of the habitual crier we try to find out the
cause of the bowel trouble and cure it; the spoiled infant we discipline rigidly, or leave it alone if
its parents prefer that kind of baby.
The Habit of Feeding Baby Every Time It Cries.—The habit of regular feeding will, if
persisted in and successfully established, render advice on this subject unnecessary. So also will
the explanation of the evil of overfeeding have its effect on mothers. Apart from these reasons,

however, the habit of feeding baby every time it cries is a pernicious one, and no doubt the
mother, who will be striving to faithfully follow instructions, will have to overcome the advice of
meddling friends who will regard it as a cruelty to allow the baby to cry. Do not give in to these
busy-bodies; insist on attending to your own affairs, but be absolutely sure baby is not crying for
a just cause. A child can only cry; that is its only language, but it cries for many things other than
the nipple or the bottle. Examine it carefully,—a wet diaper a pin, an uncomfortable position, a
drink of water, any of these may be the cause.
It is just as essential that a child should cry as that it should sleep. Every healthy child should cry
for twenty or thirty minutes every twenty-four hours. Nature calls for this as an exercise in order
to develop the lungs; therefore, if there is no just cause for the crying you must regard it as a
necessary evil, even if you look upon it as a domestic affliction.
The Habit of Walking the Floor With Baby Every Time It Cries.—This is another habit that is
indulged in to the sorrow and ridicule of the race. If you are a victim of this habit, you have
yourself to blame. It is a matter of education, or habit, pure and simple, and, like all bad habits, it
is difficult to break away from. In the preceding paragraph, you have been told that when baby
wants something, or is uncomfortable, it employs the language nature gave it,—it cries. No child
ever cried to be walked up and down the floor in the dead of the night. Begin at the beginning,
when it first cries, find out why it is crying. Offer it a little water if it is not feeding time.
Examine its diaper and if soiled change it. It may be overdressed and consequently hot,
perspiring, and uncomfortable; change its position. Find out if any pin is open and hurting it;
loosen the binder so it can breathe easily. If it is a colicky child follow the instructions given in
the treatment of colic. Be patient the first few nights, and be thorough, because you may discover
why it cries and each discovery will help you next time. If you discover something wrong, some
reasonable excuse for the crying, does it not prove the folly of walking the floor? If it wants a
drink of water, or if its diaper is wet, how is walking the floor going to cure it, or how can you
expect the baby to stop crying when you so unjustly construe its reasonable and its only way of
asking a favor? If walking the floor stops its crying, it stops it by exhausting the child, not by
relieving it of its little ailment.
Jouncing or Hobbling Baby.—This is another habit that should be frowned upon. So many
persons are addicted to this form of baby torture, that it is astonishing more immediate harm does
not result from it. Be particularly careful not to indulge in it, or permit anyone else to do it
immediately after feeding. If you form the habit of putting baby down at once after each feeding,
as you have been instructed to do, the opportunity to jounce it will not exist. A little reasoning
will clearly convince you that to subject a baby to violent exercise when its stomach is full would
interrupt digestion and so shake the full stomach hat it would distend it and cause indigestion.
You would not think of exercising yourself after a meal; why exercise a baby?
Baby Needs Water to Drink.—Boil a quantity of water each morning, put in a clean bottle, and
keep in a cool place. Give the baby some, three or four times daily between feedings. One
teaspoonful is enough to begin with, and as it grows older it will take more. It may not always
take the water but it will take what it wants, and it needs some every day; it is therefore your duty,
inasmuch as baby cannot ask for it, to offer it regularly each day as part of your daily routine.

KISSING

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

Kissing should not be allowed among children. If any kissing is done it should be on the brow,
never on the mouth, hands, or fingers.
Many diseases are carried by this pernicious habit, and you cannot afford to have baby's health
jeopardized by this promiscuous and unnecessary liberty.

ESTABLISHING TOILET HABITS

When baby reaches the age of three months, a regular systemized effort should be made to
educate it to "habits of cleanliness." Nothing can be done in this direction previous to this age, as
a child at that period of its life is scarcely conscious of the natural functions of its body. Each
time a baby, after the third month, is making an effort to move its bowels, the nurse or mother
should go to it as it lies in its crib, and talk to it by making a certain sound or say a certain word
—whichever word or words you want to educate your child to say, when it wants to move its
bowels. By constant attention and effort in this direction, a child with quick perception and
initiative will soon associate the sound and the function, and it will begin to make the sound when
the function is about to be performed. As soon as it begins to make this sound, if prior to the act
of moving the bowels, the child should be immediately taken up and held on a chamber, into
which some hot water has been put, and encouraged to relieve itself, the nurse or mother still
repeating the sound, or word, or words.
Having successfully accomplished this programme a number of times, the child should be
encouraged and petted every time it gives a satisfactory warning, and discouraged and reproved
every time it wets or soils its napkin. A little later, say about six months, the child should be held
on the chamber at a certain time each morning and evening, thus encouraging it to move its
bowels regularly twice daily. The careful carrying out of a scheme such as the above will
establish regular, cleanly habits, and will to a very large extent guard against constipation in the
future.
Baby's Comforter.—The discovery and introduction of the comforter or rubber teat was an
unfortunate episode in someone's life. By the careless, conscienceless nurse, or thoughtless
mother, it is regarded as a real comfort and blessing. Any temporary comfort, however, which the
nurse or mother may enjoy as a result of its use, is at the expense of the health of the child. Its use
is a serious reflection upon the good intention and intelligence of the mother who permits her
child to use one. It is a bad habit from every viewpoint possible. In order that mothers, open to
conviction and capable of reasoning, may appreciate the character of the harm done by the use of
the comforter, we will briefly record these conditions:
1st. The constant sucking pulls upon the delicate structures of the mouth and throat, and so
impairs the health tone of these structures that they become flaccid and feebly nourished. This to
a certain degree causes adenoids, enlarged tonsils, loose palate and weak throat, with the constant
tendency to winter colds and coughs, and to catarrh.
2nd. It causes an excessive flow of saliva. Saliva should only be stimulated previous to stomach
digestion. By causing an excessive flow of saliva into an empty stomach, the digestive powers are
interfered with, and seriously weakened. Stomach trouble, and consequently intestinal disease,
may therefore be caused by the seemingly innocent comforter.

3rd. A constantly used comforter always causes disease of the mouth. Mucous erosions, canker
sores, little ulcers, etc., are produced in this way.
4th. The use of the comforter makes it impossible to put the child to sleep, or even to leave it
alone, without first placing it in its mouth.
5th. To stifle a baby's cry, by pushing the comforter into its mouth, is as bad as giving it
chloroform to mask a serious and dangerous pain. If may have a just reason for crying, as is
explained elsewhere, and if that reason is not searched for and found, it may mean serious trouble
later.
6th. Actual deformities of the mouth are produced by constant use of the comforter. The
continuous sucking affects the gums, pushes them out of shape and position, and the teeth as a
consequence come at wrong angles, thus causing unsightly deformities, which last throughout the
life of the child.
7th. The worst fault of the comforter is to be found in its uncleanliness. We are quite satisfied that
the use of the comforter will be legislated against one of these days. If preventive medicine
means anything, it must certainly reckon with the comforter in the very near future. Have you
ever watched your baby suck on its comforter? If you have, you must have noted the tireless
energy with which it works its tiny jaws and tongue. Suddenly the comforter slips from the little
mouth and baby begins to cry, attracting the attention of the mother, or nurse, or little sister, who
promptly, recognizing the trouble, pounces on the offending comforter, which has fallen to the
floor, and with a perfunctory wipe replaces it in baby's mouth. It is done just as we have written
it, many thousand times, and yet the problem of infant mortality is represented as a vexatious
mystery. The newspapers solicit charitable aid, and write eloquent appeals regarding the necessity
of sending a few babies to the seashore in the summer time or to supply a few with ice during the
hot spells. A hundred other energetic enthusiasts send forth their laudable effort to raise the
standard of child hygiene, yet the manufacturers of the comforter, and the ignorant mother and
nurse who use it, do more harm in one day than all the honest effort of these combined forces can
neutralize in a year.
The rubber comforter is one of the most fertile causes of infection and illness in babies because of
the peculiar adaptability to collecting germs which it possesses.
When the comforter is finally discarded the habit of sucking is so firmly established that the child
will suck its thumb for many years after. This results in further disease and deformity to the
growing mouth and throat, and also to the thumb.
After a child has used a pacifier or comforter for some time it invariably becomes a mouth
breather. A mouth-breathing child is very apt to catch cold and as a consequence of the habit may
become catarrhal or tubercular.
What Can be Done to Lessen the Evil Effects of the "Comforter" Habit?—It is a most
difficult habit to cure when once established. The very least that can be done is to keep the
comforter scrupulously clean, washing it several times daily. To have not one, but two or three,
kept in a saturated solution of boracic acid, ready to put into the baby's mouth should one be
required to replace another that has fallen out. We should furnish a large shield to prevent it being
swallowed. We can try the method of weaning the baby from the comforter by tying a ribbon to it

and to the child's bodice. The system is gradually to shorten the ribbon until it becomes too short
for the baby to suck in comfort. It will then gradually grow away from the habit.

FOOD FORMULAS

Beef Juice.—Take one pound of round steak and broil it slightly. Press the juice out with a lemon
squeezer, or, with a meat-press. Season with salt and serve hot or cold as desired. If it is heated
after it has once been cold, it should not be overheated as this will coagulate the albumen which
will appear as flakes floating on the surface of the juice.
Beef Juice by the Cold Process.—Take one pound of finely chopped round steak, six ounces of
cold water, a pinch of salt; place in a covered jar and stand on ice, or in a cool place, six hours.
This mixture should be shaken from time to time. Strain and squeeze all the juice out by placing
the meat in a coarse cloth and twisting it very hard. Season and feed as above.
Beef juice made in this way is more nutritious than that made from the steak when broiled; it is
not, however, quite so palatable.
Beef juice made in either of the above ways is much more nutritious than the beef extracts sold
ready to use.
Mutton Broth.—Take one pound of finely chopped lean mutton, including some of the bone, one
pint of cold water and a pinch of salt, cook for three hours over a slow fire down to half a pint,
adding water to make up this quantity if necessary; strain through muslin. When it is cold remove
the fat and add more salt if required. It may be fed warm or cold in the form of a jelly.
Mutton Broth With Cornstarch or Arrowroot.—Add to the above sufficient cornstarch or
arrowroot to thicken, cook for ten minutes and then add three ounces of milk, or one ounce of
thick cream, to a half pint of broth. This makes a nutritious and extremely palatable broth.
Chicken, Veal, and Beef Broths.—These may be made and used in the same way as mutton
broth.
Scraped Beef or Meat Pulp.—Take a rare piece of round or sirloin steak, cut the outer part
away, scrape or shred with a blunt knife. Cutting the meat into small pieces is not satisfactory.
One teaspoonful to one tablespoonful may be given well salted, to a child a year and a half old. It
is best to begin with a small dose and work up to the larger to accustom the digestive apparatus to
its use.
Junket, or Curds and Whey.—Take one pint of warm fresh cow's milk, a pinch of salt, a
teaspoonful of granulated sugar, to which add two teaspoonfuls of Fairchild's essence of pepsin
and allow the mixture to stand until firmly coagulated—this may take about twenty minutes—
place in the ice box until thoroughly cold. Nutmeg may be added for older children and adults.
Whey.—The coagulated milk prepared as above is broken up with a fork and the whey is strained
off through cheesecloth. If a stimulant is desired, brandy, in the proportion of one teaspoonful to
six tablespoonfuls of the whey may be added.
Barley Water.—One level tablespoonful of Robinson's barley is rubbed up with a little cold
water, to this is added one pint of boiled water containing a pinch of salt. The mixture should be
stirred while the water is being added. Cook for thirty minutes in a double boiler and strain.

Enough boiling water should be added to the mixture to make up the full pint if any has boiled
away.
Barley Gruel or Barley Jelly.—Repeat the above process, but instead of using one tablespoonful
of the barley powder, use from two to four according to the consistency of the gruel or jelly
desired.
Barley water may be made from the grains. A formula for this process will be found in the
chapter on artificial feeding.
Rice, Wheat, or Oat Water.—These are made from the rice, wheat, or oat flour in the same way
as barley water described above. They may be made from the grains also, using the same
proportions as in the making of barley water.
Imperial Granum.—This is prepared in the same way as the barley flour above described.
Albumen Water.—Take half a pint of cold water, the white of one fresh egg, a pinch of salt, and
a teaspoonful of brandy, shake and feed from a spoon or from a bottle. This is frequently used in
cases of vomiting, or in irritable stomachs. It is often retained when all other food is rejected.
Dried Bread.—Cut either stale or fresh bread into thin slices and place in the open oven. When it
is dried and crisp but not browned it may be given to children in preference to crackers.
Coddled Egg.—A fresh egg with the shell intact is placed in boiling water which is immediately
removed from the fire. The egg is allowed to remain in the water for eight minutes when it is
ready for use. The white only should be used if the digestion is poor.

ARTIFICIAL FEEDING

CHAPTER XIX
ARTIFICIAL FEEDING

Elementary Principles of Milk Modification—The Secret of the Efficiency of Mother's Milk—
Two Important Factors in Successful Artificial Feeding—Every Child is a Problem in Itself—
Proprietary Foods of Little Value as Infant Foods—Their Value is in the Milk Added to Them—
The Credit Belongs to the Cow—Difference Between Human and Cow's Milk—What "Top-milk
Feeding" Means—Utensils Necessary for Home Modification of Milk—Artificial Feeding from
Birth to the Twelfth Month—How to Measure Top-milk—Easy Bottle-feeding Method—
Condensed Milk Feeding—Objections to Condensed Milk Feeding.
Elementary Principles of Milk Modification.—Mothers who have to raise their children on
artificial food should understand the elementary principles of milk modification. They should
know, for example, that the one object of milk modification is to render it as nearly an exact
substitute for mother's milk, according to the age of the child, as is possible. If we could do this
with scientific exactness, artificial feeding would be a simple process. We cannot, however; nor
has there ever been devised a method by which we may hope successfully to duplicate mother's
milk. It is a comparatively simple matter for the efficient chemist to analyze the breast milk of
any nursing mother; and it is quite possible to duplicate the milk according to the analysis, with
chemical exactness, but the two fluids will not be the same. There is present in the mother's milk
something which synthetic chemistry cannot discover. This something is nature's secret,—it is
akin to the life-giving principle which is contained in the germinal fluid, and in the hen's egg. We
cannot therefore hope to build up an artificial food that contains this mysterious life-giving
principle which is the secret of the efficiency of maternal milk,—we can only hope to
approximate it. It is possible that we might be successful so far as its nursing efficiency is
concerned, if all children were alike, if all children were of a uniform standard of health. As a
matter of fact, no two babies are exactly alike. And while the mother of each child undoubtedly
secretes a milk suitable to the degree of healthfulness of her own child, the same milk might not
be equally suitable to another child. The milk, therefore, that is manufactured to agree with an
average mother's milk is dependent for its success upon the vitality of the child to which it is fed.
If that child is not a well child, according to an accepted standard, the milk will not agree with it,
even though it is the best possible substitute for an average breast milk.
We have consequently two factors to consider in successful or efficient artificial feeding:

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

It is the lack of a uniform health standard in children that gives to artificial feeding all its
difficulties. It renders the successful artificial feeding of children a personal or individual
problem. Some children,—those who approximate a standard of health for their age; in other
words, "well" children,—thrive on a milk modification that experience has taught us is suitable
for well children of their age. Others, and they are in the majority, have to be fed on a
modification which actual test proves to agree with their digestive capabilities. Every artificially
fed child therefore must be studied from its own individual standpoint. A certain modification of

milk may not agree with a child fed every two and one-half hours, which will be found to agree if
fed in the same quantity, to the same child, every three hours. The slightest change, a change
which would seem to be so insignificant in itself as not to justify serious consideration, may mean
the difference between normal healthfulness and constant ill health. A food that is too strong for a
child's digestive ability, and which causes vomiting, colic, and diarrhea, may be rendered exactly
right by the slightest modification one of its constituents. To effect such a change quickly and
successfully, one must be trained to interpret the symptoms correctly and to know how to make
the change in the modification of the milk. Mothers cannot be expected to possess this degree of
skill: they should therefore refrain from experimenting, because an experiment on a baby is not
only dangerous, but ethically it is criminal. Call the family physician; put the burden on his
shoulder.
It is this element of uncertainty in our ability to effect a standard modification of milk that has
afforded manufacturers the rich opportunity of putting on the market various baby foods for
which much is claimed. These foods are really substitutes for the inefficiency of the average
mother. There is no real justification for their use. If all mothers were clean, faithful, and
efficient, there is no reason why each one could not be taught to modify cow's milk to suit her
child, just as satisfactorily, or more so, than a manufacturer who never saw her child. The
manufacturers, however, do the work, and the naturally ignorant or lazy and inefficient mother, is
willing to pay for the extra cost of labor, to save herself the trouble on the one hand, and to
subject her child to a series of experiments in order to discover the manufactured food that is
particularly adapted to her particular baby on the other hand. We believe that most mothers have
never considered the question from this standpoint; that most mothers adopt this method of
artificial feeding at the direct suggestion of their family physician, and are not, therefore,
responsible. These foods do not contain the nutritional elements necessary to healthy growth; or
as they exist in normal breast milk; or as they can be approximated in ordinary milk modification
at home. Proprietary foods are of decidedly poor value in infant nutrition, and should not be used.
They have a value, however, in certain diseased conditions, but within a very small range. As a
food for a healthy growing infant, they should not be used, and when the average physician
appreciates this fact, and so instructs the mothers of the country, it will be to the distinct
advantage of the race in every respect. Proprietary foods to which fresh cow's milk is added, are
not foods at all,—they depend upon the milk so far as any nutritional value is concerned; and it
would be far safer to modify at home a good milk than to buy a proprietary food, the analysis of
which cannot be depended upon. The credit for the fat, healthy babies we see advertised does not
belong to the manufacturers, but to the cow whose milk you add to the manufacturer's sugar.
The proprietary beef foods are also valueless as infant foods. In certain illnesses, when we want a
mild stimulant, a teaspoonful or two in hot water may have a certain value, but that is all. The
beef juice of home manufacture is much more valuable.
Difference Between Human and Cow's Milk.—The composition of cow's milk is as follows:

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

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

Fat 4%

Sugar 7%
Proteids 1-1/2%

It will be observed from a comparison of the above tables that cow's milk is much richer in
proteids (the substances which form with water the curd of sour milk) than is human milk. If one
remembers that cow's milk is manufactured by nature primarily for the feeding of calves, not for
babies, and that the stomach of a calf is intended to exist exclusively on vegetable products, and
that nature is preparing it for this purpose, and feeds it a food when young that will enable it to
grow so as to be adapted for that purpose, one can understand that the problem of the
modification of cow's milk to suit the stomach of a baby is not by any means a simple matter.
Since the proteids are so much in excess in cow's milk, we must dilute cow's milk with twice its
bulk or more of water to render it fit food for a new born baby. If we dilute cow's milk to this
extent to get the proteid percentage right, we immediately disarrange the percentage of the cream
or fat. We overcome this difficulty by taking the cream from the top of the bottle and diluting it
because it is richer in fat and does not need so much dilution. This is the explanation of the so-
called "top-milk feeding." The percentage of sugar represents another problem. The percentage of
sugar in cow's milk compared with the sugar in human milk is deficient, so we add milk-sugar to
the cow's milk to make up the deficient percentage.
There is yet another feature which we must rectify; cow's milk is acid, while human milk is
alkaline. To overcome this difference we add lime-water. We must also take into consideration
that cow's milk is ordinarily full of germs, while human milk is free from them; to overcome this
danger we resort to heating the milk to a degree which experience has taught us will kill all
germs. Cooked milk is not as wholesome as uncooked milk, and it has a tendency to cause
constipation. We have to a certain extent overcome the need for cooking all milk for babies, as
will be noted later, but in summer time, unless the milk is known to be pure and free from germs,
it is advisable to sterilize it.

UTENSILS NECESSARY FOR HOME MODIFICATION OF MILK

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

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

ARTIFICIAL FEEDING FROM BIRTH TO THE TWELFTH MONTH

The following formulas for the different ages may be found useful for well babies:
From the third to the tenth day:

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

Ten feedings in twenty-four hours; 1-1/2 to 2 ounces at each feeding.
From the tenth to the twenty-first day:

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

Nine to ten feedings in twenty-four hours; 1-1/2 to 2 ounces at each feeding.
From third to the sixth week:

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

Eight to nine feedings in twenty-four hours; 2 or 3 ounces at each feeding.
From sixth week to the third month:

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

Seven to eight feedings in twenty-four hours; 2-1/2 to 4 ounces at each feeding.
From third to fifth month:
After this age two bottles of milk are required, 16 ounces being taken from the top of each bottle
and mixed.

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

Six feedings in twenty-four hours; 4 to 5 ounces at each feeding.
From the fifth to the seventh month:

Milk (top 16 oz.) 21 ounces.

Milk-sugar 2 ounces.
Lime-water 5 ounces.
Water to make 42 ounces.

Six feedings in twenty-four hours; 5 to 7 ounces at each feeding.
From the seventh to the ninth month:

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

Five to seven feedings in twenty-four hours; 6 to 8 ounces at each feeding.
From the ninth to the twelfth month:

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

Five to six feedings in twenty-four hours; 7 to 9 ounces at each feeding.
It will be observed that 16 ounces of top-milk is used to make the various formulas from. This
means that the mother will dip off, with a Chapin dipper, 16 ounces from the top of a bottle of
milk which has stood for four or five hours to allow the cream to rise; she will then mix this and
take from the mixture the number of ounces called for in the formula she is using according to the
age of the child. The ordinary milk that is delivered in New York City may be assumed to have
stood the four or five hours necessary. This may not be so, however, in the country, as it is
frequently delivered there as soon as it is milked. In such cases the mother will permit it to stand
in the ice box until the cream has risen.
When the mother is about to make the mixture called for in feeding from the third to the fifth
month she will observe that 18 ounces of milk is called for. Now since she only uses 16 ounces of
the top-milk from one bottle this will not be enough. She must therefore use 16 ounces from two
bottles of milk; this she will mix together and from this mixture she will take the 18 ounces
wanted. Whatever milk is left over may be used for ordinary table purposes.

EASY BOTTLE-FEEDING METHOD

The following formulas and instructions for bottle-feeding are taken from the Rules for the Care
of Infants and Young Children which are used by Dr. Kerley at the out-patient department of the
Babies' Hospital and give the simplest and easiest means of bottle-feeding:
Bottle-Feeding.—The bottle should be thoroughly cleansed with borax and hot water (one
teaspoonful of borax to a pint of water) and boil before using. The nipple should be turned inside
out, scrubbed with a brush, using hot borax water. The brush should be used for no other purpose.
The bottle and nipple should rest in plain boiled water until wanted. Never use grocery milk. Use

only bottled milk which is delivered every morning. From May 1st to October 1st the milk should
be boiled five minutes immediately after receiving. Children of the same age vary greatly as to
the strength and amount of food required. A mixture, when prepared, should be put in a covered
glass fruit-jar and kept on the ice. For the average baby the following mixture will be found
useful:
"For a child under six weeks of age: Nine ounces of milk, twenty-seven ounces of barley-water,
four teaspoonfuls of granulated sugar. Feed from two to three ounces at two and one-quarter hour
intervals, nine feedings in twenty-four hours.
"Sixth to the twelfth week: Twelve ounces milk, twenty-four ounces barley-water, five
teaspoonfuls sugar. Feed from three to four ounces at each feeding.
"Third to the sixth month: Eighteen ounces of milk, thirty ounces of barley-water, six
teaspoonfuls of sugar. Feed four to six ounces at three-hour intervals, seven feedings in twenty-
four hours.
"Sixth to the ninth month: Twenty-four ounces milk, twenty-four ounces barley-water, six
teaspoonfuls granulated sugar. Feed six to eight ounces at three-hour intervals, six feedings in
twenty-four hours.
"Ninth to twelfth month: Thirty-eight ounces milk, twelve ounces barley-water, six teaspoonfuls
of granulated sugar. Feed seven to nine ounces at three and one-half hour intervals, five feedings
in twenty-four hours."
Barley-Water.—The barley-water used in the above formulas may be made in the following
way: To two teaspoonfuls of pearl barley, add one quart of water, and boil continuously for six
hours, keeping the quantity up to a quart by the addition of water; strain through coarse muslin.
The barley will be better if it is soaked for a number of hours, or over night, before cooking. The
water in which it is soaked is not used.
An equally good barley-water may be made in an easier way by using Robinson's prepared
barley. This may be procured in the drug stores. It is only necessary to take one even
tablespoonful of this barley to twelve ounces of water and cook for twenty minutes.
Condensed Milk.—When the mother cannot afford to buy bottled milk from the wagon, when
she has no ice-chest and cannot afford to buy ice, she should not attempt cow's-milk feeding, but
may use canned condensed milk as a substitute during the hot months only. The can, when
opened, should be kept in the coolest place in the apartment, carefully wrapped in clean white
paper or in a clean towel. The feeding hours are the same as for fresh cow's milk:
"Under three months of age: Condensed milk one-half to one teaspoonful; barley-water, two to
four ounces.
"Third to sixth month: Condensed milk, one to two teaspoonfuls; barley-water, four to six ounces.
"Sixth to ninth month: Condensed milk, two to three teaspoonfuls; barley-water, six to eight
ounces.
"Ninth to twelfth month: Condensed milk, three teaspoonfuls; barley-water, eight to nine ounces."

Objections to Condensed Milk Feeding.—Condensed milk is not to be recommended as a
permanent food where good cow's milk can be obtained. In most cases it should be used as the
sole food for a few weeks only. It may be used when the digestion is impaired for some reason. If
the symptoms are intestinal it will be more apt to agree than if they are caused by stomach
ailments. The symptoms of intestinal disturbances are,—colic, flatulence (gas), curds or specks in
the stools, constipation or diarrhea. It will not be found suitable if the child is simply vomiting.
The objections to condensed milk are: It is very rich in sugar and very deficient in proteids and
fat. Children fed on condensed milk often gain very rapidly in weight but have little strength or
resistance. They do not fight disease well for this reason; they are apt to develop rickets and
scurvy.

CHAPTER XX
ARTIFICIAL FEEDING—CONTINUED

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

HOW TO PREPARE MILK MIXTURES

The mother should always remember, that the secret of success in raising a baby efficiently on
artificial food is to be cleanly and to be exact. The bottles and the nipples must be scrupulously
clean; the hands of the mother must be clean; the water used must be boiled and each ingredient
must be measured exactly.
First dissolve the sugar in the boiled water, which must be the exact quantity; then remove the
top-milk and measure the exact amount wanted in the graduate, pour into the jar, add the water
and sugar mixture, and finally the lime water.
It is always desirable to make the entire quantity for the day at one time. After the total quantity
has been mixed in the jar, fill each bottle with the amount for each feeding, put in a cotton
stopper, and place the bottles in the ice box.
In measuring the sugar, it should be remembered that two scant dipperfuls equal one ounce by
weight of the sugar.
When each individual bottle is to be filled, do it with the aid of the glass funnel which has been
previously sterilized.
Sterilizing the Food For the Day's Feeding.—The simplest method is to place the two-quart jar
containing the milk mixture for the next twenty-four hours' feeding upon a saucer in the bottom
of an open pan, and then to pour enough tepid water into the pan (outside of the jar) until it will
come up as high as the milk level. The water in the pan is then brought slowly to the boiling
point. The pan is then moved to the back of the stove and left for half an hour. The jar is then
removed and rapidly cooled by allowing cool water to flow over the outside; the individual
bottles filled and put in the ice box.

It is always wise to taste the milk before making up the day's feeding to be sure it is not sour. The
milk from a herd of good cows is always better than the milk from one cow no matter how good
that one cow may be.
When about to feed the baby, the bottle is taken out of the ice box and heated to the desired
temperature in a water bath. The temperature of the milk can be tested by allowing a few drops to
fall on the wrist; it should feel warm, not hot; it should not be tasted by putting the bottle to the
mouth of the nurse, or mother, as it may become infected by doing so. A flannel cover, or bag,
should be made to fit the bottle and it should be put on while the baby is nursing so that the milk
may retain its heat. The baby must not be disturbed while nursing, nor should he be jounced or
carried around after nursing. These habits cause vomiting and indigestion. He should be put in his
crib.
When to Increase the Quality or Quantity of Food.—Children of the same age may have
different digestive abilities. A strong, robust child may be permitted to take a richer quality of
milk than a weak, puny infant of the same age. If the quality or quantity of each feeding is too
weak or small for the baby he will be dissatisfied and he will cry after the feeding. In such cases,
if the bowel discharges are natural and yellow without curds or white specks, and if he is not
gaining sufficiently in weight, the next stronger formula may be tried. If it is decided to put him
on the stronger mixture, it is wise to cut the quantity down for a day or two in order to test out his
digestive ability. If the stools remain good after three days, the quantity may be slowly increased
until the amount in the recipe is allowed. It is a much more serious risk to overfeed the baby than
to underfeed him. If too large a quantity is given, he may vomit it at once, or he may develop
colic with intestinal indigestion. Such babies lose weight, become fretful and irritable, even
though the appetite may remain good. If too strong a quality is given he may vomit sour, buttery-
smelling milk, or have colic, and pass curds in the stool. If this happens it may be necessary to go
back to a weak formula and work up from that standard. This is always a tedious and anxious
experience and may lay the foundation for digestive disturbances for a long time. Don't be too
anxious to increase the quality, or quantity, of your baby's food. It is much better to go slow and
have a well baby, than to try to force matters and get into all kinds of trouble. No science calls for
more elementary common sense, than the science of infant therapy.
Digestive disturbances incident to this period are fully explained in the chapter on Diseases of
Children.

FOOD ALLOWABLE DURING THE FIRST YEAR, IN ADDITION TO MILK

About the twelfth month the baby should receive plain milk mixtures instead of the top-milk
heretofore used in making up the food. At first the milk may be plain milk from an ordinary bottle
shaken up. Of this he may take five ounces, to which may be added three ounces of barley water.
The barley water may be gradually withdrawn, an ounce at a time, replacing this amount with
milk, until the child is taking eight ounces of milk and two ounces of barley water. Later plain
mixed milk will be suitable for a child about the fourteenth month.
Barley water may be added to the milk at any time after the third month in place of the plain
boiled water in the preceding formulas. It is advisable to do this if there is any trouble with
digestion, or if there are curds in the stools. Some children take more kindly to barley water than
plain water at a very early age.

Beef Juice.—The juice squeezed from broiled steak may be given a child at about the eighth or
ninth month, or, in cases of anemia, earlier than this. It is given before the milk feeding, diluted
with an equal amount of water. At first a teaspoonful of the extracted juice should be given with
the same quantity of water; increase every four days until at the end of two or three weeks two
tablespoonfuls are given.
White of Egg.—Place an egg in boiling water and allow the water to cool with an egg in it. In ten
minutes the white of the egg will be coagulated and ready for use. It may be used in place of the
beef juice if the latter does not agree and may be begun at the sixth month and given once daily.
One-half of the white of the egg should be tried, then at the end of a week, if it agrees with the
child, the whole white of one egg may be given.
Orange Juice.—This juice has a good effect on the bowels and may be given even to very young
children who are disposed to be constipated. It is also of benefit in counteracting the effect of
boiled milk. The juice should be extracted from fresh oranges and strained. One teaspoonful may
be given at first one hour before a feeding. The amount may be increased until four teaspoonfuls,
or one tablespoonful, are given daily.
Peptonized Milk.—The object of peptonization of milk is partly or wholly to digest the casein,
or curd, of the milk before feeding.
Fairchild's Peptonizing Powder is used for this purpose. The powder is put up in tubes, and
instructions are furnished in each box as to its use.
There are two methods of using the powders:
The Hot or Immediate Process.—Fifteen minutes before feeding add from one-eighth to one-
quarter of the contents of a tube to the milk mixture in the nursing bottle ready for use. The bottle
is then put in water at a temperature of from 110° to 120° F., and allowed to remain in the water
for fifteen minutes. The amount of the powder used and the temperature of the water depend upon
the amount of milk in the nursing bottle.
The Cold Process.—Four ounces of cold water are put into a clean quart bottle and the powder
from one of the tubes. Shake the mixture thoroughly until the powder is dissolved. Add a pint of
cold fresh milk, shake the bottle again and place directly on ice. When any of this milk is used the
bottle should be again shaken and put immediately back on ice.
If necessary this process may be modified so that partially or completely peptonized milk may be
made.
Partially Peptonized Milk.—Put four ounces of water and a whole tube of powder into a clean
pan and stir well; add a pint of cold milk and heat to the boiling point, stirring the mixture all the
time. There should be enough heat to bring the milk to the boiling point in ten minutes. Allow the
mixture to cool somewhat and strain into a clean jar, cork tightly and keep in a cool place. Shake
the jar before and after using any of the contents.
If partially peptonized milk is properly prepared it should not become bitter.
Completely Peptonized Milk.—Put four ounces of cold water and the powder contained in one
of the tubes into a clean quart bottle and shake thoroughly. Add a pint of cold fresh milk and
shake again; then place the bottle in a pan of warm water about 115° F., or not too hot to place the

hand in comfortably. Keep the bottle in the water bath for thirty minutes; then place the bottle
directly on ice.
Uses of Peptonized Milk.—Partially peptonized milk is useful in young infants who have
difficulty in digesting the curd of milk. Completely peptonized milk is frequently used during
attacks of indigestion. It is used also to tide a delicate infant over a period when for some reason
the digestive apparatus refuses to digest and assimilate even dilute mixtures. It is of value also in
acute or chronic illness when the child has to be fed through a tube. When it is necessary to feed
per rectum peptonized foods are often selected in preference to others.
Objections to Peptonized Milk.—Complete peptonization of milk renders the milk bitter. For
this reason many children will not take it. Very young children whose sense of taste is not
developed may be induced to take it after a few days. It is not wise to continue its use long
because the function of the stomach will become accustomed to the use of predigested food and
refuse to work when called upon. If it is used for a number of weeks it is wise to stop it gradually
in order to permit the stomach to resume its function in a normal way.
What a Mother Should Know About Baby's Feeding Bottle and Nipple.—In the first place,
always buy round bottles,—round everywhere, inside and out,—there should be no corners
anywhere. The reason for this is, that bottles that are round everywhere, are easily cleaned, and
can be thoroughly cleaned, and having no corners they do not lend themselves to collecting dirt
and bacteria. When these bottles are first bought they should be boiled. After each feeding they
should be thoroughly washed with soap or washing powder. A long-handled bottle brush should
be used to help clean the bottle. After the bottle has been thoroughly rinsed a number of times
with hot water, it should be set aside filled with warm water into which one teaspoonful of
bicarbonate of soda has been put. Before filling them with the freshly prepared food each
morning the bottles should be boiled. Every mother with a bottle-fed baby should buy a dozen
bottles, all of the same kind and size to begin with. This is a great advantage for a number of
important reasons, two or three of which I will mention:
1st. Having enough bottles means that each bottle will be used once only during the twenty-four
hours; there is less chance therefore of a bottle being cleaned carelessly.
2nd. Having a fresh bottle for each feeding permits all of the food for twenty-four hours being
made at one time. This ensures uniformity of quality of each feeding.
3rd. By cleaning all the bottles at one time (previous to filling) it is more apt to be done
thoroughly; and by making all the food for a day at one time it is more apt to be correct than if
each feeding was made separately.
The baby's nipple should be made of plain black rubber. It should not be too thick because it is
necessary to turn it inside out in order to clean it thoroughly. The hole in the nipple should not be
too large—if the child can empty the bottle in less time than fifteen minutes the hole is too large.
If the milk drops out but does not run it is about right. Don't buy nipples too long or too large. A
long nipple tends to gag the child and cause vomiting. A large nipple prevents the child from
sucking properly and usually allows the food to be taken too quickly and with air, which causes
colic and indigestion. It is well to have always half a dozen nipples of the right kind on hand.
When new, nipples should be boiled before using. After each feeding the nipple should be washed
in borax and water on both sides, then it should be put in a dish containing fresh, cold, borax
water and left there until again required. A large portion of the success of raising healthy, bottle-

fed babies is in being everlastingly clean in the details of caring for the bottles and nipples which
are in daily use.
Should a Mother Put Her Baby on Artificial Food if Her Supply of Milk, During the First
Two Weeks, is Not Quite Enough to Satisfy It?—This is a question that cannot be answered by
a simple yes or no. A great deal depends upon circumstances, and these circumstances must be
weighed and counterweighed before an answer is given. It is a serious matter, in our judgment it
is a criminal proceeding for a physician to advise the use of an artificial food without exhausting
every aid and means to preserve and increase the mother's milk. This is a subject in need of
earnest missionaries in all walks of life, and it should be the duty of every woman's club and
gathering to voice the conviction of the highest womanhood by advocating the use of mother's
milk with every child born. A woman who can and will not nurse her own child is scarcely
deserving of the name of mother.
It does not seem quite human to deprive a baby of the milk which rightfully belongs to it; yet in
certain walks of life this is not an uncommon procedure. On the other hand the percentage of
women able to nurse their children is decreasing. This is especially true as applied to cities,
though it is also true, in a less degree, in the rural districts. One eminent authority states that less
than twenty-five per cent. of the well-to-do mothers, who have earnestly and intelligently
attempted to nurse their babies, succeed in doing so for a period longer than three months. This
authority also says: "An intellectual city mother who is able to nurse her child successfully for the
entire first year is almost a phenomenon." Women nowadays have so many diversified interests,
that the primal duty of maternal nursing is not at all a fashionable function. If, however, the
mother is willing, and has conscientiously tried to nurse her baby, and after seven or eight days it
is found that she has not enough milk to satisfy it, and if the quality seems to be good, some
expedient should be immediately adopted to tide the condition over until the mother resumes her
customary household routine. The safest expedient under these circumstances is to alternate the
feedings; one feeding from both breasts of the mother, and the next an artificial food. Some
arrangement of this kind is the just and the safest way, because a very large percentage of mothers
suffer from inactivity while lying in bed after a confinement. This inactivity expresses itself in a
failure of some of the organs to perform their duty properly. This may affect the quantity, and
sometimes the quality, of the milk, but it is, as a rule, quickly rectified as soon as the mother is up
and active.
If, however, the milk is still found to be inadequate after she is up and has resumed her usual
habits, and if her health is good, and she is eating well, it is distinctly best to put the child
exclusively on an artificial diet.

CERTAIN CONDITIONS JUSTIFY THE ADOPTION OF ARTIFICIAL FEEDING
FROM THE BEGINNING

1st. Woman suffering with any wasting disease such a cancer or tuberculosis. (One of these days,
and very soon we hope, it will be legally impossible for a tubercular or cancerous patient to
become a mother.)
2nd. When a mother is the victim of any of the serious childbed complications such as
convulsions, kidney disease, extensive loss of blood or blood poisoning, or runs a high
temperature because of some disease occurring at the same time as the confinement, as, for
example, appendicitis, scarlet fever, typhoid fever, etc.

3rd. Epilepsy, chorea, insanity, are also conditions which render artificial feeding necessary.
It is much wiser immediately to put the child on artificial feeding if there is a justifiable reason
for it than to experiment, because any experiment at this time is almost certain not to be in favor
of the child. Artificial feeding is a comparatively easy and successful problem, provided it is
begun with healthy digestive organs. If you keep the child at the breast of a mother whose milk is
inadequate in quantity or quality, or both, for two or three days, and then begin artificial feeding,
the child's stomach is already unable to perform its duty, and you have to treat it with the greatest
degree of care and attention, and probably begin with a weak food, until you regain the lost
ground.
Mothers' Mistakes in the Preparation of Artificial Food.—Another interesting condition
which is quite common, is the tendency on the part of the mother to fail to follow instructions
correctly,—even though written or printed,—regarding the preparation of the baby's food. When
the baby is not thriving and gaining steadily in weight, or is fretty and cries a good deal, and does
not rest and sleep peacefully, something, of course, is wrong. If, after a careful physical
examination of the child, nothing is found to justify these symptoms, a physician invariably finds,
if he questions the mother closely, that she has mistaken the instructions and is preparing the food
wrongly.
Infinite care in every little detail is the price of success in raising babies as well as in every other
field of human endeavor. Revise carefully your method of preparing baby's food if there is any
trouble such as is described above. Despite your absolute assurance that you are making no
mistake, do not be surprised to find that you are not following directions to the letter, and because
of this unintentional mistake, your negligence is responsible for your baby's condition. Go over
the instructions with your husband, and let him follow your method of preparation, as you repeat
it. He may detect the mistake if any exists,—two heads are always better than one. So important
is this matter that the following two actual cases will demonstrate how easy it is to make a
mistake, despite the absolute confidence of the mother, in each case, that she was following the
printed directions correctly:
I was called to see a baby whose mother informed me that it was having a great deal of trouble. It
was apparently not thriving; its bowels were bad; it constantly cried, and seemed to be suffering
from colic and indigestion. The mother stated that it lay with its legs constantly drawn up and
passed enormous quantities of gas. The baby certainly looked sick. It had been a small baby at
birth; and at three months it weighed only six pounds. After a careful examination, I could find
nothing in the physical condition of the child itself, which satisfactorily explained the condition,
and had made up my mind that the food upon which it was being exclusively fed, and upon which
it had been fed since birth, was not agreeing with it. Before recommending a change of food, I
asked the mother to state in detail just how she prepared it.
The directions printed on the can in which the food was bought called for so many ounces of a
certain quality of "top milk." She thought this meant simply so many ounces off the top of a
bottle of milk, which, of course, meant that she was feeding her baby exclusively a very rich
cream and absolutely no milk. The result was that the baby—small and weak to begin with—
could not digest this rich mixture, so it gradually lost vitality, as the mother kept increasing the
strength of the food, according to the age, as directed by the instructions, until it was completely
knocked out. I pointed out her mistake and suggested a change in her methods; she was instructed
to use the formula for a child of two months, instead of the one for three months, as she was

doing. The child immediately began to pick up and in the course of six weeks was entirely cured,
and had gained considerably in weight. This mother was a careful, clean, painstaking, attentive
nurse, and it was a long time before she forgave herself for the mistake. The mistake here was a
little matter, but the results were big and convincing.
The second case was that of a child of about the same age, but in this instance it had been a
robust, healthy child when born, and of normal weight and size. The mother nursed it for about
one month, when her milk failed, and it was put upon a well-known, patent barley preparation.
The food seemed to agree with it for a time, but, as the mother explained, the child soon seemed
to be dissatisfied at each feeding,—it gave her the impression that it was not getting enough to
eat, so she increased the quantity. Despite this increase of food, it was apparent that the baby was
getting weaker, and more and more irritable, and sleepless, until there was no rest night or day for
the mother or baby. About this time the child began to "swell up" as if dropsical; it lost its healthy
color and looked as if made of wax. It was very evident that the child was being starved, yet this
scarcely seemed probable when the actual quantity of food consumed was considered. The
directions on the can of this food, called for a certain amount of the barley powder to be mixed
with boiled water; and in an additional paragraph it was directed to mix this with a certain
amount of milk. When I requested the mother to state how she prepared the food, I was
astonished to learn that she had evidently never read the second paragraph of the directions. She
was feeding her baby on barley powder and boiled water,—an excellent starvation diet. When her
attention was called to the grave carelessness she had been guilty of, she was the most contrite
mother I ever knew. As soon as the milk was added to the food the baby immediately began to
thrive was very soon a robust, healthy infant.
Of course these were errors of bad judgment and gross negligence of which few mothers would
be guilty, but these types of mistakes come to the attention of physicians frequently, and
emphasize the need of constant vigilance in every detail in the management of babies if we wish
to achieve success.

FEEDING DURING THE SECOND YEAR

At the beginning of the second year the child should be fed at the following hours, 6 and 10 a. m.,
2, 6, and 10 p. m.
Early in the second year the child should be taught to drink from a cup.
A proper diet for a child of twelve months, of average development, would be as follows:
6 a. m. Milk and barley water, or milk and oat gruel, in the proportion of seven ounces of milk to
three ounces of the diluent.
9 a. m. The juice of an orange (strained).
10 a. m. The same as at 6 a. m.
2 p. m. Chicken broth with rice or stale bread crumbs, six ounces; or a light boiled egg mixed with
stale bread crumbs; or beef juice, three ounces. Milk and gruel same as at 6 a. m., but four ounces
only.

6 p. m. Two tablespoonfuls of cereal jelly in eight ounces of milk; a piece of stale bread and
butter. (The jelly is made by cooking the cereal for three hours the day before it is wanted; it
should then be strained through a colander; oatmeal, barley, or wheat may be used.)
10 p. m. Same as at 6 a. m.
About the fifteenth month the cereals may be given much thicker and fed with a spoon. The child
can at this time take a number of various fruit juices. Orange juice is the best. Carefully strained
juice of ripe peaches, strawberries, raspberries, may be given in reasonable amounts, one or two
tablespoonfuls, once daily. Custard, cornstarch, plain rice pudding, junket, wheatena, cornmeal,
hominy, oatmeal, zwieback, bran biscuit, each with butter, may be added in reasonable quantities
between the eighteenth and twenty-fourth months. When cereals are given they should be
thoroughly cooked, usually for three hours, and strained. When apple sauce is given to a child
about the second year it should contain very little sugar and baked apples should be fed without
cream. Water must be given to the child between meals especially during the summer. It should
be boiled and cooled kept in a cool place. The following schedule for a child about the third year
constitutes a good average diet for a healthy child:

TABLE OF STANDARDS

(As Adopted and Copyrighted by the American Medical Society)

PHYSICAL DEVELOPMENT
[Transcriber's Note: The ages were difficult to read and may not all be correct.]

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

MENTAL DEVELOPMENT

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

Six Months

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

Twelve Months

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

Eighteen Months

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

Two Years

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

Two and One-Half Years

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

Three Years

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

Four Years

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

Five Years

Compares weights and lengths.... Copies a square.... Counts four pennies....
Describes a picture....
Breakfast:—(7 to 8 o'clock) Oatmeal, hominy or cracked wheat (cooked
three hours), served with milk, a little salt but very little sugar. A soft egg,
boiled, poached, or coddled. Stale bread and butter. One glass of warm
milk. At 10 o'clock, the juice of one orange.
Dinner:—(12 o'clock) Strained soup, four ounces. Chop, roast beef, steak,
chicken, small quantity of any one. Baked potato and cooked rice, or
spaghetti. A selection of green vegetables may be made from asparagus tips,
string beans, peas, spinach, cauliflower, carrots; they should be cooked until
very soft, and mashed or put through a sieve. For dessert, plain rice pudding
or bread pudding, stewed prunes, baked or stewed apple, junket, custard or
cornstarch. A glass of milk or water.
Supper:—(6 o'clock) Cereal; farina, arrowroot, cream of wheat, wheatena
(each cooked two hours), with salt but no sugar. Give two or three
tablespoonfuls. Drink of milk with stale bread and butter. Twice a week, a
little plain ice cream, or junket, custard or cornstarch.
Three meals a day at this time are better than more frequent feedings. The
child has a better appetite and much better digestion. It may be found
necessary to give delicate children a luncheon at 3 o'clock. A glass of milk
and a Graham wafer, or a cup of broth and a zwieback, will answer the
purpose. Children recovering from serious illness will need more frequent
nourishment. Up to the sixth year the diet may conform to the above
schedule, increasing the individual quantities as circumstances may
warrant.

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

After the sixth year the diet will conform to the adult diet, with certain
exceptions. The important exceptions are as follows: All meats are to be
excluded except roast beef, steak, lamb chops, roast lamb, mutton chop; all
meats should be cooked rare and either scraped or finely divided. They
should be broiled or roasted, never fried, and never given oftener than once
daily, and then only in small quantity. Pies, rich puddings, pastries of all
kinds, gravies, sauces, all highly seasoned dishes; wine, beer, coffee, tea,
should never be given to children. Ham, bacon, sausage, pork, liver, kidney,
game, and all dried and salted meats, codfish, mackerel and halibut, are
particularly bad.
The following articles are permissible: Broiled chicken, shad, bass. The
"platter gravy" from a roast is very nourishing if given in small amounts.
Milk should continue to form an important part of the dietary up to the tenth
year. It should be clean and fresh but not too rich. Sometimes it is found
advisable to dilute the milk with water that has been boiled and cooled.
Some children will take it if a pinch of salt or bicarbonate of soda is put into
it, and they will digest it easier and better. They should never be allowed to
take more than one quart daily and frequently less will do more good.
Cream is not good for children of this age. Eggs are valuable; they should
never be given fried or in the form of omelets, they are best given boiled,
poached or coddled and only slightly cooked. It is never necessary to give
more than one egg at a meal. There are children with whom eggs do not
agree; these children are disposed to "biliousness."
Vegetables.—Certain vegetables are objectionable at this age: Raw celery,
radishes, raw onions, cucumbers, tomatoes, lettuce, corn, lima beans,
cabbage, egg plant. The following are good: White potatoes (never fried),
spinach, peas, asparagus tips, string beans, celery, young beets, carrots,
squash, turnips, boiled onions and cauliflower. It is important to remember
that all vegetables should be thoroughly cooked; they cannot be cooked too
much. After boiling for some time the water should be drained off and fresh
water used to complete cooking. Vegetables should be fed in small
quantities. From the third to the tenth year they form an important and
essential part of the diet of all children. After the tenth year they can be
eaten as served to adults, and other vegetables may then be added. As a rule
salads of all kinds should be omitted until after the twelfth year.

Cereals.—Children should not be allowed to eat too much cereal at one
meal,—never more than one small saucerful. Cereals should be properly
cooked. It is not safe to adhere strictly to the directions on the package of
any cereal. As a rule they require much longer cooking. They are best
cooked in a double boiler. They may be served with milk, salt, and not more
than one teaspoonful of sugar.
Bread.—Fresh bread is never allowable. Graham wafers, oatmeal crackers,
Huntley and Palmer breakfast biscuits, bran muffins, rye bread, corn bread,
stale rolls, are all suitable to growing children.
Hot bread, fresh rolls, buckwheat or griddle cakes, all sweet cakes, are
objectionable.
Desserts.—The only permissible desserts for this age are junket, custards,
plain rice, or sago; or bread pudding. The only safe rule to follow so far as
"sweet things" are concerned, is not to give them at all. This applies to
candy, ice cream, pies, pastries, jam, syrups, preserved fruits, nuts and dried
fruits. The parent who indulges a child to "a taste," is guilty of a bad habit,
and it can only lead to trouble.
Fruits.—These should always be fresh and selected with care. Fruit is the
most important article of diet to a child of this age. Up to five years it is
safest to use only cooked fruits and fresh fruit juices: of these the juice from
sweet oranges, grape fruit, peaches, strawberries, and raspberries may be
given. Stewed or baked apples, apple sauce, figs, prunes, peaches, apricots,
pears are excellent because of their effect on the bowels. When the bowels
are loose, and especially in hot weather, great care must be taken when fruit
of any kind is used. The pulp of any fruit should never be used; cherries,
bananas, pineapples, and berries are not to be given to children. Milk should
never be allowed at the same meal when sour fruit is served.

WHAT MOTHERS SHOULD KNOW

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

THE EDUCATION OF THE MOTHER

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

WHAT MOTHERS SHOULD KNOW ABOUT THE CARE OF
CHILDREN DURING ILLNESS

Every child has a certain amount of vitality and resistance. When illness
comes it should be our duty to maintain the vitality and resistance to the
highest degree. We should, therefore, irrespective of the nature of the
illness, surround the child with all the conditions that will minister to the
preservation of whatever strength and vitality the child has. Experience has

taught us that there are certain requirements that should be carried out in the
general management of sick children.
A Sick Child Should be in Bed.—In the first place a sick child should be
in bed. There is no exception to this rule. It is impossible to do justice to a
child if you allow him to dissipate his strength and exhaust himself moving
from place to place while he is sick. A mother should not forget that it is she
who must exercise wisdom and decide what is best for her child. The
judgment of a sick person is not to be relied upon, and it would be wrong to
submit to the whims and fancies of an ailing child, if these are known to be
medically disadvantageous to its best interests.
Quiet surroundings are essential in all acute illnesses. The nurse should be
congenial to the child. If the patient demands the presence of the mother she
should remain, but she should not try to entertain him or interfere with the
nurse.
The clothing of the patient should be the ordinary night-dress which is worn
in health. In no disease is any special kind, or quantity of clothing required.
The temperature of the room should be 68° F. Thermometers are cheap and
an exact knowledge of the degree of heat in a sickroom is an essential
requisite. Nothing drains the vitality during sickness quicker than varying
degrees of heat and cold. It uses up nerve force and energy and renders the
patient irritable and difficult to manage.
The strictest attention should be paid to the ventilation of the sickroom. We
are learning more and more that fresh air is essential to the speedy cure of
all diseases and to the general well-being of the patient. A direct, continuous
communication between the sickroom and out-of-doors is imperative. It is a
splendid measure to use two rooms for the patient and to change him twice
daily, and to air thoroughly the unused room.
The sickroom itself should be large and in a quiet part of the house. In
summer time the windows may be wide open, in winter months the degree
of ventilation can be regulated by the thermometer.
Many mothers fail to appreciate that drinking water is an important
requisite in all ailments of childhood, should be given freely, but it should
be known to be absolutely pure. The same rule applies to sponging the

patient. It must be done every day; sometimes it is necessary to do it more
often, but if so it will be so directed by the attending physician.
The Diet of the Sick Child.—Prescribing the diet of the sick child is an
important undertaking. It should be remembered that during sickness the
digestive capacity is reduced; consequently the food must be lessened in
quantity and in strength. If the patient is an infant at breast the best way to
accomplish our purpose is to give before each feeding two ounces of boiled
water, cooled to the temperature of the body. This dilutes the mother's milk
and renders it more easy of digestion. If bottle-fed, it is accomplished by
replacing one-half of the milk with water. In certain diseases milk is totally
withdrawn, but these cases will be noted when discussing the treatment of
the various diseases. With older children, we give milk diluted with water,
or gruels, soups, or cereals, as conditions warrant.
Needless interference with the patient must not be indulged in. Sleep and
quiet are essential features of nature's reparative process. It is seldom
necessary to disturb a sick child for the giving of food or medicine oftener
than every second or third hour. Medicine may always be given with food.
Meddlesome interference, talkative attendants, or excessive noise may
exhaust a child and may prolong and render dangerous or fatal a condition
that would otherwise go on to recovery.
One satisfactory movement of the bowel daily is essential to the comfort
and progress of a sick person. If this does not take place naturally, it should
be obtained by an enema.
At the beginning of any illness in childhood it is a safe procedure to give a
dose of a suitable cathartic as soon as it is discovered that the child is sick.
A Child is the Most Helpless Living Thing.—Nature endows the young of
every species—except those of the human family—with certain instincts,
which, when developed, govern and control their lives absolutely. The
technical definition of an instinct is an exceedingly complicated word
picture. It is only essential to an intelligent understanding of our subject that
the reader should have a definite idea of the difference between an act that
is the result of a process of reasoning and an act that is the result of an
instinct. If a man finds his way out of his burning home he will stay out as
long as there is any danger. The crudest kind of reasoning will teach this

lesson. A horse, on the other hand—and incidentally it may be noted that a
horse is regarded as an intelligent animal—if led out of a burning stable and
let loose, will immediately reënter and be burned to death. The horse is the
victim of instinct; he obeys the unconquerable instinct to return to his stall
—he cannot reason as the man can that a home that is burning is not a
proper place to seek safety in. When an ostrich fears danger he buries his
head in the sand, under the impression that if his head is out of sight he is
safe from danger. This is his instinctive plan of procedure in the presence of
danger, and it is the plan of every ostrich, everywhere, always. A little
reasoning would show them how foolish the idea is—but they cannot
reason. That is the province of man alone. If the first member of a flock of
sheep jumps over a fence to get into the next field, every member of the
flock will follow, each one jumping the fence, though there may be an open
gate between the two fields a few yards away. Instinct dictates the plan to
the sheep as they have received instructions from their ancestors always to
"follow the lead." This is their hereditary legacy and they cannot disobey it.
Animals are born with instincts which need only circumstances to bring
them out. Now a baby is not born with instincts of this character,—it has
not even the instinct to help itself; it cannot find the breasts that were made
for it; it is more helpless than the baby cat or dog or worm. Therefore a
baby in whose brain the potential faculty of reason is slumbering must of
necessity begin its career wholly dependent upon the supervision and love
of its mother, until such time as it may be capable of reasoning for itself.
Motherhood is therefore the supreme privilege of womanhood. It cannot be
superseded, hence the fundamental factor in any system of race culture, or
in any system of infant mortality, must tend to raise the quality and the
intelligence of motherhood as a basic necessity. Motherhood at the present
time, though the most important and sacred profession in the world, is
almost exclusively carried on by unskilled labor. The maternal instinct is
deeply rooted and universal; its absence must be regarded as an
abnormality, or as a product of misdirected education. The requisites for the
mothers of the future should be absolute physical health and love of
children.
If nature endowed a baby with instincts there would be no need for reason
or education. Education cannot teach a cat how to nurse or wash a kitten
any better than it does,—its instinct is good enough. The mother of a human

baby, however, is not born with the instinct which enables her to care for
her baby equally as well as the cat cares for her kitten. She must be
educated or taught to care for it. She can then care for it better than the cat
cares for the kitten, and she can be taught to bake, to sew, to read; to play
on the piano, which a cat cannot be taught. So while a baby may be the
most helpless living thing at one stage of its career it has in it—in the
faculty of reasoning—the ability to become the Lord of all the Earth and of
all the animals therein. To limit the environment of a child by imposing
instincts upon it, would be to limit its inherent freedom. To be obliged to
obey a prescribed instinctive law would rob mankind of his creative or
reasoning faculty, and that would be to lower him to the level of the brute
creation. Reason is of no use if our acts are already determined for us. There
are therefore good reasons why the human baby should be, at the moment
of its birth, the most helpless living thing; and as a consequence it is
imperative, if the eugenic ideal is worthy of attainment, that every baby
should have the benefit of trained and efficient care and education.

THE DELICATE CHILD

There is a certain standard by which we measure the physical and mental
development of children. This standard we regard as the evidence of normal
development. Some children exceed these requirements; they are bigger and
stronger at a given age than the average child at the same age. There are
other children who cannot be called sick, but who are physically and
mentally inferior to the average standard, whom we designate as "delicate."
These children are not as big, or as strong, or as heavy, as other children of
the same age. They are born with a reduced vitality, or through
mismanagement in early infancy they have acquired a subnormal standard
of development. Children born of parents who are not of standard vitality
are predisposed to be delicate. If the parents are of average development,
and the delicacy of the child is acquired by mismanagement, the proper
dietetic and hygienic management will, as a rule, promptly result in a
satisfactory restoration to normal health.
Treatment.—When a mother awakes to the knowledge that her child is
delicate; when she understands that her child's vitality is not what it should
be, and when she resolves to "do something" in the interest of her child, she

is on the right road, and we hope to encourage her in the good intention. We
would however tell her that her effort must be thorough, and that she must
be patient and persevering. If she does not falter in well doing she will
succeed beyond her expectation, and the satisfaction she will experience in
noting the evidences of returning health and strength in the appearance and
conduct of her child, should be ample recompense for the effort made and
the time bestowed.
She must begin with a definite knowledge of just what she intends doing;
she must know, however, what must be done and she must begin at the
beginning and build from a sure foundation. It is therefore absolutely
essential to ascertain if there is any actual disease underlying the reduced
vitality which is responsible for the delicacy of the child; this necessitates a
thorough examination by a competent physician. If you are assured there is
no disease present, no tuberculosis, no syphilis, no malaria, and that
debilitating conditions, such as adenoids, sexual abnormalities, the results
of self-abuse, skin disease, do not exist, then certain fixed rules can be laid
down, and definite principles followed in the daily management.
Weight, as a Standard of Development.—It has been stated elsewhere in
this book that one of the safest guides to follow, as to whether a child is
thriving, is its weight. This can be relied upon as a general rule. A child
should therefore be weighed regularly every week. If it is not gaining an
average of four ounces weekly it is not thriving up to standard. When the
average is below four ounces there is something wrong with the quality or
quantity of the food.
How to Feed the Delicate Child.—If the child is breast-fed and the weight
standard, as evidenced by the weekly averages, is persistently below
normal, we must find a substitute for the mother's milk. If the child is
bottle-fed and it is demonstrated that it is impossible to maintain normal
development on cow's milk, a wet-nurse should be obtained. After the child
is weaned, or put upon a more liberal diet, milk should continue to be the
chief article of diet. From the first to the third year a child should take one
quart of milk daily in addition to the other food. There are some children,
however, who seemingly cannot take milk without getting indigestion; they
should be put on skimmed milk, to which may be added a small quantity of

sugar to make up for the loss of fat. Mothers must be certain that too much
milk is not given, or the desire for other necessary food will diminish.
After the first year it is a very good plan to give one teaspoonful of scraped
beef daily. If this is well borne, two may be given and later three. It can be
given immediately before the regular feeding of cereal and milk. From the
twelfth to the sixteenth month eggs may be given: at first one-half, and later
a whole egg mixed with bread crumbs. Various vegetables should also be
given cooked in the form of a purée. If at any time the child should refuse
the food, or act as if it had no appetite, leave the milk out of the diet; this
may then restore the appetite and it will take the other food freely; the milk
can be resumed later.
As the child grows older, the distaste for milk may grow, or he may be one
of those children with whom milk really does not agree; in either event, do
not hesitate to leave it out of the child's dietary. These children should be
encouraged to eat plenty of good butter on their bread and crackers. Butter
will not only agree with them, but it will supply any fat deficiency in the
general diet. The diet may now consist of milk (unless it disagrees), cereals
cooked three hours, raw or rare meat, poultry, eggs, vegetables, purées,
cooked and raw fruit, bread, crackers.
How to Bathe the Delicate Child.—Regular daily baths are particularly of
benefit to the delicate child, despite the prevailing fear that they may catch
cold. The salt bath is advised and the time to take it is just before retiring.
The room should be warm and the temperature of the water should be 90°
F.: it should not last longer than five minutes, and the water should be
cooled down to 70° F., before the child is removed from the bath. While the
cold water is running in, the surface of the body should be briskly rubbed
with the mother's hands and after removal the child should be dried with a
fairly coarse bath towel to ensure a good reaction. Very delicate children
need not have the temperature of the water reduced; others may stand water
of 80° F., but no lower. In the poorly nourished it is frequently
advantageous to rub the body, after drying, with olive oil or goose oil. This
aids nutrition and because of the massage it aids circulation. In some older
children a daily cold spinal douche seems to act particularly well. If the
child does not promptly react from the effect of the cold water it is best to
discontinue it.

Airing the Delicate Child.—Delicate children should, above all things, be
assured of the maximum amount of fresh air and sunlight. Many mothers
entertain the idea that these children are disposed to take cold easily, if in
the open air,—which is not the case. All children need an abundance of
fresh air and the delicate need it particularly. The season of the year and the
character of the weather will, of course, dictate just how much open-air
exercise they may take.
If the weather is very cold and the air damp, or if there is a very cold high
wind, it is best to remain indoors; otherwise the child should remain out for
four or five hours. Indoor airing is obtained by dressing the child to go out-
doors, putting him in his carriage, and leaving him before an open window
in a room of good size with all the doors closed so as not to create a
draught.
Habits of the Delicate Child.—The amount of sleep necessary for a
delicate child is the same as for a normal child of the same age. The room
should always be well aired, night and day, and should be devoted to the
exclusive use of the child.
These children should never be allowed to sit on the floor. It is always a
difficult matter to avoid this, but it must be religiously guarded against;
otherwise a cold is the inevitable result.
A change of air is sometimes advisable and essential, especially during the
hot, humid weather of July and August. Much better results will be obtained
by sending these children to the mountains than to the seashore.
Delicate children should always be clothed warmly, but not too warmly.
The feet and legs must always be kept comfortable. Moderate exercise,
short of fatigue, is necessary. A midday nap after the noon meal should be
taken every day. The child should be undressed and put to bed for two hours
and left there, whether it sleeps or not. This applies to delicate children of
all ages.
The education of delicate children should be postponed until the health is
restored. They should, however, be made to obey and they should be taught
good habits. When school work begins it should be made light and easy.
They should not go to school before the eighth year, and then not unless

physically fit. They should not play at rough games or with rough
companions, though it is not wise to shield them too much. Their habits and
peculiarities should be studied and every possible effort made to direct them
kindly and wisely so that they may contribute to their own upbuilding.
A systematic observance of these suggestions will save many lives and will
aid very considerably in producing stronger men and women. Infinite
patience, tact and self-sacrifice is necessary, but the results in every case
justify the measures adopted.
Indiscriminate Feeding: Poor Appetite.—In considering many of the
diseases of childhood the term "indiscriminate feeding" is used. An
explanation of just what is meant by this will be of decided advantage.
There are two fundamental essentials in the successful feeding of infants
and children: regularity and suitable food.
A child whose feeding intervals are not regular and whose food is
unsuitable is a victim of indiscriminate feeding.
The lack of observance of the regularity rule always leads to loss of appetite
and indigestion.
Loss of appetite is a serious condition in a growing child and may give
infinite trouble. Indigestion in a growing child is unnecessary, unfortunate,
and frequently is the one factor that spoils an entire life. It is unnecessary,
because it means and is caused by neglect on the part of the mother; it is
unfortunate, because it always paves the way for any serious ailment that is
epidemic or "in the air"; and it is important, because it very frequently
weakens the stomach and renders it unfit for normal digestion for a long
period, if not for life.
If for some reason a child's appetite becomes poor and it is not properly
managed until the appetite is restored to normal, indiscriminate feeding is
always the result.
The reason for the poor appetite may be because the child is kept indoors
too long, or because it is being fed on unsuitable food, or is living in
unsanitary surroundings, or many other reasons, sometimes trifling reasons,
may cause it. When a child will not eat at meal time, the mother feels that it
should eat sometime, so she encourages it to eat between meals, and

because of a mistaken kindness she breaks the law of regularity,—a law that
can never be broken without serious results following. A child in this
condition becomes a disturber of the peace; the parents can do nothing with
him; he insists on eating just what he likes and when he likes; and he
chooses, as a rule, candy, cake, pastries, ice cream, tea, coffee. Indigestion
follows, the child loses weight, is languid and listless and constipated.
When finally the physician is called in he finds it necessary to go back to
first principles. He lays down the law in a definite, stern way, and the
mother and the child must obey. Most parents know and admit they are
doing wrong to give in to a whimsical child, and if they would only make
up their minds to conquer when conquering is easy they would save
themselves many heartaches, many regrets, and the child much suffering
and much possible permanent injury as a consequence. Usually one parent
is willing to be master but the other lacks the mental equipment to meet the
issue, and argues, as he or she imagines, in favor of the child. The parent
whose instinct is correct, whose judgment is true, whose interpretation of
the situation is just, should not be dissuaded, or argued away from his or her
duty. If it is the first real problem in your domestic experience in which a
decided stand must be made, make it without fear and without hesitation,
and carry it through to the bitter end. Results will justify and vindicate you.
The general treatment of these children will be found outlined in the
following paragraph on Loss of Appetite.
Loss of Appetite.—If a child complains of not being hungry, and will not
take enough food, and if this condition continues for some time, we must
regard the matter as being abnormal and find the cause. This is necessary
because a child must eat in order to maintain a certain standard of growth
and vitality. These children are not sick; they are active and continue to play
as usual and they sleep soundly, but they have no appetite. One of the most
frequent causes of this condition is too frequent feedings. Some children are
naturally small eaters. They thrive and maintain a satisfactory weight; their
system seems not to demand large quantities or even ordinary quantities of
food. Parents observe this habit of little eating and begin to coax and bribe
the child to eat more at meal time, and to eat between meals. In this way the
child really overeats, the appetite becomes capricious, and the stomach
rebels. In a very short time the condition of "loss of appetite" is established

as a consequence. Another cause is the drinking of too much milk, and yet
another and very common cause is indiscriminate eating of candy, cakes
crackers, and fruit between meals. Children who are fed at the table with
adults eat things they should not eat, and spoil their digestive organs and
loss of appetite is the result. The Scotch custom of compelling children to
eat at a separate table is an excellent one. They are not tempted to ask for
things they cannot have. Lack of fresh air and exercise frequently results in
impaired appetite.
Treatment.—The very first thing to do with these children is to stop any
habit that may be responsible for the loss of appetite. If the child has been
eating between meals, stop it absolutely. If too much milk has been taken,
stop milk entirely. If the child has not been getting enough fresh air, or if it
has been sleeping in a badly ventilated room, or if baths have been too
infrequent, rectify the fault. If eating at the family table and fed
indiscriminately, change the programme; feed him before the family sits
down to meals. Now regulate the time of feeding to suit the age of the child
and adhere to strict regularity. It is a pernicious and absolutely wrong
custom to force children to eat, or to coax them to eat when they do not
want to eat. Loss of appetite will never be cured by forced feeding, or by
reducing the interval between feedings, or by giving the child stronger or
more concentrated food under the mistaken idea that in this way the loss of
appetite can be "made up." The interval of feeding should rather be
lengthened than otherwise in order to give the digestive organs an
opportunity to regain the normal desire for food. Pay strict attention to the
bowels. Be certain the child has a daily satisfactory movement and that he
drinks frequently between meals.
If the child does not promptly respond to the proper hygienic and dietary
treatment as outlined above there are two things that can be done:
1st: Send the child away. A change of scene and climate will sometimes
work like a charm in these cases, and will, after a reasonable length of time,
establish a permanently good appetite.
2nd: If this is not possible, as sometimes it may not be with poor patients,
then we can give the child suitable tonics.

Overeating.—The large majority of individuals eat too much. Most of us
would enjoy better health, better spirits, and greater efficiency if we
consumed from one-third to one-half less food than we habitually do.
Every living organism requires a certain amount of nourishment according
to the work performed and to replenish wear and tear; when food is
supplied in excess, the system cannot utilize it, but it is compelled to rid
itself of the excess in some way. The work involved in this eliminating
process is exceedingly detrimental to the various organs and to the
individual. To overeat is to overwork, and to overwork a machine or an
animal is not only poor economy but bad judgment. If the digestive
apparatus is required to work overtime, it is a self-evident assumption that
the various organs will not digest efficiently the food necessary for ordinary
existence. If the necessary nourishment is not adequately digested, the
general health will suffer as a consequence. If the general health is below
standard the individual will not be competent to carry on the requirements
of a normal, healthy life.
We must, however, give some thought to the effect which the excess of food
exerts upon the human machine.
Nature provides and maintains a standard relationship between the capacity
of the individual and his needs. A child has a digestive capacity to digest
and assimilate a quantity of food sufficient for his growth and proper
nourishment; an adult maintains the same standard according to his
requirements. All the other organs are adjusted to harmonize with this
scheme. If we overeat, the immediate result is to disorganize this
relationship between the various organs; hence we have a multitude of
effects which manifest themselves in various ways as a direct result of
overeating. The combined general effect expresses itself in the form of what
is regarded as poor health and a low standard of efficiency. When a larger
quantity of food is taken into the stomach than it can properly digest within
a reasonable time, two conditions immediately follow. The stomach itself is
dilated and the food is not thoroughly digested. If the habit is persisted in,
indigestion, and later chronic gastritis ensues. The direct symptoms of these
conditions are given in detail in another part of this book. Very few
individuals, however, appreciate the indirect consequences of overeating
and of indiscriminate eating on the general health. It is impossible to

tabulate in so many words the effect which this habit has on efficiency and
temperament. We read and hear a great deal to-day about efficiency. Now,
an individual's efficiency is an expression of that individual's health
standard or capacity. To be 100 per cent. efficient one must enjoy good
health. It would be absurd to expect a high standard of efficiency from an
individual with a low standard of health. Poor health means poor vitality.
Vitality is the mark of the master. Without vitality one can never dominate.
All the great achievements of the race have been consummated by those
who conserved their vitality. No single factor contributes a larger
percentage of inefficients and failures than overeating. The man or woman
who, from habit or experience, has learned the lesson of right eating and
living need not be lacking in efficiency, nor need they despair of the
attainment of success.
Symptoms of Overeating.—Efficiency depends not only upon one's
capacity to perform, but upon the character of the performance. The spirit
must be willing to perform. The overeater is heavy, phlegmatic, indifferent,
lacking in energy, tact and initiative. She is constantly subjecting her system
to needless overwork; she is depressed, nervous, imaginative and she is not
ambitious. She is a victim of self-poisoning, of constipation, indigestion,
headaches, flatulency, neuralgia, vertigo, and melancholia. An overeater
never enjoys good health, never is efficient, and cannot possibly be
successful.
To enjoy good health one should know how to select food and how to
combine and proportion it. It has been said that the American people are a
race of dyspeptics, and it must be admitted that the assertion is more or less
true. There are millions of people who suffer from indigestion in some
degree, and it may justly be said that indigestion has its beginning in
overeating, in some form. It may not be overeating in actual bulk, but it is
overeating some article or articles that do not agree with the individual, and
the fact that certain articles do not agree is unquestionably dependent upon
the nervous temperament of the American people—and the temperament of
a people is a product of the kind of existence the people subject themselves
to. We are, therefore, unwittingly, victims of our environment.
Correct eating means simple eating—only a few things at a time. Food
should be selected according to one's age and occupation, and according to

the season of the year. To eat habitually large quantities and at the same
time a large variety is suicide pure and simple. If one dared to make the
experiment of cutting down one's diet one-half, it is absolutely certain the
effect would be immediate benefit. The benefit would not only be manifest
in the physical betterment, but the efficiency and general well-being would
be greatly enhanced. It is not the kind of food that makes a dyspeptic, but
the quantity. A well person need not consider whether a certain kind of food
will or will not agree, providing she does not eat too freely of that food, or
combine it with other food. The combination of which may in itself form
too much of one kind at a time.
Some people imagine, for example, that oatmeal porridge does not agree
with them. When the matter is inquired into, however, it is found that they
habitually eat bread, eggs, and other articles, with coffee at the the same
meal with the porridge. From this combination they experience distress and
blame the porridge. If these would take a plate of oatmeal porridge with
cream and salt, and some stewed fruit for breakfast they would not
experience any trouble, and this would be an ample meal for the ordinary
individual. It is not the porridge, but the unsuitable combination, that is at
fault. The same may be said of milk. Many people state that they cannot
take milk and they deprive themselves of one of the very best articles of
diet because of this idea. There are very few people in the world who
cannot take milk in some way. It is not the milk that is at fault; it is the
combination of it with other less nutritious articles that is the cause of the
distress. Even candy is responsible for thousands of cases of indigestion.
Anyone may safely take a reasonable quantity of good candy, but if it is
taken at a wrong time, or combined with other articles, it may readily
produce indigestion.
Indiscriminate eating and overeating are prolific causes of rheumatism,
kidney disease, heart disease, liver troubles, obesity, arteriosclerosis, and
apoplexy. These diseases are notoriously on the increase and must be
construed as a direct consequence of the tendency of the American people
to overeat and to eat indiscriminately.
Bran as a Food.—In the chapter on constipation there may be found a
formula for making bran muffins. These muffins are invaluable to children
in health, and to the victim of indigestion or constipation, whether child or

adult. One muffin with each meal will solve the problem of constipation in
growing children without the use of drugs or other aid. They will regulate
the bowels of adults in many instances without resorting to drugs.
Raw fruit in season, or stewed fruit, or a baked apple, with a light boiled
egg and one bran muffin, is an ample and a nourishing breakfast for a child
at school.
For lunch the same child should have a plate of thoroughly done vegetable
soup, a bran muffin, and more fruit. After school, a glass of milk with two
or three Graham wafers may be given.
For dinner the child at school may have a mixed meal. This meal should not
be later than six-thirty o'clock and the child should retire at eight-thirty at
the latest. A bran muffin should be taken with this meal unless the child's
bowels are too loose.
Mothers should insist on their children eating these muffins. If a child eats
only what it likes it will not eat what is good for it. If the mother insists in
the right way she will win; if she does not the child will win. If the child
wins, the mother is the wrong kind of mother. I do not know of any other
single article of diet that is of such value to growing children as these bran
muffins. Children who eat them regularly will have less sickness than other
children; they will be strong, healthy and full of energy. The bran in itself is
not responsible for this list of excellent acquirements, but the regular eating
of the bran is. Most ailments of children are of gastro-intestinal origin; bran
keeps the entire length of the gastro-intestinal tract sweet and clean; if the
child eats a bran muffin with each meal it will not have much desire or
much room for any other form of bread or pastry. If white bread or pastry is
abstained from the child will not have indigestion, or constipation, and
hence it will not be constantly poisoning itself as most children do whose
diet is not restricted and whose bowels are more or less constipated.
These muffins should be made of the ordinary unsifted bran. If this is not
procurable the sifted bran (Johnstone's) may be employed. This bran may
be bought in any good grocery.
Modern milling methods, modern cookery, and modern methods of forced
farming, have each contributed their share of rendering food inert and

frequently deleterious. The miller has extracted the coarse cellulose from
the various flours in the effort to manufacture a product suitable to the
super-civilized public demand. This cellulose is absolutely essential to
gastric and intestinal digestion, and if children are deprived of it
constipation and indigestion are the natural result. Forced farming
accomplishes the same effect—the fiber of the vegetable is deficient. Bran
is rich in mineral salts, iron, protein, and phosphates, and gives to growing
children the ingredients which ordinary food is deficient in. Bran prevents
intestinal fermentation and children who eat it are free from intestinal gas
and putrefaction. It harmonizes chemically with all other foods. Children
should be made to take it every day as a matter of self-preservation and of
duty.
Hysterical Children.—Hysteria is not a disease of infancy or of young
children. It is seen as a rule after the eight year. Male as well as female
children may be the victims to an equal degree. It is much more frequently
seen in the offspring of parents who are themselves nervous, or alcoholic, or
who suffer from insanity, or have insanity in the family history. If these
children in addition to the hereditary influence suffer from stomach or
intestinal disease, or general poor health and are overworked at school, they
are very apt to become hysterical.
They are capricious, indifferent, and excitable. Their disposition is irritable;
they frequently exhibit fits of great excitability of temper and passion. They
cry or weep without cause. They often have hallucinations and while asleep
have attacks resembling night terrors. They complain of pains in the joints,
and are frequently treated for disease that does not exist. Such condition as
hysterical cough, spasm of the muscles of the face, mouth, eyes, and of the
neck exist and are difficult to diagnose from real disease. These children
complain of painful sensations and sensitive areas and exaggerate all
symptoms unnecessarily.
The possibility of curing these patients is good, providing the treatment is
faithfully carried out. It is less favorable when marked hereditary influences
are strong.
Treatment.—In all children of distinctly nervous type and especially those
of nervous parents, the first essential duty is to develop their muscular

system. Try in every way to make healthy animals of them. Attention and
treatment should not be directed toward the nervous system. If the child is
made strong by out-door life, good plain, digestible food, early hours,
regular sleep in thoroughly aired rooms, regular bathing, and if the school
work is conducted with moderation and judgment, the nerves and the
nervous temperament will participate in the healthy growth which will
follow as a result. Tea and coffee should be forbidden. Exciting books and
questionable entertainment as given in picture shows and theaters must not
be allowed. If older members of the family, or parents, are excitable and
nervous the children should be sent away to the country from them.
They should be put in charge of a person who will exercise firm control
over them. It may be necessary to take these patients away from other
children, and isolate them under proper control until they are able to control
themselves. They should be interested in exercise that compels them to
work; they should live and if convenient sleep out of doors; and they should
take iron or cod liver oil, or any other indicated tonic. If they complain of
pain they should receive cold-water douches, or the cold pack, or the
shower bath; and they should be put to bed and treated firmly but kindly.
Attention to the bowels is always essential, because these children are as a
rule the victims of chronic constipation.
What a Mother Should Know About Cathartics and How to Give a
Child a Dose of Castor Oil.—Broadly speaking there are three kinds of
cathartics. I will, in a simple way, explain their action so that a mother may
know which one to select under certain circumstances. Frequently a mother
is told by her physician to "keep the bowels of her child open." Few
mothers know how to keep the bowels open, and as this is an important
matter, every mother should know the reason why "any" laxative or
cathartic is not always suitable.
Castor Oil.—This is one of the oldest and one of the best cathartics we
possess for children. It is a mechanical cathartic; it acts in exactly the same
way as a street-cleaning machine. It cleans the street by sweeping or
pushing everything before it.
Calomel—This is a chemical cathartic. It acts through the blood. When it is
absorbed by the blood its chemical ingredients act on certain nerves as

irritants. These nerves excite the liver and bowel to action and an
evacuation is the result.
Citrate of Magnesia.—This is a saline laxative. It acts by drawing out of
the bowel wall enough liquid from the blood to sweep the contents out. It
may be likened to the street cleaner who flushes and cleans the street by
means of a hose pipe attached to the water hydrant.
Under what condition should a mother use these remedies? Castor oil is
ordinarily the best cathartic in childhood; it is not, however, always the
best. Most ailments of children are of gastro-intestinal origin—they have
either overeaten or they have eaten the wrong kind of food. The stomach
and bowel are overloaded: they must be cleaned out. We want a mechanical
cathartic, one that will push everything ahead of it, so we use castor oil.
When a child needs a cleaning out, use castor oil. By a "cleaning out" we
mean, when we know he has eaten too much of a questionable variety of
food, as pastries, cakes, fruit, ice cream, etc., as children do at parties; or
when he has eaten unripe fruit, as green apples, etc.; or when for some
reason he is constipated and complains of not feeling well, use castor oil.
If you decide to use castor oil, use enough. A large dose will act promptly
and with less pain and with more certain results than a small dose.
It is always safe and it is always best to decide upon castor oil as the proper
remedy, if the child has no fever. If he has a fever he will most likely vomit
castor oil when another kind of cathartic would stay on the stomach.
Castor oil works more effectively, more thoroughly, and is less likely to be
vomited if given on an empty stomach, so we give it two hours after eating
and we give no food for two hours after it is taken.
Castor oil is distinctly of advantage in many chronic diseases of the
intestines because of its healing properties. In chronic colitis, for example,
when the child is suffering with malnutrition, irregular bowel action with an
odor, and mucous or bloody stools, a combination of castor oil and salol, in
emulsion, in small doses,—to which a small quantity of opium may be
added or withheld according to the frequency of the movements,—with an
occasional colon irrigation, is sometimes invaluable.

Mothers must remember that castor oil is not good in the treatment of
constipation, because its after effect is to constipate, consequently we would
not use it "to keep the bowels open,"—it is only of use to clean the bowel
out thoroughly when that is indicated.
How to Give a Dose of Castor Oil—The best way to give a child castor oil
is as follows: Place the bottle containing the oil on its side on a piece of ice
in the ice box; chill it thoroughly. Take a tablespoon and smear it with
butter; pour the ice cold oil into the spoon; it will stick together like a piece
of chewing gum and it will slide out of the buttered spoon in one lump. In
this way it will not spread over the mouth and teeth and throat, leaving a
bad taste, but will go straight and surely into the stomach. The child cannot
swallow some and retain enough in the mouth to sputter it all over itself and
only get half a dose; it will not nauseate it, because it practically is tasteless
if given cold, and the stomach will tolerate the cold oil much better than
when given in the ordinary way.
A baby can be given oil in the same way, but in smaller doses. When the
teaspoon is put into the mouth of a baby it should be immediately turned on
its side so that it will keep the mouth open. If the nose is held closed and the
mouth wide open for a few seconds the baby cannot spit the oil out—it
must swallow, and if the oil sticks together as cold oil will, it gets the whole
dose. It usually takes two persons to give a baby a dose of oil—one to open
the mouth and give the medicine, the other to hold the nose and arms.
Calomel.—The general indication for calomel is fever. When a child
develops a disease it immediately gets a temperature, and very frequently
the fever is quite high because the slightest ailment gives a child fever.
When fever begins, digestion practically stops, it is therefore imperative to
clean the whole gastro-intestinal canal; otherwise the undigested material
will putrefy and poison the entire system and render the disease more
serious than it need be.
Now we select in such conditions calomel for two reasons:
First, because the presence of fever indicates that infection of the blood is
taking place; this may come either from the intestinal canal itself, or from
the germs of the disease with which the child is suffering. Since calomel
acts chemically through the blood it is the cathartic indicated.

Second, because a cathartic like castor oil does not act through the blood
and it would most likely be vomited by a fevered stomach.
Certain conditions indicate calomel; biliousness and jaundice, for example,
because it has a specific action on the liver and if the liver is at fault
calomel is the proper remedy.
Calomel is best given in small divided doses, 1-10 of a grain every half
hour, for ten doses. It is best given combined with soda; every drug store
carries tablets of calomel and soda for this reason.
Calomel should never be given in the treatment of constipation, nor should
it be used indiscriminately by mothers, as much harm may result. It has its
specific use as indicated above, but it should never be used under any other
circumstances.
Citrate of Magnesia.—This is a mild laxative. After the bowels have been
thoroughly opened with castor oil or calomel, small doses of citrate of
magnesia may be given for a few days, "to keep the bowels open." There is
no danger or harm in its use if used for this purpose. It must not be used,
however, in the treatment of constipation of children for the simple reason
that you cannot cure constipation by the use of drugs of any kind. Laxatives
of this type have become a national curse. Adults, especially women, use
them constantly. All these advertised saline laxative waters work by
weakening the blood—when a dose is taken the chemicals in it draw
through the bowel wall blood serum, and produce, because of the excess of
this watery fluid, large, and frequently many, liquid movements.
If this practice is continued, as it often is every day, the quality of the blood
will suffer seriously, and many individuals are the victims of neuralgic
pains, headaches, nervousness, insomnia, anemia, and general broken health
as a direct consequence of this pernicious habit.
Mothers will try to remember, therefore, that drugs and saline waters have
no place in the treatment of constipation in children or themselves.
Constipation must be treated by diet, exercise regular living and by the
observance of hygienic and sanitary common-sense rules.

VACCINATION

Time for Vaccination.—The best time to vaccinate a child is during the
first three months if he is healthy. The reason for selecting so early a period
is because the constitutional disturbances are much less at this time than in
later childhood. It should not be done during active dentition. If the child is
delicate if his nutrition is bad it should be deferred until a later time.
Children suffering from eczema or from any skin disease or those syphilitic
should not be vaccinated until it is compulsory, or until exposed to small-
pox.
Methods of Vaccinating.—It is customary in America to vaccinate at one
point rather than to make a number of inoculations as is the custom in some
other countries. The leg or the arm is the usual location selected. In infants
the sore can be protected better on the leg; in children of the run-about age,
the arm is the better location because it can be kept at rest easier.
Before vaccinating the skin should be rendered surgically clean; this can be
done by washing with soap and water, drying and then rubbing with
alcohol. The wound should be left uncovered for about twenty minutes to
dry, it may then be covered with a bandage, or with a vaccine shield. The
part should not be washed for twenty-four hours.
The Symptoms of Successful Vaccination.—Nothing is noticed until the
third or fourth day, when a red papule appears. In the course of the
following day a vesicle appears; this vesicle enlarges until it reaches its full
development on the ninth day. The size of the vesicle is about one-half inch
in diameter; it is surrounded with a reddish inflammatory area for about two
inches. The vesicle begins to dry and is shortly a dark crust which remains
from one to three weeks and then falls off. It leaves a bluish scar which
soon turns white and the part is roughened and honeycombed. During the
period when the vaccination is at its height the child suffers from fever and
irritability and loss of appetite.
If vaccination does not "take" in an infant it should be done two or three
times and if then unsuccessful it should be repeated every year until it takes.
The fact that vaccination does not take does not imply that the child would
not take small-pox but rather that the vaccine used is not suitable. There are
some children, however, who seem to be immune to vaccination.

Sometimes the symptoms are more severe than those enumerated; this
seems to depend upon the susceptibility of the child. The vesicle may be
much larger and the area of inflammation much more dense and angry. The
fever may be higher and may last longer; there may be a general rash and
the degree of depression more profound. Vesicles may be produced on other
parts of the body as a result of scratching. Mothers must always remember
that vaccination is a surgical wound to begin with and that it is capable of
infection in the same way as are other wounds, and that any result coming
from such an infection is not due to the vaccine or to the process of
vaccination, but to the infection. Many people get unjust ideas about
vaccination from just such cases. If the mother is not cleanly or neglects the
vaccinated area and permits it to become infected she must not and others
should not decry vaccination as a consequence. Anyone who doubts the
virtue of vaccination is condemning himself; he is simply ignorant of the
accumulation of evidence in favor of it and assumes a position without any
possible justification. The mortality of vaccination is stated by Voigt from
statistics to be 35 in 2,275,000 cases. In fact, all the deaths are from causes
which are preventable and no doubt the result of direct carelessness on the
part of the operator or the mother.
Treatment.—The mother must understand in what way she may contribute
to the successful termination of a case of vaccination. She should see that
the part upon which the child is to be vaccinated is absolutely clean so far
as she can make it with soap and water. She should see that the part is
allowed to dry thoroughly after vaccination. She should not wash the part
for at least twenty-four hours. If a vaccine shield is put on she should not
disturb it. If the mother is prepared to do her part faithfully a vaccine shield
is not necessary from a medical standpoint and in some cases it is
objectionable. A simple, clean bandage is all that is necessary. It is very
important that the child be kept from scratching the part; most of the
troubles of vaccination come from this habit. It is desirable that the limb
should be kept at rest during the stage when the process is at its height. If
the vesicle discharges it is necessary that the area should be kept clean and
dusted with boracic acid. If the wound becomes infected it must be treated
by a physician. The mother must not resort to home remedies in such cases
unless she is prepared to take the consequences, which may be serious.

CHAPTER XXII
CONSTIPATION IN INFANTS AND CHILDREN

"It is a greater disgrace to be sick than to be in the penitentiary. When you
are arrested it is because you have broken a man-made statute, but when
you are ill, it is because you have disobeyed one of God's laws."
Constipation—Regularity of Bowel Function—The Function of the
Stomach—Fermentation—Incomplete Constipation—Importance of a
Clean Bowel—A Daily Movement of the Bowel Necessary—Constipation
in Breast-Fed Infants—Treatment of Constipation in Breast-Fed Infants—
Constipation in Bottle-Fed Infants—Treatment of Constipation in Bottle-
Fed Infants—Constipation in Children Over Two Years of Age—Diet List
for Constipation in Children—Bran Muffins in Constipation—Treatment of
Obstinate Constipation—Oil Injections in Constipation.

CONSTIPATION. REGULARITY OF BOWEL FUNCTION

The most frequent cause of ill health and inefficiency in the human race is
inattention to regulation of the bowel function. Good health depends upon
many causes of which good blood is an absolutely necessary requisite.
Good blood depends upon what feeds and sustains it. There are other
contributing factors, such as the proper kind of exercise, the proper amount
and quality of fresh air, the method of living, etc., but these are all food in a
sense. The food we take in is acted upon by the various digestive juices
until everything is extracted from it that contributes to the building up of the
body. Whatever is left, whatever the body does not want, is immediately, or
within a reasonable time, passed out in the form of a movement of the
bowels.
If any part of the digestive function is deficient, impaired health, or mental
and physical inefficiency expressed in the form of indigestion, is the result.
If the bowel is at fault, constipation is the usual consequence. A perfectly

healthy living machine must maintain a perfect digestion and regular bowel
movements.
The Function of the Stomach is to mix and churn the food, and to add
certain ingredients to the mixture so that before it is carried into the
intestines it is (as far as it is the stomach's duty to render it) ready to be
absorbed into the system. Before it reaches that part of the intestine which
absorbs, it is acted upon again and certain other ingredients are added to it
by certain other digestive organs. In time it is in shape to be used and it is
sent along on its way. As it passes onward the little sucking glands in the
wall of the bowel suck up all the liquid element in the mass of food. The
liquid element in the mass is the food itself, rendered liquid by the stomach
and other digestive organs and juices. The remaining solid mass is that part
of the food which the body cannot use and does not want. By the time the
liquid element is absorbed, the solid mass (always kept moving by the
bowel wall) has reached the rectum, ready to be passed out at once, or very
soon, provided—and upon this provision depends the success of the entire
process,—it has all been done within a certain time. If the stomach takes too
long to do its work we have indigestion. If the bowel takes too long to do its
work we have constipation.
Fermentation.—Now let us consider the matter from another standpoint. If
food stays too long in the stomach it begins to ferment. When anything
ferments it makes and evolves gas. You, no doubt, have noticed many times
how the cork pops out of a bottle if its contents are "working," or
fermenting. If you watch that bottle you will notice that it is quietly or
actively evolving air bubbles. That is gas,—gas manufactured by the
process of fermentation. This is exactly the process that goes on in the
stomach or bowel of a dyspeptic, and it is this collection of foul, poisonous
gas that causes the distress and bloated feeling which every dyspeptic
suffers from after eating,—if it is this "flatulent" type of indigestion which
is present.
The Significance of Constipation.—If the food takes too long to pass
through the bowel it causes, as we have stated, constipation. What is the
real significance of constipation? It means that in passing through the bowel
the food has given up all its liquid element (which is all its nourishing
element), but the bowel has been too slow in passing it along. Consequently

it is not ready to be expelled while it is yet a harmless semi-solid mass. It
stays in the bowel too long—it begins to putrefy, bacteria attack it, and it is
soon a semi-liquid, foul, rotting mass. The sucking glands in the intestinal
wall continue to suck—that is their duty. They cannot discriminate between
what is good and what is bad—they simply go on absorbing whatever is
there to absorb. So there are absorbed into the system liquid and gaseous
products which are poison.
This process has been called by a number of names; "self-poisoning"
explains the condition thoroughly. The other names are, auto-infection,
auto-intoxication, enteric-infection, enteric-toxemia, intestinal indigestion.
The condition is a serious one, because it is absolutely impossible to feel
well, or to enjoy good health, while it lasts. The feeling of being constantly
sick, yet not sick enough to stop working or to demand a radical cure,
affects a woman's efficiency, interferes with her capacity to work, her
ability to render the home an abode of contentment, to be an agreeable
companion, or to adequately take care of her children.
The constant absorption of intestinal poisons affects the system itself,—the
symptoms are headache, neuralgia, loss of appetite, nervousness, insomnia,
vertigo, inability to concentrate, lassitude, indigestion. The condition which
we name constipation is therefore one of supreme importance. From a
medical standpoint, it is the biggest problem in the whole realm of disease.
It is the most significant hygienic function of life, and it is becoming more
and more important, and more and more a problem. Every modern factor
upon which physical efficiency seems to depend is an enemy to the
systematic regulation of this function. Our method of hurried and
indiscriminate eating, our system of strenuous living, our unsanitary
environment, our business activity, our method of pursuing pleasure, take
no account of, and resent the time devoted to cultivating, as a hygienic
necessity, this toilet requirement. This imperative call of nature is pushed
aside by the child at play, by the housewife for a duty which could wait, by
the merchant for an engagement. It is particularly an American disease, and
it is uniquely an American woman's affliction. It is a curious commentary
on the intelligence of the American people, who are ordinarily alert and
analytical, to realize how few of them really know how serious a matter
constipation is. They don't know because they have given the matter

absolutely no thought. They have accepted it as a mere matter of fact,
almost of fate.
Incomplete Constipation.—There is a type of constipation that is not
known to the average person and not well understood by those few who
know of its existence. In this form of constipation there is a daily bowel
movement but the movement is not complete. The bowel does not
thoroughly empty itself; it has established this habit because of conditions
under which it has had to do its work. If a woman neglects herself, becomes
muscularly inactive, does not take proper out-door exercise, grows fat and
lazy, eats irregularly and indiscriminately,—the bowel suffers with the rest
of the system. The woman may have a healthy appetite, may eat the wrong
things at the wrong time, yet the bowel is supposed to go on acting rightly,
but it does not. It, too, becomes lazy and acquires bad habits, and this form
of incomplete constipation is the result. These patients look healthy and get
little sympathy for any pains they may have. They may even gain in weight;
they get headaches once in a while, and if they go shopping or visiting they
don't feel quite well afterward. They are suffering from the effects of
chronic constipation, though their bowels are apparently regular. They are
marching onward toward apoplexy or Bright's disease of the kidney.
Importance of a Clean Bowel.—Every mother, sooner or later, observes
that a physician always thoroughly cleans out the bowel of a sick child at
once, no matter what the character of the sickness is. He does this for two
reasons,—first, because he knows that the great majority of children's
ailments are of gastro-intestinal origin; second, if the origin of the disease is
not in the stomach or bowels, experience has taught him that if the bowels
are clean at the beginning of a disease, that disease will run a milder and
shorter course than if complicated with a condition of self-poisoning. If a
child develops fever the digestive function stops; whatever food is in the
stomach or bowel will promptly ferment and putrefy because of the
abnormal heat caused by the fever and the arrested digestion. If this is not
cleaned out at once the self-poisoning process begins.
The above is a suggestive admission for a physician to make. It simply
means that the vast majority of the calls made by a physician on ailing
children are caused by errors in diet and can be completely cured by a dose
of castor oil or calomel, or, better still, need never occur.

A mother who neglects, who is guilty of inattention to the conditions of her
child's bowel, fails in one of the most important duties of motherhood. I
know as a father and a physician that if a child's bowel acts regularly and
thoroughly, that child is fortified to the highest efficient degree against the
multitude of little ailments common to all children. A clean bowel means
good blood, good digestion, ability to exercise properly, to sleep soundly
and to think clearly. Such a child will resist infection and throw off the
minor troubles that pave the way for serious sickness. It is a secret worth
knowing.
A Daily Movement of the Bowel Necessary.—In order to preserve good
health one thorough movement of the bowel is necessary daily. A baby may
have two or three and enjoy robust health. A larger daily number suggests
an abnormal condition of the bowel and an investigation should be made. If
a nursing baby's bowels do not move before bedtime it should be given an
injection of equal parts of glycerine and hot water, one-half cupful; or an
enema of soap and water, or a glycerine suppository. When a child is six
months old, in some sooner, it should be put on the stool at a certain time
every morning. This will aid in the establishment of the habit, as a child
soon understands why it is made to assume this position and acts
accordingly.
The condition referred to above and which we termed incomplete
constipation may affect the nursing infant. A child's bowels may move daily
and yet the child will suffer from constipation. If the movements are
watched it will be observed that certain children strain when at stool, and
after a time succeed in passing hard, dry lumps or balls of fecal matter.
Such a movement is a certain indication that the bowel is not emptying
itself satisfactorily and that a constant toxemia or poisoning is going on.
Very faithful efforts should be made to remedy this condition by the use of
articles of diet that are known to be laxative, otherwise the condition is one
that will "grow" with the child and establish an obstinate chronic
constipation with all its miseries and dangers.
Constipation in Breast-Fed Infants.—Many nursing infants thrive and
gain in weight, yet they are constipated. Before you drug your baby be sure
the fault is not your own. Many mothers are responsible for the constipation
with which baby suffers. If the mother is constipated, so will the child be.

Cure the constipation of the mother and the baby's bowels will regulate
themselves. Nursing mothers who are large tea-drinkers have irregular
bowels as a rule. A baby whose mother is lazy or indolent, who does not
take a reasonable amount of exercise, whose diet is faulty and whose hours
are bad, is a sufferer from constipation. The mother's life must be regulated,
her diet and habits corrected, and the instructions carried out as already
recommended. The breast milk should be examined and if any cause for
constipation exists in it, it should be rectified as suggested elsewhere.
If it is thought advisable to resort to drugs for the immediate relief of the
constipation of infants, the best ones are the aromatic fluid extract of
cascara sagrada; milk of magnesia with equal parts of the aromatic syrup of
rhubarb given in doses of one to three teaspoonfuls daily.
Irrigations, enemas, and suppositories should not be used continuously. The
habit is a bad one. The parts become accustomed to their use and fail to act.
If the child is passing dry and hard stools it is of advantage to inject two
ounces of warm sweet oil at night, allowing it to remain in the bowel until
the following morning. See page 312.
Constipation in Bottle-Fed Infants.—It is much easier to treat the
constipation of bottle-fed babies than of those breast-fed, because the food
can be changed to ensure regular bowel movements. The first change to be
made in a bottle-fed baby who is habitually constipated is to add more
cream to the food. The way to do this is to take out of the bottle of each
feeding one tablespoonful of the food and put in its place one tablespoonful
pure cream. If this change partly rectifies the bowel ailment, add more
cream until the bowels are of the proper consistency. Milk given
constipated babies should be raw, never boiled, as boiled milk will always
aggravate the trouble.
The use of oatmeal water instead of plain water in making the baby's food
may cure the bowel trouble. Taking the sugar of milk out of the baby's food
and putting in its place the same quantity of Mellin's food will sometimes
cure the constipation.
One or two teaspoonfuls of milk of magnesia put into one feeding daily, or
fifteen drops to one tablespoonful of the aromatic fluid extract of cascara
sagrada will move the bowels. Orange juice, strained, two teaspoonfuls

twice daily, is an excellent remedy and should be tried in every case. Sweet
oil and pure cod liver oil, in doses of thirty drops to two teaspoonfuls three
times daily after feedings, if the little patient is poorly nourished. If the
stools remain hard and dry, an injection of two ounces of warm sweet oil at
bedtime is an excellent method of aiding the bowel. The oil should remain
in the bowel all night. This lubricates the parts, softens the fecal mass and
stimulates the gut to perform its own work. See page 312.
Constipation in Children Over Two Years of Age.—Most children when
put upon a varied diet after the nursing days are over are relieved of any
constipation which may have existed up to that time. There are a few,
however, whose condition does not seem to improve. These children need
attention. We should first insist on regular habits. A child should be told that
its bowels must move every morning after breakfast. If this is absolutely
insisted upon the child will soon recognize the uselessness of fighting the
proposition and submit. If at any time a conscientious effort is made to
move the bowel without result after fifteen minutes it is wise to use a
glycerine suppository so that the bowel will empty itself.
It has been stated in another part of this book that there are children with
whom milk does not agree. Experience has taught us that milk, especially
milk that has been boiled, causes more cases of constipation in growing
children than all other causes combined. Find out if it is milk that is the
cause in any individual case. While these children cannot take whole milk
just as it comes from the dairy without suffering in a great many ways, they
can take milk and water, or milk and oatmeal water, prepared in the
following way, without becoming constipated. A bottle of fresh milk is
allowed to stand in a cool place for five hours, when the top ten ounces are
skimmed off with a Chapin dipper and mixed with twelve ounces of
oatmeal gruel or plain water. This can be used as a drink.
Parents can select from the following list of articles such combinations as
may be suitable to constitute the regular meals of a constipated child:

Lamb chops.
Rare steak.
Rare roast beef.
Hashed chicken.

Soft boiled eggs.
Cracked wheat.
Hominy.
Cornmeal.
Oatmeal, Scotch.
Bran biscuits.
Oatmeal crackers.
Graham wafers.
Stewed or baked apple.
Apple sauce.
Plain vanilla ice cream.
Animal broths, purées of peas.
Beans, and lentils.
Peas.
String beans.
Spinach.
Cauliflower.
Asparagus.
Stewed tomatoes, strained.
Whole wheat bread.
Zwieback.
Custard.
Stewed prunes.
Junket.
Cornstarch.
Malted milk is agreeable and advisable as a drink.
Orange juice or a scraped raw apple is allowable at this time. Constipated
children should eat plenty of good butter. Olive oil, two or three
teaspoonfuls after each meal, is excellent. It can be kept up for months to
advantage. Older children may eat raw and cooked fruits, figs, dates, baked
potatoes, poultry, and fish. One or two raw apples or a peach or orange may
be given daily. A strict observance of the above rules and diet will result in
normal movements of the bowel if persisted in for a reasonable time. It may
be necessary occasionally to use a suppository or an enema now and again
until the habit is established.

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

RECIPE FOR BRAN MUFFINS

Take one pint of best flour, one quart unsifted bran, one teaspoonful
bicarbonate of soda (baking soda), a pinch of salt. Mix these thoroughly
together, then add: six to eight tablespoonfuls good, New Orleans molasses,
one pint of milk. Mix together very thoroughly. Put in muffin rings and
bake in oven. About one ounce should be put in each ring as they raise
easily. Eat with plenty of good butter. They should be given to children
before each meal, when they are hungry, not after their stomachs are full.
Put bran in dish first. Sift in flour, soda and salt. Mix these thoroughly
together, then add one pint of milk (two cupfuls) and six to eight
tablespoonfuls of New Orleans molasses. The quantity of molasses depends
upon the individual taste. They are good for any child or adult whether
constipation exists or not.
Drugs may be of temporary service in some cases. A pill of cascara sagrada
is the best for this purpose. It should not be continued for more than two
weeks. Castor oil, calomel, and other frequently-used cathartics should
never be used in simple constipation.

TREATMENT OF OBSTINATE CONSTIPATION

There are cases that resist treatment of the kind described above. Diet and
drugs do not succeed in establishing the habit of daily bowel movements. In
these cases radical treatment is imperative. The diet should be the same as
that described above, but it will be found advisable to cut out milk
altogether. Cereals can be taken with sugar and butter instead of milk. The
oil injection plan of Professor Kerley has given me excellent results. I quote
his comments upon and method of giving it:—

"Oil Injections."—"For this purpose a soft-bulb syringe of four ounces'
capacity is ordered. Over the hard rubber tip is place a small sized adult
rectal tube or a No. 18 American catheter. The catheter or tube is cut so that
but nine inches remain for use. The cut end is forced over the small, hard
rubber tip of the syringe. A fountain syringe is impracticable for this
purpose, as it is soon destroyed by the oil and rendered unfit for use.
Besides, sufficient pressure is not produced to force the oil into the gut even
with a high elevation of the bag. The child is placed on his back or on his
left side. The syringe is filled with oil, the tube is lubricated, and passed
through the rectum as far as it can go. When it has been passed to the full
nine inches, as may readily be done with a little practice, the syringe is
emptied and the tube withdrawn. The injection should be given after the
child has been placed in bed for the night. It is our object to have the oil
retained during the night. If a passage of the bowels is produced at the time,
or if the oil leaks out during the night, a small quantity should be used. In
some of my patients I have been able to use but one ounce. In very few,
indeed, does it cause an evacuation at the time. If there is a tendency to
leakage a napkin should be worn to avoid soiling the bed-linen. The
following morning after breakfast, the child is placed on the vessel and kept
there until a bowel movement results or until fifteen minutes have elapsed.
In a great many cases if the constipation has been obstinate for months, the
bowel will be at once evacuated. When this does not occur in fifteen
minutes, a glycerine suppository is inserted, which invariably produces an
evacuation. This use of the suppository, according to my observation, can
usually be dispensed with in a very few days; the use of the oil, however,
may have to be continued for several weeks. When the child has had the oil
nightly and an evacuation the next morning without assistance for two
weeks, I direct that the oil be omitted for a night and the effect noted. If the
usual passage occurs after breakfast, the oil is given for five nights and then
omitted. If the case progresses satisfactorily the use of the oil is gradually
omitted, being given at first every second night, then every third, fourth, or
fifth night, etc. A considerable number of cases have been completely
relieved in two months. In the event of no passage following the omission
of the oil, its use is continued for two weeks longer, when it is again
omitted for a night." To illustrate this point the following case is cited.

"Illustrative Case.—A boy three years of age had never had a bowel
evacuation without drugs, soap enemas, or suppositories since birth, and
finally these were no longer effective. The mother, thoroughly frightened,
brought the child to me. Eight months of diet and the use of the oil were
required before he was entirely well. It is now three months since the local
treatment was discontinued and the bowel function remains normal.
"The diet with the absence of milk must be continued for months after the
patient is apparently well, and he must not be allowed to pass a single
morning without an evacuation at the usual time. In assuming the
management of one of these cases I explain to the mother or nurse that the
treatment is not pleasant for the child or the attendant, and that it may have
to be persisted in for weeks, and unless she is willing to carry it out to the
end, it would better not be undertaken. I assure her, however, that with her
coöperation, which is usually readily given, the child will make a complete
recovery. Cases that are slow in responding to treatment, I usually give the
additional advantage of abdominal massage from twenty minutes to one-
half hour, before the child is placed at stool. The massage should practiced
by one skilled in the work.
"The above local measures apply particularly to children after the
eighteenth month. They may be used earlier, however, following out the
diet along the lines laid down for bottle-fed children who suffer from
constipation. In very young children a smaller amount of oil should be used,
never more than two ounces, usually one ounce is all that is required. When
the oil treatment is under way, whatever the age of the patient, laxative
drugs should not be given."

CHAPTER XXIII
CONSTIPATION IN WOMEN

Chief Cause of Constipation in Women—Constipation a Cause of Domestic
Unhappiness—The Requirements of Good Health—The Cost of
Constipation—Constipation and Social Exigencies—One of the Important
Duties of Mothers—Constipation and Diseases of Women—Constipation is
Always Harmful—Constipation and Pregnancy—Explanation of
Incomplete Constipation—Causes of Constipation—Negligence—Lack of
Exercise—Lack of Water—Lack of Bulk in the Food Taken—Abuse of
Cathartic Drugs and Aperient Waters—Overeating—Treatment of
Constipation in Women.
It has been stated that constipation is almost universal among the women of
America. It is a fact that very few American women enjoy, to a reasonable
degree, a permanently satisfactory bowel condition. Constipation is an
acquired habit and unquestionably negligence is the primary and the chief
cause of it. The negligence, no doubt, begins at a very early age; it is at least
an established habit before any intelligent, consecutive effort is made to
remedy it. Inasmuch as women are the mothers of the race, and as their part
in the scheme of life is the supreme one; and as constipation has been
shown to be a serious, far-reaching, significant disease, a very sincere and
persistent crusade should be made to educate women as to its importance.
For a less altruistic purpose, tremendous popular movements have been
carried to success. For a less service rendered to the race names have
achieved renown. In addition to the symptoms stated in the preceding paper,
the condition which we now desire to emphasize is the effect of the constant
self-poisoning on the general health and its effect upon a woman's
reproductive efficiency.
The poison being constantly absorbed, means general bad health, bad health
to a degree depending upon the degree of constipation which is the cause of
the poisoning. It may be simply that the woman does not wholly enjoy good

health, or that she is completely incapacitated because of chronic bad
health, or any degree of indifferent health between these two extremes.
If the degree of poison is sufficient to cause habitual poor health, its effect
upon the blood must be bad, and the effect of the bad blood upon the
nervous system and the other vital organs cannot be good. Now if this
process has been going on for many years, the condition of the woman, who
is its victim, as an efficient machine, compared with the woman in whom
this condition never did exist, must be very different indeed. This condition
of affairs—inasmuch as constipation is so common in women—must have a
tremendous significance when estimating the vitality and efficiency of the
coming generation.
We might go much further and yet be sure of our position, and maintain that
it is this national autotoxemia, this scourge of womanhood, that is to a great
extent responsible for the characteristic American "vice of neurasthenia,"
and of the domestic infelicity and unhappiness which are so common in the
large cities of this country. If we add to the intestinal autotoxemia of
constipation, the tendency to, or vice of, indiscriminate eating and drinking
—of which the American people are particularly guilty—we would be on
firmer ground. In fact we would feel that we had pointed out the one
underlying cause of most of the domestic irritability prevalent to-day, which
is of serious importance, and which is, fortunately, capable of correction. It
is a matter of everlasting and continuous education.
The Requirements of Good Health.—There are certain fundamental basic
requirements which are essential to good health: fresh air, good water, a
reasonable amount of physical and mental exercise, nutritious food,
freedom from unnecessary and unreasonable worry, frequent bathing, and a
daily movement of the bowels. The reason why constipation is of such
serious importance is because it is the only basic requirement of good
health that afflicts a large majority of the race at the same time. The health
of so many is being undermined by this one affliction, that it dominates all
other factors that have any bearing upon posterity. A woman may enjoy all
the essential conditions necessary to good health, yet she may be
constipated, and the presence of this condition will undermine, in her
constitution, all the benefits she derives from her advantageous
environments. It will do more; it will be responsible for the disposition,—

the temperament,—of that woman. The natural disposition of that woman
may be an amicable one; if it were allowed to express itself naturally it
would be kind, gentle, considerate, affectionate. No woman, however, the
victim of chronic constipation, can preserve an equable temperament or an
amicable disposition. It is impossible—with her nerves being constantly
poisoned—that she can hold the symptoms of that condition in abeyance.
She must be irritable and nervous and sick of herself and everything and
everybody. The home as a direct result suffers; its atmosphere is not one of
contentment and peace and affection. Constipation, therefore, blights the
home and the influence of one blighted home may have a far-reaching
effect on the story of the human race. It is responsible also for that woman's
mental attitude outside the home. Instead of exerting an optimistic
influence, her whole existence is a message of pessimism and
discouragement. Multiply these influences and messages to correspond with
the prevalence of the disease and we have a condition that is tremendously
significant, a condition that is really a pressing economic issue. A
constipated woman is an anti-eugenist—a eugenic atrocity.
We have no desire to create a false impression or to build up a foolish fear.
Are we justified in regarding this as one of the most important, if not the
most important, disease condition; the most menacing physical vice, which
the human race has to combat? Let us offer the following brief facts in
witness of our stand:
The Cost of Constipation.—It has been estimated that consumption (the
great white plague) kills one-tenth of all the human race. Cancer kills half
as many, or one in every twenty. Constipation, and the diseases which are
caused directly by it, kills one in every three of all the people on the
civilized globe.
Constipation has been responsible for the expenditure of millions of dollars
in advertising in the newspapers alone,—more, probably, than has been
spent in advertising remedies for all other diseases combined. Do you
suppose this money was a donation? Do you suppose these keen, alert
interpreters of the spirit of the times, the up-to-date business men, were not
and are not aware that constipation is the "universal disease"?

Every drug store, in every civilized spot on earth, has its shelves loaded
down with constipation remedies; dinner pills, liver pills, cathartic pills,
tablets in all possible coatings and combinations, mineral waters from a
multitude of springs, aperient drinks by the dozen, laxative teas and
cordials, cathartic oils and emulsions. If the demand for these articles
should cease most of the drug stores would close up.
Many millions of dollars have been made and are being made by various
men and concerns, who have devised ingenious mechanical agencies which
are supposed to cure, and in curing renew the lost health caused by
constipation. We have in mind in this connection, a man who conceived the
ingenious plan of putting the opening of an ordinary fountain syringe in the
middle instead of at the end and made a fortune out of it. In this opening he
places an upright nozzle, and instead of hanging the bag up and allowing
the water to run into the bowel, he has the patient sit on the bag and thereby
the water is forced into the bowel. He has written a two-hundred page book
on the advantages of this idea, and his "literature" contains the names of
famous men and women in all walks of life who use his device. The name
of one of the famous judges of the Supreme Court of the United States was
there; another was the name of a popular operatic beauty who writes for the
daily press little essays on "How to be beautiful!" and "How to keep well!"
He deserves his success. He is an emancipator and has doubtless done a
great deal of good. His success demonstrates, beyond contradiction, the
prevalence of the malady under discussion, and it must be remembered that
he is only one of hundreds who garner from the same ample harvest.
If we could estimate in value the economic loss sustained by the race
because of the inefficiency of the victims of intestinal intoxication, due to
constipation, the sum would be colossal. Even then it would only represent
the direct economic deficiency—it would not express, nor could any figure
adequately represent, the indirect loss sustained by the race because of the
temperamental characteristics, which are the products of intestinal
poisoning, and which produce domestic tragedies and economic failures.
Has this array of evidence any meaning, or does it just happen to be so? We
leave it to the reader; if it stimulates thought, or pricks a conscience it will
have done its duty.

Constipation and Social Exigencies.—The cause of constipation in
women, whose social station commands every sanitary, hygienic, and
dietary luxury, is their method of living, the food they eat, and the
negligence which is almost obligatory because of social exactions. If
constipation did not so frequently accompany "good" living (which is the
modern name for overeating and drinking) we would have thousands and
thousands of healthy, robust, contented women, fit and willing to assume
the onerous duties concomitant with motherhood. All their enthusiasm,
however, is expended in the effort to keep "in the ring," to overcome the
effects of the poison of constipation, to preserve their youth and freshness,
to undo what neglect has accomplished. It is because of the failure of this
simple function that my lady seeks the masseur, the facial artist, the society
doctor, the beauty expert, and the thousand and one agencies, which an
extravagant and profligate age has made necessary to foster the efficiency
of its votaries.
I am optimistic, however, regarding the future. I believe the human race is
improving, despite the disadvantageous surroundings and conditions which
hamper honest effort and stultify truth. A higher efficiency is the goal, and
the intention is to obtain this desideratum by fair and by just means. There
is an awakening, an unrest, a groping for knowledge in almost every field of
human endeavor, and there is none in which the yearning for fact, for truth,
for instruction, is stronger and keener, than in the world-wide movement in
the interest of a better motherhood, and in a more serious study of child life.
It is an encouraging sign, a hopeful promise, of what the future has in store.
One of the Important Duties of Mothers.—The immediate lesson to be
learnt from the facts just recounted is to instruct mothers in their duty
toward their daughters. If each mother would retain the confidence of her
daughter sufficient to instruct her in the duties which are important, how
much needless suffering would be saved. To know as a matter of fact
whether the daughter's bowels are in good condition will appeal to all who
read this as being of very great importance. It is not only necessary to know
if they have a movement every day, it is necessary to know the character of
the daily movement; whether it is hard and dry and necessitates straining,—
the evil consequences of which, in young girls, is very serious indeed,—or
if it is habitually loose and suggestive of what has been described as
incomplete constipation.

If the mothers of America would consecrate themselves to this simple task,
who could tell in mere words the effect it would have on the race yet
unborn? There are problems of scientific intent, and of fancy names, that
engage the attention of philanthropically inclined ladies, and which are
emblazoned on the society columns of the daily press, of much less
importance to the human family than the homely duty we ask mothers to
devote themselves to.
Constipation and Diseases of Women.—Constipation is present in a very
large majority of the cases of diseases of women. It may be caused by
disease of the womb, or it may cause disease of the womb. There is no
question about the bad effect constipation has upon all diseases of this type.
In many cases it is absolutely impossible to effect a cure without first curing
the accompanying constipation.
We seldom appreciate how severe a degree of constipation a growing girl
will submit to without seeking relief. Some of the worst cases of
constipation that have been known, have been in girls between the ages of
sixteen and twenty. The mechanical effects of such a condition can well be
imagined. The constant, severe straining, necessary to evacuate the bowel,
has, in very many instances, produced congestion and displacement of the
womb and ovaries. It is not observed at this time, or if observed it is not
understood, and thus is laid the foundation for years of neurasthenia,
helplessness, and disease.
The more we investigate the ramifications of constipation the more we learn
of its seriousness and of its significance.
Constipation is Always Harmful.—There is no period in life when
constipation can be borne with impunity. Youth, with its virility and vitality,
will endure its consequences with an apparent negation, so far as positive or
specific results are concerned, but it is only an apparent impunity. There is
always a certain amount of strength built up, held in reserve as a heritage of
youth, which will withstand a certain amount of physical license, but if this
reserve is assailed by an unnecessary imposition, and is successfully
undermined, there will be infinitely less reserve to call upon in the
legitimate battle of life. Life is too real, too concentrated, too strenuous, and
health is too precious to be wilfully wasted in any form of self-abuse.

Constipation and Pregnancy.—Mothers will appreciate from the
foregoing explanation why constipation is eugenically a crime during
pregnancy. The evils which result from constipation mechanically,
frequently have serious consequences by interfering with the circulation of
the blood to the womb, by forcing the womb to assume wrong positions, by
straining at stool, and by preventing the kidneys from functionating
properly; these may render the life of the pregnant woman miserable, and
may be the direct cause of a painful, prolonged, difficult labor. The evils
which result from constipation because of the absorption of poisons by the
bowel are of the gravest importance during pregnancy. These poisons affect
the general health; the victim is tired, listless, and apathetic, and is thereby
disinclined to exercise adequately; the appetite is poor; there are headaches,
neuralgias, insomnia, nervousness, melancholia, and general mental and
physical inertness. What hope may a pregnant woman entertain of having
"an easy confinement," or of bringing a healthy child into the world under
these circumstances? Who is to blame? Sometimes it is necessary to tell the
unadorned truth,—the woman is to blame. No woman has a right to assume
the responsibilities of maternity who has not had enough respect for herself
to discontinue habits which caused this failing, or who has not had strength
of will enough to begin its successful cure. Get busy,—do something,—it is
never "too late," but do it now.
Before we take up the treatment of constipation in women, it is necessary to
explain more fully the type of constipation which we referred to as
"incomplete" constipation. There is a condition of the bowel, in which we
find its wall coated with hard fecal matter. The size of the bowel may be
dilated as a consequence. This condition may occupy part, or most, of the
entire length of the large intestine. In the middle of this hard mass there is a
small channel through which semi-liquid matter passes. When the bowel
moves, it is this semi-liquid matter that passes out, and this constitutes the
daily movement. We have consequently a condition in which we have a
daily movement but not a complete emptying of the bowel. The character of
the stools from such a bowel must necessarily be more or less of a semi-
liquid consistency, because the intestine, being coated with a hard dried out
layer of old fecal substance, is prevented from absorbing the liquid part of
the fresh fecal mass passing through it. This condition may exist for a
considerable time, but it will slowly undermine the health and vitality of

any person in whom it exists. The symptoms which a patient in this
condition complains of are,—a feeling of being tired and languid, no energy
or vim, headache, loss of appetite, loss of flesh, neuralgic pains, nausea,
vertigo (dizziness), insomnia, frequent colds, cold hands and feet,
biliousness, sallow skin and muddy complexion, liver spots, coated tongue
and a "bad breath," nervousness, melancholia, various abnormal conditions
and diseases of the skin, pimples, blackheads, eruptions, eczema, piles,
appendicitis, diseases of the intestinal wall as a result of the constipation,
Bright's disease of the kidney, and many other morbid conditions. Any
physician could name many symptoms, which were never properly
understood but which are now known to be caused by the absorption of
poisons resulting from inactivity of the bowels. Patients may not necessarily
have all of the above symptoms; they may have a number of them, or they
may have all of them, and they may have others not mentioned at all.
Treatment of Constipation in Women.—To effect a movement of the
bowels in a patient who is a victim of constipation is not a cure. We can
indefinitely cause bowel action by drugs, etc., but the condition will remain
the same or worse. When habitual constipation exists there is an underlying
condition affecting the entire system which indicates that something is
radically wrong. It may be necessary to change the whole routine of the
patient's life. It will certainly be necessary at the very beginning to inquire
into the daily diet, exercise, and surroundings.
During the past ten years there has been born every few days a new medical
"ism," a new religious cult. Why? Because human nature is an unstable
equation. We are never satisfied with the old order of things and there will
always be a following wherever there is a leader. These "isms" and cults do
not survive. Some seem to thrive, others die a natural death. There is a law,
as old as the hills, that you cannot get something for nothing in this world.
We learn its bitter truth as the years pass, and when we get over the day
dreams and the sentiment of youth we settle down to real work. If we desire
to retain good health, or regain lost health, we must do something. No one
can hand it to us on a silver plate, nor can anyone work a miracle in our
behalf. We cannot buy health, we must deserve it.
This is the secret of the success of all schemes to cure disease. The human
family will not knuckle down and swallow the truth. The man or woman in

poor health is looking for Aladdin's lamp everywhere and always. A new
bait, dressed up in lubricated, oily words, promising impossible results, will
be accepted as the simple unadorned truth, and will be bought and paid for,
in the end forgotten. The royal road, the easy road, which they are looking
for is impossible. There is no way by which any one of us may continue to
break the laws of nature and retain or regain our lost health. Miracles are
impossible. Prayers without deeds are empty mouthings and a waste of
time. Let us see how this works out in the treatment of constipation. We
must find the cause of the constipation. I will name the causes in their order
of frequency.
Negligence.—This is unquestionably the primary cause of almost all cases
of bowel inactivity. As has been already noted, the exigencies of modern
life are of such a strenuous nature that we do not find the time to devote to
this function the degree of systematic attention which it demands in order to
preserve a healthy condition of intestinal regularity. The bowel is simply a
complex muscle controlled by an elaborate system of nerves of an
involuntary type. In order to preserve the highest degree of efficiency of
this complicated mechanism, it must be permitted to obey the laws nature
endowed it with and which it must obey. When the fecal mass reaches the
rectum the nerve centers, acting through the spinal cord, send a message to
the rectum something like this: "Empty yourself of your contents, we have
made all preparations and everything is ready." The rectum obeys to the
extent of notifying you that it wants to be relieved; you feel the desire to
evacuate the bowels. If you obey, all is well, nature is appeased, you
encourage the systematic regularity necessary to good health. If you do not
obey, you upset the delicate mechanism, and frequent negligence of this
character will result in the complete disarrangement of this complex
machinery so that it will fail to warn you that a bowel movement is
necessary and constipation is established. We must therefore retrace our
steps and re-educate the bowel systematically to empty itself at a certain
time every day. This can be done in nearly every case without artificial
assistance. It may take time but it is worth a little methodical persistence.
The point is, you must do it; no "ism" or esoteric agency can do it for you.
Mothers will recognize from this explanation the necessity of establishing
the habit in children at the earliest possible moment.

Lack of Exercise.—What does the word exercise imply? It implies
movement, better circulation of the blood, better health and tone to every
part of the body, more oxygen, and a richer, better quality of blood, and
because of a better quality of blood, which is the fuel of the body machine,
we have a better, smoother working machine. Every human being requires a
certain amount of exercise; otherwise the machine will not run smoothly. If
this exercise is not obtained, things begin to go wrong. One of the very first
signs to indicate that the machine is not running as it ought to run, is a
sluggish condition of the whole digestive apparatus and a certain degree of
bowel inactivity (constipation) follows. There is no substitute for this need.
Drugs will not help you, mechanical devices will not do the work for you,
though they may aid you. You must do the work yourself. If you fail or
hesitate to recognize the truth, if you temporize or procrastinate, you are
only deferring the issue. The argument that you have not the time, that your
work will not permit you, is no argument at all. You must do it or reap the
consequences; you certainly cannot escape them. The wise woman accepts
the situation, the fool goes to an early grave.
Lack of Water.—Constipation may be due to a deficiency of water in the
system. Women who suffer from this type do not drink enough water. The
bowel may be willing and able to do its duty, but is handicapped because a
certain amount of liquid is essential to proper digestion and natural bowel
activity. At least six glasses of water should be taken by every healthy adult
human being in each twenty-four hours. The best time to take this water is
as follows: one glass on arising, two between breakfast and lunch, two
between lunch and dinner, and one on retiring. Between meals means one
hour after a meal and at least one-half hour before the following meal. No
liquid should be taken during a meal, or immediately after, or before a meal.
All water taken may be hot or cold, according to the fancy of the taker. It is
of advantage to squeeze the juice of half a lemon into the water taken on
arising if there is any tendency to constipation or if the liver is lazy or
torpid. It is also good for the complexion.
Lack of Bulk in the Food Taken.—Sometimes the character of the food
taken is such that there is no body to it. The process of digestion so
completely liquefies it that the bowel has no solid matter to manipulate. To
excite the peculiar movements of the intestinal wall there must be substance
in the contents. The variety of the daily food must be so arranged as to

provide this. A list of these foods is provided elsewhere in this book.
Certain other foods stimulate intestinal activity, not because of their bulk,
but because of the chemical elements they contain. All forms of sugar, the
sugars of fruits, the acids of fruits and vegetables, are excellent natural
laxatives. Sour milk and buttermilk, oils and fats, are also of distinct value
in this respect.
On the other hand, soups, gruels, porridges, and purées are constipating
because the digestive process reduces them to liquids and leaves no bulk for
the bowel to act upon. New bread, hot biscuits, "noodles," and doughy
foods are also objectionable, especially to children. Hot baths, hot drinks,
hot enemas, and sweating are also constipating because they extract so
much liquid from the bowel leaving the contents excessively dry.
Abuse of Cathartic Drugs and Aperient Waters.—This is a widespread
evil; it may justly be regarded as a national curse. The victims of this
custom do not realize that they are addicted to a habit which must be rightly
regarded as equally as bad as the drink habit, so far as its ultimate effect on
the general health and the prospect of longevity is concerned. Its popularity
is a product of our national vice of indiscriminate eating and drinking. It is
more common among the class who live in restaurants, hotels, and boarding
houses, who keep late hours, eat late suppers and who do not exercise
enough. These individuals eat too much and live too high. After a time the
liver becomes sluggish, the stomach fails to digest properly, the bowels lose
their tone, and flatulent indigestion or some other more or less serious
condition follows; to maintain the pace, to feel and keep fit, they discover
that a glass of some advertised aperient or laxative water before breakfast
works wonders, tides them over for the time being and keeps them "in the
ring." They compliment themselves and push the specter of age aside.
The thought that they were not "as young as they once were," or that they
must go slow, was not a very pleasing suggestion, so having found a "cure"
by adding another bad habit on top of an existence which is composed of
nothing but bad habits, they start all over again. The suggestion that their
trouble is a warning that "things are going wrong" and that the whole plan
of living must be radically and promptly changed does not meet with their
approval, and so the Department of Health statistics heap up the records of

deaths due to heart disease, hardening of the arteries, Bright's disease of the
kidneys and apoplexy. It is not a happy tale, but the truth is often tragic.
When a woman finds that her physical efficiency depends upon the habitual
use of cathartic drugs or laxative waters, she must regard the knowledge
with respect, she must give it serious consideration, and she must adopt
means to so change her method of living, that nature will be given a chance
to work in her interest—not against her. Better to find out exactly where the
trouble is now, and go after it than to travel too far along the wrong road.
Many die from the "disease" of procrastination.
Overeating.—Overeating may be included in this classification because it
so overworks the digestive apparatus that it is impossible for it satisfactorily
to complete its function. Any reader desirous of understanding the full
significance of overeating in this connection should carefully read the
article on this subject on pages 289 and 290.
There are, of course, a great many other causes for constipation but these
are the important ones. When we find the cause of any particular case it will
suggest the remedy and we must employ it faithfully if we hope to effect a
cure. If it is negligence, we must correct that fault and compel our daily
routine to accommodate itself to a regular observance of this function. If it
is lack of exercise, we must get more exercise, or if it is lack of bulk in our
food, we must change our method of living and select with more care the
foods we eat. If it is lack of water, we can correct the constipation by adding
the proper amount of water at the proper time.
A patient who has been a victim of chronic constipation for some time must
live a life somewhat after the following general plan:
She should increase the vegetables, fruits, and fats in her diet and she
should drink enough water. It is a good plan to sip slowly one-half pint of
hot or cold water morning and evening. Daily exercise in the open air is
advisable; exercise of some kind, even if taken indoors, is imperative.
Walking, riding, bicycling, tennis, golf, swimming, are the best forms of
exercise for women. Indoor gymnastics can be made a satisfactory
substitute. After the exercise a hot shower bath and a cold sponge bath or
cold plunge or a swim should follow.

Women in very moderate circumstances may walk briskly a distance of
three or four miles, and on returning can take a warm bath followed by a
brisk rub-off with a coarse towel wrung out of cold water, or they can use a
hose with a spray nozzle and allow the cold water to run over them for a
few seconds after the warm dip in the bath tub. After the adoption of these
measures the bowels may tend to regulate themselves. If so, this is the
proper time to cultivate the habit of regularity, by selecting a certain time
each morning or before retiring for this function. The patient should go to
the toilet at the regular time even if the desire is not present. By straining
slightly, and by encouraging the voluntary desire, the bowel may receive the
necessary stimulation and an evacuation may result. If there should seem to
be no disposition on the part of the bowel to become accustomed to this
procedure, we must aid it for the time being. A glycerine or soap
suppository, a glass of aperient water, Pluto, Hunyadi, Apenta, or the
imported Carlsbad salt in warm water, or the effervescent Citrate of
Magnesium, will result in a prompt emptying of the bowel. There are a
great many other cathartic drugs and many well-known laxative pills, etc.,
but these are not necessary if a systematic effort is being made to cure the
constipation, because success will come within a reasonable time if the
patient will not become unduly discouraged. Many victims are deficient in
fat; the bowel needs lubrication; we therefore recommend a good quality of
olive oil, one tablespoonful after each meal. Frequently it is of advantage to
inject, high up in the bowel, two or three ounces of sweet oil at night, as is
done in children, and which is fully described in the previous chapter.
If the constipation is due to deranged nerves, in which the reflexes of the
intestinal wall seem to share, we advise massage of the abdomen, and an
occasional hot or cold rectal injection. The proper quantity to use for this
purpose is from two to three quarts. The solution to use is the normal salt
solution. See page 627.
In that form of incomplete constipation in which we stated that there was a
layer of hard, impacted feces covering the bowel wall, a special method of
treatment is necessary. In these cases nothing will succeed as satisfactorily
as very hot, high rectal injections. The object of course is to rid the bowel of
the old, hard, dry mass, which has collected there, before we can hope to
get the bowel into condition to perform its own work. It is almost incredible
that the human bowel can hold so much old dried-out, nasty stuff as is

stored up in these constipated bowels. Hot salt water, as hot as can be
tolerated, two or three quarts at a time, is the correct way to dislodge this
mass. It will not be done at once; it frequently takes two or three weeks
before the bowel is fairly clean. The irrigations should be given every
second night until the bowel is clean. The method of giving these washings
is fully described on page 312. While these irrigations are being given the
patient should take olive oil by the mouth, one tablespoonful after each
meal. The proper food, open-air exercise, sanitary living, plenty of water,
and regular attention to the bowel movements will in the end cure the
affliction.

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