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Title: The Mother and Her Child

Author: William S. Sadler
Lena K. Sadler

Release date: March 14, 2007 [eBook #20817]

Language: English

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T H E M O T H E R

A N D H E R C H I L D
BY

WILLIAM S. SADLER, M. D.
PROFESSOR OF THERAPEUTICS, THE POST-GRADUATE MEDICAL
SCHOOL OF CHICAGO; DIRECTOR OF THE CHICAGO INSTITUTE
OF PHYSIOLOGIC THERAPEUTICS; FELLOW OF THE
AMERICAN MEDICAL ASSOCIATION; MEMBER OF
THE CHICAGO MEDICAL SOCIETY; THE ILLINOIS
STATE MEDICAL SOCIETY; THE AMERICAN
ASSOCIATION FOR THE ADVANCEMENT
OF SCIENCE, ETC.

AND

LENA K. SADLER, M. D.
ASSOCIATE DIRECTOR OF THE CHICAGO INSTITUTE OF PHYSIOLOGIC
THERAPEUTICS; FELLOW OF THE AMERICAN MEDICAL
ASSOCIATION; MEMBER OF THE CHICAGO MEDICAL
SOCIETY; THE MEDICAL WOMEN'S CLUB OF CHICAGO;
NATIONAL CONGRESS OF MOTHERS AND
PARENT-TEACHER ASSOCIATION; THE
CHICAGO WOMAN'S CLUB, ETC.

I L L UST R AT E D

TORONTO

McCLELLAND, GOODCHILD & STEWART
CHICAGO: A. C. McCLURG & CO.
1916

Copyright
A. C. McClurg & Co.
1916

Published August, 1916

Copyrighted in Great Britain

W. F. HALL PRINTING COMPANY, CHICAGO

TO
"BILLY"
WHO, BECAUSE OF HIS UNCONSCIOUS CONTRIBUTIONS TO ITS
PRACTICAL FEATURES, SHOULD BE REGARDED AS A
CO-AUTHOR, THIS VOLUME IS AFFECTIONATELY
DEDICATED BY HIS PARENTS
THE AUTHORS

PREFACE

For many years the call for a book on the mother and her child has come to
us from patients, from the public, and now from our publishers—and this
volume represents our efforts to supply this demand.
The larger part of the work was originally written by Dr. Lena K. Sadler,
with certain chapters by Dr. William S. Sadler, but in the revision and re-
arrangement of the manuscript so much work was done by each on the
contributions of the other, that it was deemed best to bring the book out
under joint authorship.
The book is divided into three principal parts: Part I, dealing with the
experience of pregnancy from the beginning of expectancy to the
convalescence of labor: Part II, dealing with the infant from its first day of
life up to the weaning time; Part III, taking up the problems of the nursery
from the weaning to the important period of adolescence.
The advice given in this work is that which we have tried out by experience
—both as parents and physicians—and we pass it on to mothers, fathers,
and nurses with the belief that it will be of help in their efforts at practical
and scientific "child culture." We believe, also, that the expectant mother
will be aided and encouraged in bearing the burdens which are common to
motherhood by the advice and instruction offered.
While we have drawn from our own professional and personal experience
in the preparation of this book, we have also drawn freely from the present-
day literature dealing with the subjects treated, and desire to acknowledge
our indebtedness to the various writers and authorities.
We now jointly send forth the volume on its mission, as a contribution
toward lightening the task and inspiring the efforts of those mothers, nurses,
and others who honor us by a perusal of its pages.

William S. Sadler.
Lena K. Sadler.
Chicago, 1916.

CONTENTS

PART I
THE MOTHER

CHAPTER PAGE
I The Expectant Mother 1
II Story of the Unborn Child 7
III Birthmarks and Prenatal Influence 14
IV The Hygiene of Pregnancy 21
V Complications of Pregnancy 35
VI Toxemia and Its Symptoms 47
VII Preparations for the Natal Day 53
VIII The Day of Labor 63
index Twilight Sleep and Painless Labor 71
X Sunrise Slumber and Nitrous Oxid 84
XI The Convalescing Mother 93

PART II
THE BABY

XII Baby's Early Days 103
XIII The Nursery 114
XIV Why Babies Cry 123
XV The Nursing Mother and Her Babe 133
XVI The Bottle-Fed Baby 147

XVII Milk Sanitation 156
XVIII Home Modification of Milk 165
XIX The Feeding Problem 177
XX Baby's Bath and Toilet 190
XXI Baby's Clothing 202
XXII Fresh Air, Outings, and Sleep 213
XXIII Baby Hygiene 222
XXIV Growth and Development 232

PART III
THE CHILD

XXV The Sick Child 251
XXVI Baby's Sick Room 266
XXVII Digestive Disorders 274
XXVIII Contagious Diseases 285
XXIX Respiratory Diseases 300
XXX The Nervous Child 308
XXXI Nervous Diseases 323
XXXII Skin Troubles 333
XXXIII Deformities and Chronic Disorders 341
XXXIV Accidents and Emergencies 348
XXXV Diet and Nutrition 360
XXXVI Caretakers and Governesses 370
XXXVII The Power of Positive Suggestions 380
XXXVIII Play and Recreation 390
XXXIX The Puny Child 400
XL Teaching Truth 405
Appendix 427
Index 449

ILLUSTRATIONS

The mother and her child Frontispiece
FIGURE PAGE
1 Steps in early development 10
2 The "expectant" costume 23
3 The photophore 43
4 Taking the blood pressure 48
5 Breast binder 59
6 How to hold the baby 110
7 Making the sleeping blanket 117
8 In the sleeping blanket 118
9 Homemade ice box 149
10 Heating the bottle 151
11 A sanitary dairy 158
12 Articles needed for baby's feeding 167
13 Supporting the baby for the bath 194
14 Developmental changes 240
15 The cooling enema 290
X ray showing tuberculosis of the
16 346
lung
Father and Mother Corn and Morning
17 406
Glory

PART I

THE MOTHER

THE MOTHER AND HER CHILD

PART I

THE MOTHER

CHAPTER I

THE EXPECTANT MOTHER

There can be no grander, more noble, or higher calling for a healthy, sound-
minded woman than to become the mother of children. She may be the
colaborer of the business man, the overworked housewife of the tiller of the
soil, the colleague of the professional man, or the wife of the leisure man of
wealth; nevertheless, in every normal woman in every station of life there
lurks the conscious or sub-conscious maternal instinct. Sooner or later the
mother-soul yearns and cries out for the touch of baby fingers, and for that
maternal joy that comes to a woman when she clasps to her breast the
precious form of her own babe.

MOTHERHOOD THE HIGHEST CALLING

Motherhood is by far woman's highest and noblest profession. Science, art,
and careers dwindle into insignificance when we attempt to compare them
with motherhood. And to attain this high profession, to reach this manifest
"goal of destiny," women are seeking everywhere to obtain the best
information, and the highest instruction regarding "mothercraft,"
"babyhood," and "child culture."
In an Indiana town not long ago, at the close of a lecture, a small,
intellectual-appearing mother came forward, and, tenderly placing her tiny
and emaciated infant in my arms, said: "O Doctor! can you help me feed
my helpless babe? I'm sure it is going to die. Nothing seems to help it. My
father is the banker in this town. I graduated from high school and he sent
me to Ann Arbor, and there I toiled untiringly for four years and obtained
my degree of B. A. I have gone as far as I could—spent thousands of dollars
of my unselfish father's money—but I find myself totally ignorant of my
own child's necessities. I cannot even provide her food. O Doctor! can't
something be done for young women to preparé them for motherhood?"

MOTHERCRAFT PREPARATION

The time will come when our high and normal schools will provide
adequate courses for the preparation of the young woman for her highest
profession, motherhood. This young mother, who had reached the goal of
Bachelor of Arts, found to her sorrow that she was entirely deficient in her
education and training regarding the duties and responsibilities of a mother.
In every school of the higher branches of education that train young women
in their late teens there should be a chair of mothercraft, providing practical
lectures on baby hygiene, dress, bathing, and the general care of infants,
and giving instruction in the rudiments of simple bottle-feeding, together
with the caloric values of milk, gruels, and other ingredients which enter
into the preparation of a baby's food.
Young women would most enthusiastically enroll for such classes, and as
years passed and marriage came and children to the home, imagine the
gratitude that would flood the souls of the young mothers who were
fortunate enough to have attended schools where the chairs of motherhood
prepared them for these new duties and responsibilities.

EARLY MEDICAL SUPERVISION

Just as soon as it is known that a baby is coming into the home, the
expectant mother should engage the best doctor she can afford. She should
make frequent calls at his office and intelligently carry out the instruction
concerning water drinking, exercise, diet, etc. Twenty-four hour specimens
of urine should be frequently saved and taken to the physician for
examination. In these days the blood-pressure is closely observed, together
with approaching headaches and other evidences of possible kidney
complications. The early recognition of these dangers is accompanied by
the immediate employment of appropriate sweating procedures and other
measures designed to promote the elimination of body poisons. Thus
science is able effectively to stay the progress of the high blood-pressure of
former days, and which was so often followed by eclampsia—uremic
poisoning.
In these days of careful urine analysis, expertly administered anaesthetics,
and up-to-date hospital confinements, the average intelligent woman may
enter into pregnancy quite free from the oldtime fears, whose only rewards

were grief and cankering care. All fear of childbirth and all dread of
maternal duties and sacrifices do not in the least lessen the necessary
unpleasantness associated with normal labor. It lies in the choice of every
expectant mother to journey through the months of pregnancy with
dissatisfaction and resentment or with joy and serenity. "The child will be
born and laid in your arms to be fed, cared for, and reared, whether you
weep or smile through the months of waiting."

THE RESENTFUL MOTHER

A little woman came into our office the day of this writing, saying: "Doctor,
I'm just as mad as I can be; I don't want to be pregnant, I just hate the idea."
As I smiled upon this girl-wife of nineteen, I drew from my desk a sheet of
paper and slowly wrote down these words for the head of a column: "Got a
mad on," and for the head of another, "Got a glad on;" and then we quickly
set to work carefully to tabulate all the results that having a "mad on" would
bring. We found to her dismay that its harvest would be sadness of the
heart, husband unhappy, work unbearable, while all church duties as well as
social functions would be sadly marred. Then, just as carefully, we
tabulated the benefits that would follow having a "glad on." Her face broke
into a smile; she laughed, and as she left the office she assured me that she
would accept Nature's decree, make the best of her lot, and thus wisely
align herself with the normal life demands of old Mother Nature. This view
of her experience, she came to see, would bring the greatest amount of
happiness to both herself and husband. She left me, declaring that she was
just "wild for a baby;" and there is still echoing in my ears her parting
words: "I'm leaving you, Oh, such a happy girl! and I'm going home to
Harold a happy and contented expectant mother."
There often enters on the exit of a discontented and resentful expectant
mother, a woman, very much alone in the world—perhaps a bachelor maid
or a barren wife, who, as she sits in the office, bitterly weeps and wails over
her state of loneliness or sterility; and so we are led to realize that
discontentment is the lot of many women; and we are sometimes led to
regret that ours is not the power to take from her that hath and give to her
that hath not.

EARLY SIGNS OF PREGNANCY

Among the first questions an expectant mother asks is: "What are early
signs of pregnancy?" The answer briefly is:

1. Cessation of menstruation.
2. Changes in the breast.
3. Morning sickness.
4. Disturbances in urination.

Menstruation may be interrupted by other causes than pregnancy, but the
missing of the second or third periods usually indicates pregnancy.
Accompanying the cessation of menstruation, changes in the breast occur.
Sensation in the breasts akin to those which usually accompany
menstruation are manifested at this time in connection with the unusual
sensations of stinging, prickling, etc. Fully one-half of our patients do not
suffer with "morning sickness;" however, it is the general consensus of
opinion that "morning sickness" is one of the early signs of pregnancy, and
these attacks consist of all gradations—from slight dizziness to the most
severe vomiting. It is an unpleasant experience, but in passing through it we
may be glad in the thought that "it too, will pass."
Because of the pressure exerted by the growing uterus upon the bladder,
disturbances in urination often appear, but as the uterus continues to grow
and lifts itself up and away from the bladder these symptoms disappear.
Chief of the later signs of pregnancy are "quickening" or fetal movements.
The movements are very much like the "fluttering of a young birdling."
They usually are felt by the expectant mother between the seventeenth and
eighteenth weeks. This sign, together with the noting of the fetal heartbeat
at the seventh month, constitute the positive signs of pregnancy.

PROBABLE DATE OF DELIVERY

And now our expectant mother desires to know when to expect the little
stranger. From countless observations of childbirth under all conditions and
in many countries, the pregnant period is found to cover about thirty-nine
weeks, or two hundred and seventy-three days. There are a number of ways

or methods of computing this time. Many physicians count back three
months and add seven days to the first day of the last menstruation. For
instance, if the last menstruation were December 2 to 6, then, to find the
probable day of delivery, we count back three months to September 2, and
then add seven days. This gives us September 9, as the probable date of
delivery. The real date of delivery may come any time within the week of
which this calculated date is the center.
As a rule, ten days to two weeks preceding the day of delivery, the uterus
"settles" down into the pelvis, the waist line becomes more comfortable,
and the breathing is much easier.
On the accompanying page, may be found a table for computing the
probable day of labor, prepared in accordance with the plan just described.

TABLE FOR CALCULATING THE DATE OF CONFINEMENT
Jan. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Oct. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 Nov.
Feb. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28
Nov. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 1 2 3 4 5 Dec.
Mar. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Dec. 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 Jan.
April. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
Jan. 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 Feb.
May. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Feb. 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 1 2 3 4 5 6 7 Mar.
June. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
Mar. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 April.
July. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
April. 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 1 2 3 4 5 6 7 May.
Aug. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
May. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 June.
Sept. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
June. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 July.
Oct. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
July. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 Aug.
Nov. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
Aug. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 Sept.
Dec. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
Sept. 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 1 2 3 4 5 6 7 Oct.

Supposing the upper figure in each pair of horizontal lines to represent the first day of the last
menstrual period, the figure beneath it, with the month designated in the margin, will show the
probable date of confinement.

CHAPTER II

STORY OF THE UNBORN CHILD

To every physician in every community, sooner or later in his experience
there come thoughtless women making requests that we even hesitate to
write about. Their excuses for the crime which they seek to have the
physician join them in committing, range all the way from "I don't want to
go to the trouble," to "Doctor, I've got seven children now, and I can't even
educate and dress them properly;" or, maybe, "I nearly lost my life with the
last one."

EMBRYOLOGICAL IGNORANCE

One little woman came to us the other day from the suburbs, and honestly,
frankly, related this story:
"We've been married just six months, I have continued my stenographic
work to add the sixty-five dollars to our monthly income. Doctor, we must
meet our monthly payments on the home, I must continue to work, or we
shall utterly fail. I am perfectly willing a baby shall come to us two years
from now, but, doctor, I just can't allow this one to go on, you must help me
just this once. Why doctor, there can't be much form or life there, it's only
three months now, or will be next week, and you know it's nothing but a
mass of jelly."
She had talked with a "confidential friend" in her neighborhood, had been
told that she "could do it herself," but fearing trouble or infection, had come
to the conclusion she had better go to a "clean, reputable physician," to have
the abortion performed.
This is not the place to narrate the experiences of the unfortunate victims of
habitual criminal abortion, but we would like to impress upon the reader
some realization of the untimely deaths, the awful suffering, and the life-
long remorse and sorrow of the poor, misguided women who listen to the
criminal advice of neighborhood "busybodies." The infections, the

invalidism, the sterility that so often follow in the wake of these practices,
are well known to all medical people.

THE STREAM OF LIFE

And so after the patient's last statement, "It's nothing but a mass of jelly,"
we began the simple but wonderfully beautiful story of the development of
the "child enmothered." Just as all vegetables, fruits, nuts, flowers, and
grains come from seeds sown into fertile soil, and just as these seeds
receive nourishment from the soil, rain, and sunshine, so all our world of
brothers and sisters, of fathers and mothers, came from tiny human seeds,
and in their turn received nourishment from the peculiarly adapted stream
of life, which flows in the maternal veins for the nourishment and
upbuilding of the unborn embryo.
Every little girl and boy baby that comes into the world, has stored within
its body, in a wonderfully organized capsule, a part of the ancestral stream
of life that unceasingly has flowed down through the centuries from father
to son and from mother to daughter. This "germ plasm" is a divine gift to be
held in trust and carefully guarded from the odium of taint, to be handed
down to the sons and daughters of the next generation. Any young man who
grasps the thought that he possesses a portion of the stream of life, that he
holds it in sacred trust for posterity, cannot fail to be impressed with a sense
of solemn responsibility so to order his life as to be able to transmit this
biologic trust to succeeding generations free from taint and disease.

THE PROCESS OF FERTILIZATION

Just as within the body of "Mother Morning Glory" (See Fig. 18) may be
found the ovary or seed bed, so there are two wonderfully organized bodies
about the size of large almonds found in the lower part of the female
abdomen on either side of the uterus, and connected to it by two sensitive
tubes. There ripens in one of these bodies each month a human baby-seed,
which finds its way to the uterus through the little fallopian tube and is
apparently lost in the debris of cells and mucus which, with the
accompanying hemorrhage go to make up the menstrual flow. This
continues from puberty to menopause, each gland alternatingly ripening its

ovum, only to lose it in the periodical phenomenon of menstruation, which
is seldom interrupted save by that still more wonderful phenomenon of
conception.
At the time of conception, countless numbers of male germ-cells (sperms)
are lost—only one out of the multitude of these perfectly formed sperms
made up of the mosaics of hereditary depressors, determiners, and
suppressors that so subtly dictate and determine the characteristics and
qualifications of the on-coming individual—I repeat, only one of these
wonderful sperms finds the waiting ovum (Fig. 1). In this search for the
ovum, the sperm propels itself forward by means of its tail—for the male
sperm in general appearance very much resembles the little pollywog of the
rain barrel (Fig. 1).
The fateful meeting of the sperm and the ovum takes place usually in the
upper end of one of the fallopian tubes. It is a wonderful occasion. The
wide-awake, vibrating lifelike sperm plunges head first and bodily into the
ovum. The tail, which has propelled this bundle of life through the many
wanderings of its long and perilous journey, now no longer needed, drops
off and is lost and forgotten. This union of the male and female sex cells is
called "fertilization." There immediately follows the most complete
blending of the two germ cells—one from the father and one from the
mother—each with its peculiar individual, family, racial, and national
characteristics. Here the combined determiners determine the color of the
eyes, the characteristics of the hair, the texture of the skin, its color, the size
of the body, the stability of the nervous system, the size of the brain, etc.,
while the suppressors do a similar work in the modification of this or that
family or racial characteristic.

Fig. 1. Steps in Early Development.

THE FIRST WEEKS OF LIFE

The fertilized ovum remains in the tube for about one week, when it slowly
makes its way down into the uterus, all the while rapidly undergoing

segmentation or division. It does not grow much in size during this first
week, but divides and subdivides first, into two parts, then four, then eight,
then sixteen and so on, until we have a peculiar little body made up of many
equally divided parts, and known as the "Mulberry Mass" (Fig. 1). The
blending of the sperm and ovum has been perfect, the division of the
original body multitudinous.
While this division of the united sex cells is progressing, a wonderful
change is also taking place in the inside lining of the uterus. Instead of the
usual thin lining, it has greatly thickened and has become highly sensitized,
and as the ovum enters the uterus from the fallopian tube, this sensitized
lining catches it and holds it in its folds—actually covers it with itself—
holding the precious mass much as the cocoon, you have so often seen
fastened to the side of a plant or leaf, holds its treasure of life.
Just as soon as the new uterine home is found the baby heart begins to make
its appearance, as also do many other rudimentary parts. By the end of the
third week, our round mass has flattened and curved and elongated, and the
nervous system and brain begin to develop, while the primitive ears begin
to appear. At this time, the alimentary canal presents itself as one straight
tube which is a trifle larger at the head end. And it is interesting to note that
at this early date, even the arms and legs are beginning to bud and push out
from the body.

LATER EMBRYONIC DEVELOPMENT

In the fourth and fifth weeks, the lungs and the pancreas may be found, the
heart develops, the nervous system has taken on more definite form, and
several of the larger blood-vessels are appearing.
By the eighth week, by the most wonderful and complicated processes of
overlapping, pushing out, indentation, enfolding, budding, pressing, and
curving, the majority of the important structures are formed—the eyes, ears,
nose, hands, feet, abdominal organs, and numerous glands. Thus, at the end
of two months, almost every structure and organ necessary to life is present
in a rudimentary state.

AT THE END OF THREE MONTHS

By the close of the third month, witness the work of creation! From the
blending of the two germ cells there has come forth a beautifully formed
body (Fig. 1). True, it is but three and one half inches in length, but it is
nevertheless a perfect body. About this time, the sex may be determined.
The eyes, nose, ears, chin, arms and legs and even the fingers and toes may
all be clearly distinguished.
A "jelly mass" at three months? No, by no means! No! Life and form and
features are all there. It really has a face, whose features may easily be
delineated.
In all my experience, I have yet to find the woman who wished to continue
in her wicked and criminal intent after she had listened to this story of the
creative development of the first three months of her "child enmothered."
During the next four months, which take us to the close of the seventh,
rapid growth and farther development take place to the extent, that, should
birth occur at that time, life may continue under proper conditions.

LAST WEEKS OF PREGNANCY

Everything is now nearing completion—only awaiting further growth,
development, and strength—except some of the bone development, which
takes place during the remaining two months. Growth is rapid, strength is
doubled, and as the two hundred and seventy-three days draw to a close,
everything has been completed. It has all taken place according to the laws
of creation in an infinite way and with clock-like precision.
With the developmental growth of the product of conception, the uterus or
room that had been particularly prepared for the "big reception" of the
second week, has also grown to great dimensions. It fills almost the entire
abdomen and as a result of the pressure against the diaphragm the breathing
is somewhat embarrassed.
The door of this "room" has been closed by a special mechanism, while, in
the fullness of time, Mother Nature begins the delicate work of opening the
door, through whose portals passes out into the world the completed babe.

The authors feel that this discussion of, and protest against, abortions,
should be accompanied by an appropriate consideration of the control of
pregnancy. We are never going to eliminate the abortion curse of present-
day civilization by merely preaching against it—warnings and
denouncements alone will not suffice to remove the stain. Notwithstanding
our feelings and convictions in this respect, we are also well aware of the
fact that public sentiment is not now sufficiently ripe to welcome such a full
and frank discussion of the subject of the prevention of conception as the
authors would feel called upon to present; we are equally cognizant of the
fact that existing postal regulations and other Federal laws are of such a
character (at least capable of such interpretation) as possibly to render even
the scientific and dignified consideration of such subjects entirely out of
question.

CHAPTER III

BIRTHMARKS AND PRENATAL INFLUENCE

In the preceding chapter we learned that when the two germ cells came
together, there occurred a complete blending of two separate and distinct
hereditary lines, reaching from the present away back into the dim and
distant past. By the union of these two ancestral strains a new personality is
formed, a new individual is created, with its own peculiar characteristics.

HEREDITARY TRAITS

Probably none of the laboriously acquired accomplishments of the present
generation can be directly—and as such—handed down to our children.
What we are to be and what we will do in this world was largely determined
by the laws of heredity by the time we were well started on our
development experience en-utero during the third or fourth week of our
prenatal existence, as outlined in a former chapter.
It is now generally accepted in scientific circles that acquired characteristics
are not transmissible. Someone has aptly stated this truth by saying that
"wooden heads are inherited, but wooden legs are not." This does not by
any means imply that we do not have power and ability to fashion our
careers and carve out our own destiny, within the possible bounds of our
hereditary endowment and environmental surroundings. Heredity does
determine our "capital stock," but our own efforts and acts determine the
interest and increase which we may derive from our natural endowment.
From the moment conception takes place—the very instant when the two
sex cells meet and blend—then and there "the gates of heredity are forever
closed." From that time on we are dealing with the problems of nutrition,
development, education, and environment; therefore, so-called prenatal
influence can have nothing whatever to do with heredity.
A father may have acquired great talent as a physician or a surgeon, in fact
he may hold the chair of surgery in a medical college, but each of his

children come into the world without the slightest knowledge of the subject,
and, as far as direct and immediate heredity is concerned, will have to work
just about as hard to master the subject as will the same average class of
children whose parents were not surgeons. This must not be taken to mean
that certain abilities and tendencies are not inheritable—for they are; but
they are inherited through the parents—and not from them—directly. These
transmitted characteristics are largely "stock" traits, and usually have long
been present in the "ancestral strain."

MATERNAL IMPRESSIONS

A mother may sing and pray all through the nine months of expectancy, or
she may weep and scold, or even curse. In neither case can she influence
the spiritual or moral tendencies of her child and cause it, through supposed
prenatal influence, to be born with criminal tendencies or to grow up a
pious lad or become a devout minister. These tendencies and characteristics
are all largely determined by the "depressors," "suppressors," and
"determiners" which were present in the two microscopic and mosaic germ
cells which united to start the embryo at the time of conception.
The child is destined to be born, endowed, and equipped with the mental,
nervous, and physical powers which his line has fallen heir to all through
the past ages. Down through the ages education, religion, environment, and
other special influences have no doubt played a small part in influencing
and determining hereditary characteristics; just as environment in the ages
past changed the foot of the evolving horse from a flat, "cushiony" foot with
many toes (much needed in the soft bog of his earlier existence) into the
"hoof foot" of later days, when harder soil and necessity for greater
fleetness, assisted by some sort of "selection" and "survival," conspired to
give us the foot of our modern horse, and this story is all plainly and
serially told in the fossil and other remains found in our own hemisphere. It
would appear that many, many generations of education and environment
are required to influence markedly the established and settled train of
heredity regarding any particular element or characteristic in any particular
line or lines of hereditary tendencies.

EUGENIC SUPERSTITION

There is probably more misinformation in the minds of the people on the
subject of "maternal impressions" and "birthmarks" than any other scientific
or medical subject. The popular belief that, if a pregnant woman should see
an ugly sight or pass through some terrifying experience, in some
mysterious way her unborn child would be "marked," deformed, or in some
way show some blemish at birth, is a time-honored and ancient belief.
Such unscientific and unwarranted teaching has been handed down from
mother to daughter through the ages, while the poor, misguided souls of
expectant women have suffered untold remorse, heaped blame upon
themselves, lived lives literally cursed with fear and dread—veritable slaves
to superstition and bondage—all because of the simple fact that a certain
percentage of all children born in this world have sustained some sort of an
injury or "embryological accident" during the first days of fetal existence.
For instance, take the common birthmark of a patch of reddened skin on the
face, brow, or neck. As soon as the baby is born, the worried mother asks in
anxious tones: "Doctor, is it all right, is it perfect, has it got any
birthmarks?" On being told that the baby has a round, red patch on its left
brow, the ever-ready statement of the mother comes forth: "Yes, I knew I'd
mark it, I was picking berries one day about three months ago, and I ate and
ate, until I suddenly remembered I might mark my baby, and before I knew
what I was doing, I touched my brow and I just knew I had marked my
baby." Do you know, reader, that that birthmark was present fully four
months before she passed through that experience in the berry patch? And
yet so worried and apprehensive has been the pregnant mother, that,
although she can never successfully predict the "birthmarks" and blemishes
of her child, nevertheless when these defects are disclosed at birth she is
unfailingly able immediately to recall some extraordinary experience which
she has carefully stored away in her memory and which, to her mind, most
fully explains and accounts for the defect.
Is it much wonder that in the very early days of embryonic existence,
during the hours of delicate cell division, indentation, outpushing,
elongation, and sliding of young cells—is it much wonder, I repeat—that
there occur a few malformations, blemishes, or other accidents which
persist as "birthmarks?"

CAUSES OF BIRTHMARKS

There are many factors which may enter into the production of birth-
blemishes, deformities, monstrosities, etc. These influences are all governed
by certain definite laws of cause and effect. A pre-existent systemic disease
in the father, or a coexistent disorder in the mother, may be a leading factor.
A mechanical injury, such as a sudden fall, a blow, or a kick, or certain
kinds of prolonged pressure, not to mention restrictions and contractions of
the maternal bony structures, may all possibly contribute something to these
prenatal miscarriages of growth and development. Maternal or prenatal
embryonic infections could bring about many sorts of birthmarks and
malformations. These defects might also be caused by certain types of
severe inflammatory disorders in the uterus during the early days of
pregnancy.
The same factors that produce the accidents of embryology resulting in
malformations or monstrosities in the human family, are also operative in
the case of our lesser brethren of the animal kingdom, for monstrosities and
birth-defects are very common among the lower animals, notwithstanding
the fact that the animal mother probably does not "believe in birthmarks."
"It is a striking fact that during the nineteenth century, the teratologists,
those who have scientifically investigated the causes of monstrosities and
fetal morbid states, have almost without exception, rejected the theory of
maternal impressions." Scientists and physicians are coming to recognize
the fact that fears and frights do not in any way act as causes in the
production of monstrosities and deformities. Let us seek forever to liberate
all womankind from the common and harassing fear and the definite dread
and worry that, because they failed to control themselves at the instant of
some terrifying sight or experience, they were directly responsible for the
misfortune of their abnormal offspring.
It should be remembered that there exists no direct connection whatsoever
between the nervous system of the unborn child and the nervous system of
the mother. The only physiological or embryological relationship is of a
nutritional order, and even that is indirect and remote.

ROLE OF THE PLACENTA

By the end of the third month, the "cocoon" attachment described in chapter
two has disappeared; the fetus is slowly pushed away from the uterus which
has so snugly held it for more than eleven weeks; while upon the exact site
of its previous attachment the thickened uterine membrane undergoes a very
interesting and important change—definite blood vessels begin to form—
which begin indirectly to form contact with the maternal vessels, and thus it
is that the placenta, or "after birth" is formed; and then, by means of the
umbilical cord, nourishment from the mother's blood-stream is carried to
the growing and rapidly developing child. In exchange for the nourishing
stream of life-giving fluid by which growth and development take place, the
embryo gives off its poisonous excretions which are carried back to the
placenta, from which they are absorbed into the veinous circulation of the
mother; so, while the mother does, through the process of nutrition,
influence growth and development in the embryo, she is wholly unable to
produce specific changes and such definite developmental errors as
birthmarks and other deformities.
Just as truly as it would be impossible so to frighten a setting hen as to
"mark" or otherwise influence the form or character of the chicks which
would ultimately come forth from the eggs in her nest, it is just as truly
impossible to frighten the pregnant mother and thereby influence the final
developmental product of the human egg which is so securely tucked away
in its uterine nest; for, when conception has occurred, the human embryo is
just as truly an egg—fashioned and formed—as is the larger and shell-
contained embryo of the chick which lies in the nest of the setting hen.
And so we are compelled to recognize the fact that there is little more
danger to the unborn child when the mother is frightened than when the
father is scared. The one contributes as much as the other to the general
character of the child, while neither is to blame for development errors and
defects.

SUGGESTION AND HEREDITY

Certain fears are suggested to children. For twenty years I lived under the
delusion that I was terribly afraid of snakes—more so than any other human
being; for I was told when a mere child that I had been "marked with the

fear of snakes," that just two months before I saw the peep of day, my
esteemed mother had been terrified by a snake. Everywhere I went, I
announced to sympathizing and ofttimes mischievous friends, that "I was
marked with the fear of snakes and must never be frightened with them." It
is needless to add in passing, that I was teased and frightened all through
my girlhood days. I was a veritable slave to the bondage of snake-fear.
Everywhere I went I looked for my dreaded foe, expecting to sit on one,
step on one, or to have one drop into my lap from the roof.
The day of deliverance came after marriage, when in a supreme effort to
deliver me from the shackles of fear, the goodman of the house tenderly, but
firmly, maneuvered a morning walk so that it halted in front of a large plate-
glass window of the Snake Drug Store in San Francisco. Just back of this
plate glass, and within eighteen inches of my very nose, were fifty-seven
varieties of the reptiles, big and small, streaked and checkered, quiet and
active. After much remonstrance and waiting, I came-to—gazed at the
markings, beautiful in their exactness—while slowly the change of mind
took place. Faith took the place of fear, calmness subdued panic, and I was
wondrously delivered from the veritable bondage of a score of years. And
so it is that the mother suffers and then the child suffers, ofttimes a living
death, because of the superstition "I'm marked," while there is ever present
the fear or dread that "something is going to happen, because I'm different
from all other individuals—because 'I'm marked!'"

CHAPTER IV

THE HYGIENE OF PREGNANCY

As soon as a woman discovers that she is pregnant, she should sit down and
quietly think out the plan for the nine months of expectancy.
The cessation of the menses may come as a surprise to her, and for a while
she is more or less confused; she must go over the whole situation and
adjust future plans to fit in with this new and all important fact. From a
large experience with maternity cases, I have reached the conclusion that
the larger percentage of pregnancies do come as a surprise, and in many
instances a complete change of program must be painstakingly thought out.
This is especially true of the business woman, the professional woman, the
busy club woman, or the active society woman.

EARLY PLANNING

Let me say to the woman who is pregnant for the first time, the experiences
of the pregnant state should cause you no fear, worry, or anxiety. Giving
birth to a baby is a perfectly natural, normal procedure, and if you are in
reasonable health—if your physician tells you you are a fairly normal
woman—then you can dismiss further thought of danger and go on your
way rejoicing. For thousands of years maternity has been women's
exclusive profession and no doubt will continue to be many ages hence.
By far the most important and the first thing to do is carefully to select the
best physician your means will allow, and place yourself under his or her
care. Your doctor will help you to plan wisely and intelligently during the
waiting time, for physicians have learned from experience that the better
care the pregnant woman receives, the easier will be her labor, and the more
speedy and uneventful the recovery.
And now, we proceed to take up one by one the particular phases of the
hygiene of pregnancy which touch the comfort, convenience, and health of
both the mother and her unborn child.

THE CLOTHING

At all times and under all circumstances the pregnant woman's clothing
should be comfortable, suitable for the occasion, artistic, and practical. And
to be thus beautifully clothed is to be as inconspicuous as is possible. Of all
times, occasions, and conditions, that of pregnancy demands modesty in
color, simplicity in style, together with long straight lines (Fig. 2). For the
"going out" dress, select soft shades of brown, blue, wine, or dark green.
Let the house dresses be simple, easy to launder, without constricting waist
bands, of the one-piece type, in every way suitable for the work at hand.
Under this outer dress, a princess petticoat should cover a specially
designed maternity corset (if any corset at all be worn), to which is attached
side hose-supporters. A support for the breasts may be worn if desired, it
should be loose enough to allow perfect freedom in breathing.
The union suit may be of linen, silk, or cotton, with the weight suitable for
the season. Stockings and shoes should be of a comfortable type, straight
last, low or medium heel and at least as wide as the foot. There are two or
three shoes on the market that are particularly good, whose arches are
flexible, heels comfortable, straight last, and whose soles look very much
like the lines of the foot unclothed. This style is particularly good during the
maternity days. Painful feet are a great strain upon the general nervous
system. Who of us has not seen women with strained, tense faces hobbling
about in high-heeled, narrow-toed shoes? And if we followed them we
would not only see tenseness and strain in the features of the face, but could
hear outbursts of temper on the least provocation. Aching feet produce
general irritability. If ease of body and calmness of spirit is desired, wear
shoes that are comfortable, and the surprising part of it is that many of them
are very good looking.

Fig. 2. The "Expectant" Costume.
The long lines, so admirable for maternity wear are portrayed in this
handsome afternoon costume. Tunic waist is made with shoulder yoke
from which fullness hangs in fine plaiting with panel at back, front and
under arms. The set in vest is of black-striped gold cloth trimmed with
gold thread crochet buttons and with tiny waistcoat of black moire.
Sleeves are of Georgette crepe. Loose adjustable girdle of black moire
ribbon. Full skirt is attached on elastic to china silk underbodice.
Material Crepe de chine or any other soft, clinging fabric.

Toward the end of pregnancy ofttimes the feet swell, in which instance
larger shoes should be worn in connection with the bandaging of the ankles
and legs.
During the latter days of expectancy an abdominal supporter may be worn
advantageously. Much of the backache and heaviness in the pelvis is
entirely relieved by the supporting of the pendulous abdomen with a well-
fitted binder. An ordinary piece of linen crash may be fitted properly by the
taking in of darts at the lower front edge; or elastic linen, or silk binder may
be secured; in fact, any binder that properly supports the abdomen will
answer the purpose.
It should be within the means of every pregnant woman to have a neat,
artistic out-door costume, for social, club and church occasions (Fig. 2). For
no reason but illness should an expectant mother shut herself up in doors.
True men and true women hold the very highest esteem for the maternal
state, and the opinion of all others matters not; so joyfully go forth to the
club, social event, concert, or church; and to do this, you must have a well-
designed, artistic dress. The material does not matter much, but the shade
and style are important.

DIET

There are certain laws which govern the diet at all times; for instance, the
man who digs ditches requires more of a certain element of food and more
food in general, than does the man who digs thoughts out of his brain. The
growing child requires somewhat different elements of food than does an
adult. In other words, "The diet should suit the times, occasions,
occupations, etc."
In the case of the expectant mother it should be remembered that the child
gains nine-tenths of its weight after the fifth month of pregnancy, and it is,
therefore, not necessary that a woman shall begin "eating for two" until
after the fifth month. And since it is also true that the baby doubles its
weight during the last eight weeks of pregnancy, it follows that then is the

time when special attention must be given to the quantity as well as the
quality of "mothers' food."
During the first five months, if the urine and blood-pressure are normal, the
"lady in waiting" should follow her usual dietetic tastes and fancies so long
as they do not distress or cause indigestion. Because of the additional work
of the elimination of the fetal wastes, much water, seven or eight glasses a
day, should be taken; while one of the meals—should there be three—may
well consist largely of fruit. All of the vegetables may be enjoyed; salads
with simple dressings and fruits may be eaten liberally. Of the breads, bran,
whole wheat, or graham are far better for the bowels than the finer grain
breads, or the hot breads.
Something fresh—raw—should be taken every day, such as lettuce,
radishes, cabbage salad, and fresh fruits.
If the prospective mother is accustomed to the liberal use of meat, providing
the blood-pressure and urine are normal, she may be able to indulge in meat
once a day. Many physicians believe that the maternal woman should eat
meat rather sparingly—from once a day to once or twice or three times a
week.
Of the desserts, gelatine, junket, ice cream, sponge cake, and fruit are far
better than the rich pastries, which never fail even in health to encourage
indigestion and heart burn. The fruitades are all good. Candies and other
sweets may be eaten in moderation. Alcohol should be avoided. Tea and
coffee should be restricted, and in many cases abandoned. For many, two
meals and a lunch of fruit or broth are better than three full meals. There is
a continual and increased accumulation of waste matter which must be
thrown off by the lungs, kidneys bowels, and skin; so that clogging of one
channel of elimination makes more work for one or more of the other
eliminative organs.
Sometimes the craving for food is excessive, and the desire to nibble
between meals is quite troublesome. These unusual feelings should be
controlled or ignored. A glass of orangeade will sometimes satisfy this
unnatural craving. Save your appetite for meal time—for a good appetite
means good digestion —all things equal. The woman who habitually eats

between meals is the sluggish, constipated individual who needs to acquire
self-control and learn self-mastery.

WATER DRINKING

Water is the circulating medium of the body, from which the digestive
secretions are formed, and by which the food is assimilated and distributed
to individual cells. And, finally, water is the agent for dissolving and
removing waste products from the body through the various eliminating
organs. We literally live, think, and have our being, as it were, under water.
The tiny cell creatures of our bodies, from the humble bile workers of the
liver to the exalted thinking cells of the brain, all carry on their work
submerged. Accordingly, the amount of water we drink each day,
determines whether the liquids circulating through our tissues shall be pure,
fresh, and life-giving, or stagnant, stale, and death-dealing.
Thirst is the expression of the nervous system, constituting a call for water,
the same as hunger represents a call for food. Pure water, free from all
foreign substances, is the best liquid with which to quench this thirst.
It is just as important to supply abundance of water for the proper bathing
and cleansing of the internal parts of the body, as it is to wash and bathe the
external skin frequently. The living tissues are just as literally soiled and
dirtied by their life action and their poisonous excretions, as is the skin
soiled by its excretions of sweat and poisonous solids. Thus the regular
drinking of water is absolutely necessary to enable the body to enjoy its
internal bath, and this internal cleansing is just as grateful and refreshing to
the cells and tissues, as is the external bath to the nerves which exist in the
skin.
The total amount of water necessary varies according to the nature of one's
work, the amount of sweating from the skin, the moisture of the
atmosphere, the amount of water in the food, etc. We believe the average
person requires about eight glasses of liquid a day; that is, about two quarts.
By the word "glass" we refer to the ordinary glass or goblet, two of which
equal one pint. This amount of water should be increased, if anything,
throughout pregnancy; while, during the later months, the amount of water
taken each day should be at least doubled.

In the condemnation of so-called artificial beverages, an exception should
be made of the fruit juices. The fresh, unfermented juices of various fruits
come very near being pure, distilled water, as they consist of only a little
fruit sugar and acid, together with small amounts of flavoring and coloring
substances, dissolved in pure water. None of these substances contained in
pure fruit juice needs to be digested.
Lemonade not too sweet, and taken in moderate quantities, is certainly a
beverage free from objection when used by the average pregnant woman.
Unripe or overripe fruits frequently cause bowel disturbances; as also do the
millions of germs which lurk upon the outside of fruits, and which find their
way into the stomach and bowels when these fruits are eaten raw without
washing or paring. Otherwise, the juices of fruits and melons are
wholesome food beverages when consumed in moderation.

EXERCISE

It should be the regular practice of every expectant mother to spend a
portion of each day in agreeable, suitable exercise or physical work of some
description. This exercise will be far more beneficial if it can be taken in the
open air. The weather and the strength of the patient must be taken into
consideration and the necessary modifications of the daily exercise should
be made.
An expectant mother living in the city and enjoying the average health and
strength, should engage in such agreeable exercise as the raising of flowers,
the training of vines, with brisk walks in the fresh air. As much time as
possible should be spent in the parks.
The rural "mother in waiting," may do light gardening, raising of chickens,
or pigeons, training of vines, or other outdoor work she may enjoy.
No matter what kind of weather prevails, a daily brisk walk should be
taken, out of doors, on the porch or in a room with open windows. A daily
sweat, as well as the daily prayer, is good for the well-being of the
expectant mother. All forms of light housework are commendable. Keep out
of crowds. Spend more time in the parks than in the department stores. An
occasional evening at the concert or theater is diversion and harmless

provided the ventilation is good. Such exercises as horseback riding,
bicycling, dancing, driving over rough roads, lifting and straining of any
kind, and all other forms of fatiguing exercise should be avoided.

REST

Rest and relaxation are quite necessary for men and women even in the best
of health. A kind providence has arranged that we spend a large portion of
our time resting, and sleeping. In addition to unbroken rest at night it is well
for the prospective mother quietly to withdraw from the family circle, when
the first signs of fatigue begin to appear, and indulge in a little rest, before
she gets into a state of nervousness—where nerves twitch and she becomes
irritable.
A mother who has borne six children, who has had little domestic help, and
who yet retains her youthful appearance and energy, thinks her present
condition due to the fact that while carrying and nursing her babies she
never permitted herself to reach that stage of exhaustion where her nerves
twitched, her voice shrilled, and she became irritable. She made it a practice
to drop her work when these symptoms began to appear, and to seek the
sanctuary of a quiet room apart from her family, if only for ten or fifteen
minutes. And, most important, from the very start she trained her household
to respect her right thus to draw apart.
I have told many women whose household duties press hard: "Your
husband would rather see a cold lunch on the table, or 'go out' for dinner,
while his wife rested, smiling and happy, than to have a most sumptuous
meal spread before him and the wife tired, and fretful." Every woman
should make it the rule of her life to stop just this side of the outburst of
words, and lie down long enough, breathing deeply, to calm the spirit.

FRESH AIR

"With all persons plenty of fresh air, night and day, is indispensable to
health, and to none more than the pregnant woman. She should sleep with
the windows open, or out of doors, at all seasons of the year; of course,
making due allowance for the severity of the winters in the North. It is not

only necessary to provide for the adequate ventilation of sleeping-rooms,
but also for that of the living-rooms of the house.
Many persons, who are quite particular to open wide the windows of the
bedrooms, forget that the other rooms need it quite as much. All the rooms
of the house which are occupied should be thoroughly ventilated by
throwing doors and windows open every morning; at night when the family
is assembled the air must be changed now and then or it will become unfit
for human lungs."
Men and women are outdoor animals. They were made to live in a garden,
not a house. Remember that each person requires one cubic foot of fresh air
every second. Don't allow the temperature of living-rooms, during the
winter season, to go above sixty-eight degrees. If your home has no system
of ventilation, open wide the windows and doors several times a day and
enjoy the blessings of a thorough-going flushing with fresh air.
Oxygen is the vital fire of life. Our food, however well digested and
assimilated, is just as useless to the body without oxygen, as coal is to the
furnace without air. It is equally important to keep up the proper degree of
moisture in the air of the living-rooms.

BATHING

Bathing is made necessary by the clothes we wear and by our indoor life. If
the skin were daily exposed to sunshine and fresh air, it would seldom be
necessary to bathe. The neglect of regular bathing results in overworking
the liver and kidneys, and debilitates the skin. Regular bathing—ofttimes
sweating baths—is very essential to the hygiene of pregnancy.
The neutral bath (97 F.) is excellent to quiet the nerves and induce sleep.
Morning bathing is an exceedingly valuable practice. If properly taken
before breakfast or midway between breakfast and lunch, it is found to be
refreshing and tonic in nature. The feet should be in warm water, the
application of cold should be short and vigorous. A rough mit dipped in
cold water, rubbed over the body until the skin is pink, is a splendid tonic.

Warm cleansing baths should be taken twice a week at night. There is no
good reason for the use of the vaginal douche during pregnancy.

THE TEETH

Because the mother's system is drained of the lime salts which aid in
building up the bones of the child, along with other metabolic changes
which cause the retention of certain acids which ofttimes affect the teeth,
they should be frequently examined and carefully guarded. Severe dental
work should be avoided, but all cavities should receive temporary fillings
while the teeth are kept free from deposits.
As a preventive to this tendency of the teeth to decay, a simple mouth wash
of one of the following may be used after meals:

1. One teaspoon of milk magnesia.
2. One tablespoon of lime water.
3. One-half teaspoon common baking soda.
Any one to be dissolved in a glass of water.

DIRECTIONS FOR SAVING URINE SPECIMENS

Beginning with the second voiding of urine after rising on the morning of
the day you are to save the specimen, save all that is passed during the
following twenty-four hours, including the first voiding on the second
morning. Measure carefully the total quantity passed in the twenty-four
hours. Shake thoroughly so that all the sediment will be mixed, and
immediately after shaking take out eight ounces or thereabouts for delivery
to the physician the same forenoon. The following items should be noted,
and this memoranda should accompany the specimen:
1. Patient's name.
2. Address.
3. This specimen was taken from a twenty-four hour voiding of urine,
which began at .... a. m. ...., and ended at .... a. m. ....

4. The total quantity voided during this twenty-four hours was .... pints.
This specimen should reach the laboratory by ten o'clock the same morning.
It is of utmost importance the specimen should be taken to your physician
every two weeks, and oftener if conditions indicate it. Take it yourself at the
appointed time.

THE BOWELS

Owing to the increasing pressure exerted upon the intestines, most
expectant mothers experience a tendency to sluggish bowels and
constipation. This unpleasant symptom is usually increased during the later
months.
In the first place, a definite time must be selected for bowel action. It may
ofttimes be necessary, and it is far less harmful, to insert a glycerine
suppository into the rectum, than to get into the enema habit. The injection
of a large quantity of water into the lower bowel will mechanically empty
it; but the effects are atonic and depressing as regards future action.
Before we take up the advisability of taking laxatives let us consider what
foods will aid in combating constipation. The following list of foods are
laxative in their action and will be found helpful in overcoming the
constipation so often associated with pregnancy:
1. All forms of sugar, especially fruit sugar, honey, syrup, and malt. All the
concentrated fruit juices. Sweet fruits, such as figs, raisins, prunes, fruit
jellies, etc.
2. All sour fruits, and fruit acids: Apples, grapes, gooseberries, grape fruit,
currants, plums, and tomatoes.
3. Fruit juices, especially from sour fruits: Grape juice, lemonade, fruit
soup, etc.
4. All foods high in fat: Butter, cream, eggs, eggnog, ripe olives, olive oil,
nuts—especially pecans, brazil nuts, and pine nuts.
5. Buttermilk and koumiss.

6. All foods rich in cellulose: Wheat flakes, asparagus, cauliflower, spinach,
sweet potatoes, green corn and popcorn, graham flour, oatmeal foods,
whole-wheat preparations, bran bread, apples, blackberries, cherries,
cranberries, melons, oranges, peaches, pineapples, plums, whortleberries,
raw cabbage, celery, greens, lettuce, onions, parsnips, turnips, lima beans,
and peanuts.
White bread should be tabooed, and in its place a well-made bran bread
should be used. Two recipes for bran bread follow, one sweetened and
containing fruit, the other unsweetened:

BRAN BREAD RECIPES

1. Two eggs, beaten separately; three-fourths cup of molasses, plus one
round teaspoon of soda; one cup of sour cream; one cup of sultana seedless
raisins; one cup of wheat flour, plus one heaping teaspoon baking powder;
two cups of bran; stir well and bake one hour.
2. One cup of cooking molasses; one teaspoon of soda; one small teaspoon
of salt, one pint of sour milk or buttermilk, one quart of bran, one pint of
flour. Stir well, and bake for one hour in a very slow oven. It may be baked
in loaf, or in gem pans, as preferred. The bread should be moist and tender,
and may be eaten freely, day after day, and is quite sure to have a salutary
effect if used persistently.
The drinking of one-half glass of cold water on rising in the morning often
aids in keeping the bowels active. Of the laxative drugs which may be used
at such a time, cascara sagrada and senna are among the least harmful. Two
recipes of senna preparation follow, and may be tried in obstinate cases:
1. Senna Prunes. Place an ounce of senna leaves in a jar and pour over them
a quart of boiling water. After allowing them to stand for two hours strain,
and to the clear liquid add a pound of well-washed prunes. Let them soak
over night. In the morning cook until tender in the same water, sweetening
with two tablespoons of brown sugar. Both the fruit and the sirup are
laxative. Begin by eating a half-dozen of the prunes with sirup at night, and
increase or decrease the amount as may be needed.

2. Senna with prunes and figs. This recipe does not call for cooking. Take a
pound of dried figs and a pound of dried prunes, wash well. Remove the
stones from the prunes and if very dry soak for an hour. Then put both fruits
through the meat chopper, adding two ounces of finely powdered senna
leaves. Stir into this mixture two tablespoons of molasses to bind it
together, the result being a thick paste. Begin by eating at bedtime an
amount equal to the size of an egg, and increase or decrease as may be
necessary. Keep the paste tightly covered in a glass jar in a cool place. If the
senna is distasteful a smaller quantity may be used at first.

CARE OF THE BREASTS

The breasts are usually neglected during the months of pregnancy, and as a
result complications occur after the baby comes which cause no end of
discomfort to the mother. If, during the pregnancy, the breasts are washed
daily with liquid soap and cold water, and rubbed increasingly until all
sensitiveness has disappeared, they may be toughened to the extent that no
pain whatsoever is experienced by the mother when the babe begins to
nurse. During the last month of pregnancy a solution of tannin upon a piece
of cotton may be applied after the usual vigorous bathing. If the nipples are
retracted they should be massaged until visible results are attained.

THE MENTAL STATE

Keep the mind occupied with normal, useful, and healthy thoughts. Listen
to no tales of woe. Stay away from the neighborhood auntie dolefuls. Keep
yourself happy and free from all worry, care, and anxiety.
"Put no faith in fables of cravings, markings, signs, or superstitions. They
are all unfounded vagaries of ignorant old women and will not bear
investigation."
Don't take drugs for worry and sleeplessness. Take a bath.
The secret of deliverance from worrying is self-control. Minimize your
difficulties. Cultivate faith and trust.

The conditions which favor sound sleep are: Quiet, mental peace, pure
blood, good digestion, fresh air (the colder the better), physical weariness
(but not fatigue), mental weariness (but not worry).
When tempted to borrow trouble, when harassed by fictitious worries,
remember the old man who had passed through many troubles, most of
which never happened. Train the mind to think positive thoughts. Replace
worry-thought with an opposite thought which will occupy the mind and
enthuse the soul. Drive out fear-thought by exercising faith-thought.
Cultivate the art of living with yourself as you are, and with the world as it
is. Learn the art of living easily. Associate with children and learn how to
forget the vexing trifles of everyday life.
There is something decidedly wrong with one's nerves when everybody is
constantly "getting on them." They are either highly diseased or abnormally
sensitive. Every woman is a slave to every other that annoys her.
Fear is capable of so disarranging the circulation as to contribute to the
elevation of blood-pressure—which will be more fully considered in a later
chapter.

CHAPTER V

COMPLICATIONS OF PREGNANCY

It is the purpose of this chapter to take up the various complications which
may appear in the course of an otherwise normal pregnancy, and offer
advice appropriate for their management.

MORNING SICKNESS

About one-half of the expectant mothers that come under our care and
observation, experience varying degrees of nausea or "morning sickness."
This troublesome symptom makes its appearance usually about the fourth
week of pregnancy and lasts from six to eight weeks.
On attempting to rise from the bed, there is an uncomfortably warm feeling
in the stomach followed by a welling up into the throat of a warmish,
brackish tasting liquid which causes the patient to hasten to rid herself of it;
or, as she rides on the train, on the street cars, in a carriage or automobile,
she frequently senses the same unpleasant and nauseating symptoms during
the second and third months of pregnancy. Normally, this uncomfortable
symptom quite disappears by the end of the third month. A number of
remedies have been suggested for it, but that which seems to help one, gives
little or no relief to another; we therefore mention a variety of remedies
which may be tried.
First and most important of all remedies—is to keep the bowels open.
Sluggishness of the intestinal tract greatly increases the tendency to
dizziness and nausea. During the attack, it is advisable not to attempt to
brush the teeth, gargle, or even drink cold water. While you are yet lying
down, the maid or the goodman of the house should bring to you a piece of
dry, buttered toast, a lettuce sandwich with a bit of lemon juice, or perhaps a
cup of hot milk or hot malted milk. Coffee helps to raise the blood-pressure,
and all articles of diet that tend to raise the blood-pressure are best avoided
during pregnancy. A cup of cocoa may be tried, but, as a rule, women at this

time do not relish anything sweet. Oftentimes a salted pretzel is just the
thing, or a salted wafer will greatly help. Remain in bed from one-half to
one hour and then rise very slowly. There should be plenty of fresh air in
the room, as remaining in overheated places is quite likely to produce a
feeling of sickness at the stomach.
When the attack comes on during a train ride, open the window and breathe
deeply, this, with the aid of a clove or the tasting of a bit of lemon, will
usually give relief. In extreme instances the patient should lie down flatly
on the back, with the eyelids closed. Go to the rear of the street car, so that
you can get off quickly if necessity demands; breathe deeply of the air;
resort to the use of cloves or lemons; and thus by many and varied methods
will the expectant mother be enabled to continue her journey or finish her
shopping errand. We would suggest that, as far as possible, walking should
be substituted for riding. I have never heard of a woman being troubled
with nausea while walking in the parks, on shady streets, along the country
road, or on the beach.
Of the medicines prescribed for "morning sickness" and the nausea of
pregnancy, cerium oxalate taken three times a day in doses of five grains
each, is probably one of the best.
The persistent or pernicious vomiting which continues on through
pregnancy will be spoken of later.

HEARTBURN

Acid eructations are spoken of as "heartburn," and are occasioned by the
increased activity of the acid making glands of the stomach. Under certain
conditions this acid content of the stomach is regurgitated back into the
throat and even belched up into the mouth. In this condition it is well to
avoid most acid fruits. Ice cream and other frozen desserts are beneficial.
The lowered temperature of cold foods depresses the activity of the acid
glands, as also does the fats of the cream, while protein food substances
such as white of egg, cheese, and lean meat, help by combining with the
excess of acid present in the stomach. Buttermilk or the prepared lactic acid
milk, if taken very cold, is often helpful, notwithstanding it is an acid
substance, in connection with the dietetic management of heartburn. If the

acid eructations be troublesome between the meals, the taking of calcined
magnesia (one round teaspoon in a glass of cold water), or, one-half
teaspoon of common baking soda in a glass of water, will afford immediate
and temporary relief. Simply nibbling a little from a block of magnesia will
often give instant relief. These alkalines effectively neutralize the
mischievous acids which cause the so-called "heartburn."

IRRITABILITY OF THE BLADDER

The flexing or bending forward of the gravid uterus, by making pressure on
the bladder, sets up more or less irritation and consequent disturbance of the
urinary function. The capacity of the bladder is actually diminished, and
this produces frequent urination. There is usually no pain connected with
this annoying symptom—the chief discomfort is the frequent getting up at
night. This inconvenience may be lessened by drinking less water after six
p. m. These bladder disturbances are most marked in the earlier months, and
gradually disappear as the uterus raises higher up into the abdomen;
although this symptom may reappear in the last two weeks, as the head
descends downward on its outward journey.
Should the urine at any time become highly colored, take a specimen to
your physician at once. Twenty-four hour specimens of urine should be
taken by the patient to her physician every two weeks. Do not send it—take
it.

LEUCORRHEA

While leucorrhea is an unusual complication of pregnancy, it is often very
troublesome and sometimes irritating. Do not take a vaginal douche unless
it has been ordered by your physician, and even then make sure that the
force of the flow of water is very gentle. The bag of the fountain syringe
should be hung only about one foot above the hips. Soap and water used
externally, followed by vaseline or zinc ointment, will usually relieve the
accompanying irritation.

THREATENED ABORTION

In the third chapter attention was called to the formation of the placenta or
"after birth," on the site of the attachment of the cocoon embryo. At this
particular time of the pushing away of the embryo from the uterine wall,
one of the accidents of pregnancy occurs, in which the embryo becomes
completely detached and starts to escape from the uterus, accompanied by
varying degrees of pain and hemorrhage. The symptoms of this threatened
abortion are:

1. Heavy menstrual pains.
2. Backache.
3. Hemorrhage.

The approach of the calendar date of the third month of pregnancy should
be watched for, and all work of a strenuous nature studiously avoided; while
at the first signs of the backache or any unusual symptom, the expectant
mother should immediately go to bed and send for the physician. One
patient who had aborted on four different occasions was able to pass this
danger period by adhering to a rigid program of prevention during her fifth
pregnancy. Two weeks before the third month arrived she discontinued her
teaching and went to bed. She remained there four weeks, thus running over
into the middle of the following month. Gradually, she resumed her duties
of teaching, carried her precious bundle of life to full term, and is now the
proud and happy mother of a splendid baby girl.
Should abortion seem imminent, from one-eighth to one-fourth of a grain of
morphine sulphate will greatly reduce all uterine contractions, and this, with
the general quieting effect on the whole system, will usually suffice to
prevent an abortion. The patient should quietly remain in bed from three
days to one week.
If the abortion takes place—if a clot accompanied by hemorrhage is passed
—save everything, lie in bed very quietly and send for your physician at
once; and when he does arrive, be content if he does not make an internal
examination at once, for if he should there is more or less danger of
infection. And I repeat—throw nothing away—burn nothing up, save
everything that passes until your physician has carefully examined it.

SUDDEN ABDOMINAL PAIN

Sudden or severe pains in the abdomen should be reported at once to your
physician, while you should immediately go to bed and quietly remain there
until you receive further instruction from your doctor when he calls.
In the later stages of pregnancy any appearance of blood should likewise be
noted and reported without delay. These symptoms may not always be
serious, but they are also associated with grave complications, and should,
therefore, be given prompt attention.

MISCARRIAGE

Abortion is a term used to designate the loss of the embryo prior to or at the
third month. Miscarriage applies to the expulsion of the fetus or emptying
of the uterus after the third month. It is possible for a miscarriage to occur
anytime during the interim between the fourth and ninth months. After the
uneventful passing of the third month, if an accident threatens, we instruct
the mother to remain quietly in bed three to five days at the calendar date
comparable with each menstrual period; and as she approaches the seventh
month, we adjure her to be unusually careful and prudent.
The causes of miscarriages are many: Disease of the embryo, imperfect
fetal development, some constitutional disease of the mother, a faulty
position of the uterus, or it may result from something unusual about the
lining of the uterus such as an endometritis—an inflammation of the mucus
membrane.
Expectant mothers who manifest symptoms of a threatened miscarriage
should studiously avoid such exercises as climbing, riding, skating, tennis,
golf, dancing, rough carriage or automobile riding, and such taxing labor as
sweeping, lifting, washing, running the sewing machine, window cleaning,
the hanging of pictures, draperies, etc.

CRAVINGS

Within reason, a pregnant mother should follow her natural appetite and
satisfy her dietetic longings. Should she desire unusual articles of food, as
far as possible she should have them. The idea has long prevailed that if the

mother does not get what her longing soul supremely desires, that the on-
coming baby is going to cry and cry until it is given what the mother
wanted with all her heart and did not get. Such an idea is the very
quintessence of folly and the personification of foolishness and superstition.
Many a precious babe has suffered as a victim of this notion of "craving"
and "marking." One mother gave her baby a huge mouthful of under-ripe
banana because "she knew that was just what he wanted, because, when
pregnant, she had craved and craved bananas and for some reason or
another she did not get them." The soft, smooth piece of banana slipped
down the baby's throat—on into the stomach and intestines—caused
intestinal obstruction and finally the end came; and we registered one more
victim to the fallacies of fear and the superstitious belief in "cravings" and
"markings." Occasionally some cravings are unusual and freakish, for
instance, egg shells, leather, candles, chalk, and other abnormal tastes are
developed. Of these we have only to say, "Rise above them, become
mistress of the situation and change your longings." If such abnormal
cravings come to you in the kitchen, don your bonnet and go at once out of
doors and take a walk. Don't be foolish just because somebody told you
foolish stories about these things.

CONSTIPATION

Bowel hygiene is an important part of the management of pregnancy.
Constipation often proves to be very troublesome. In another chapter this
subject is treated at some length. Here, we pause only long enough to say
that habit has much to do with this difficulty. A regular time should be set
apart each day for attending to this important matter.

HEMORRHOIDS

Of all the maladies that the human family falls heir to, hemorrhoids are
among the commonest and, we may add, the most neglected. Any woman
who enters pregnancy, suffering from hemorrhoids, is going to have her full
share of suffering and pain before she has finished with her labors. Taken
early, they may be greatly helped, if not entirely relieved, by the daily use
of the medicated suppository (See Appendix). The bowel movements

should never be allowed to become hard, the dietetic advice of another
chapter should be carefully followed and the oil enema, as described in the
appendix, should be used if necessary. For immediate relief, hot witch-hazel
compresses may be applied; or, in the case of badly protruding piles, the
patient should immerse the body in a warm bath and by the liberal use of
vaseline they can usually be replaced. The physician should be called and
he will advise any further treatment the case may require.

VARICOSE VEINS

Varicose veins or the distension of the surface veins of the legs are very
common among women in general and pregnant women in particular. The
legs should be elevated whenever the patient sits, while in bad cases they
should be bandaged while standing. There are many elastic surgical
stockings on the market today that, if put on before rising in the morning,
will give much relief and comfort all during the day. Any large medical
house or physician's supply house can furnish them according to your
measurements—which should be taken before getting out of bed in the
morning. These measurements are taken according to instructions and
usually are of the instep, ankle, calf of leg, length of ankle to knee, etc.

CRAMPS

Cramps are sharp, exceedingly painful muscular spasms occurring in the
muscles of the calf of the leg, the toes, etc. The expectant mother in the later
months of pregnancy awkwardly turns in bed, is suddenly awakened and
without a moment's warning, is seized with a most excruciating pain in her
leg or toe. The most effectual treatment for these cramps is quickly to apply
a very cold object to the cramping muscle. Extremes of either heat or cold
usually relieve as well as the vigorous grasping or kneading of the muscle.
A hot foot bath on going to bed will often prevent an attack. A long walk in
the latter months of pregnancy should invariably be followed by a short hot
bath or a foot bath. Many attacks may be avoided by this procedure.

SWELLINGS

All swellings should be taken seriously by the pregnant mother to this
extent, that she save a twenty-four hour specimen of urine and that she
personally take it to her physician, with a report of her "swellings." This
symptom may or may not indicate kidney complications. The blood-
pressure together with chemical and microscopical analysis of the urine will
determine the cause.
Slight swelling of the feet is often physiological and is due to pressure of
the heavily weighted uterus upon the returning veins of the legs. The
progress of the veinous blood is somewhat impeded, hence the
accumulation of lymph in the tissues of the legs, ankles, and feet.
Never allow yourself to guess as to the cause of swellings, always take
urine to the physician and allow him definitely to ascertain the true cause.
All tight bands of the waist and knee garters must be discarded at this time.
The same general treatment suggested for varicose veins holds here.

GOITRE

The enlargement of the thyroid gland—goitre—is physiological during
pregnancy, and is believed to be caused by the throwing into the maternal
blood stream of special protein substances derived from the fetus. As just
stated, this is more or less physiological, will usually pass away after the
babe is born, and, therefore, need give the mother no particular concern.
Tight neck bands should be replaced by low, comfortable ones. The bowels
should move freely every day, and water drinking be increased as well as
sweating of the skin encouraged by a short, hot bath, followed by the dry
blanket pack, while the head is kept cool by compresses wrung from cold
water. In this manner the elimination of these poisons is increased through
both the skin and the kidneys.

Fig. 3. The Photophore.

BACKACHE

The backache of the later months of expectancy is very annoying and often
spoils an otherwise restful night's sleep. This is probably also a pressure
symptom, if the physician's analysis of the urine proves that the kidneys are
not at fault. If you have electric lights in the home, a very useful
contrivance can be made which will give you great relief. The light end of
an extension cord, five to seven feet in length, is soldered into the center of
the bottom of a bright, pressed tin pail about twelve inches in diameter at
the top and nine or ten inches deep. With the bail removed, screw in a
sixteen or thirty-two candle power bulb and attach the extension cord to a
nearby wall or ceiling socket. This arrangement supplies radiant heat and is
called a photophore (See Fig. 3). Apply this twofold remedial agent—light
and heat combined—to the painful back (underneath the bed clothing) and
our restless mother will go to sleep very quickly. This may safely be used as
often and as long as desired.

PERNICIOUS VOMITING

Persistent, prolonged, and very much aggravated cases of morning sickness
are termed pernicious vomiting. The patient emaciates because of the lack
of ability to keep food long enough to receive any benefits therefrom.
In treating these cases the sufferer should be put to bed in a room with
many open windows, or, if the weather permit, should be out of doors on a
comfortable cot. She should remain in bed one hour before the meal is
served and from one to three hours afterward. The mind should be diverted
from her condition by good reading, friends, or other amusements. The
utmost care and tact should be used in the preparation of her food, and art
should be manifested in the daintiness of the tray, etc. We found one mother
was nauseated even at the sight of her tray and so we planned a call that
should bring us to her home at the meal hour. The tray came in with the
attendant in unkempt attire, who said, as she placed it carelessly down on a
much-loved book our patient had been reading: "I heard you say you liked
vegetable soup so I brought you a big bowl full." As I gazed at the tray, I
saw a large, thick, gravy bowl running over with the soup. I usually like
vegetable soup, but at the sight of that sloppy looking bowl—well, I
thought I should never care for it again.
After installing a new maid who had a sense of service and daintiness, and
who took real pleasure in the selection of the dishes for the tray, as well as
the quality and quantity of food served in them, our patient made speedy
recovery, went on to full term and became a happy mother.
There is no doubt that the mind has very much to do with this vexing
complication of pregnancy. One mother immediately stopped vomiting
everything she ate when told by her husband that "the doctor said he was
coming in the morning to take you away from me to the hospital if you
didn't stop vomiting." Everything known should be tried for the relief of
these patients and in extreme cases, when the mother's life is endangered,
pregnancy should be terminated.

INSOMNIA

The neutral full bath, temperature 97 F., maintained for twenty minutes to
one-half hour, should be taken just on going to bed. The patient must not
talk—must rest in the bath—absolutely quiet. The causes of insomnia
should be determined if possible, and proper measures employed to remove
them. They may consist of backache, cramps, frequent urination, pressure
of the uterus on the diaphragm or pressure against the sides of the abdomen.
The bed should be large, thus giving the patient ample room to roll about.
The following procedures may be tried in an effort to relieve the
sleeplessness:
Rubbing of the spine, alcohol or witch-hazel rubbing of the entire body, the
neutral bath, or the application of the electric photophore—described a few
pages back—may be made to the painful part. Do not resort to drugs,
unless you are directed to do so by your physician.

HEADACHE

Headaches should not be allowed to continue unobserved by the attending
physician. Measure the daily output of urine, which should be at least three
pints or two quarts. In case of daily or frequent headaches, notify your
physician at once and take a twenty-four hour specimen of urine to him.
Headache is an early symptom of retained poisons and if early reported to
the physician quick relief can be given the patient and often severe kidney
complications be avoided by the proper administration of early sweating
procedures. Water drinking should be increased to two quarts (about ten
glasses) a day. Less food and more water are the usual indications in the
headaches of pregnancy.

HIGH BLOOD-PRESSURE

Blood-pressure is called high when the systolic pressure registers above 150
to 160 millimeters of mercury. Pressure above 165 should be taken
seriously and the patient should keep in close touch with her physician. Tri-
weekly examinations of the urine should be made, while eliminating baths
should be promptly instituted. The subject of blood-pressure in relation to

pregnancy will be fully dealt with in the next chapter—in connection with
toxemia, eclampsia, etc.

CHAPTER VI

TOXEMIA AND ITS SYMPTOMS

At the close of the preceding chapter on the complications of pregnancy,
brief mention was made of blood-pressure as a possible source of anxiety.
This chapter will be devoted to a further discussion of the subjects of
toxemia, eclampsia, convulsions, and especially blood-pressure—in
connection with other leading symptoms of these serious complications of
pregnancy.

TOXIC SYMPTOMS

In a former chapter we learned that the developing child nearly doubled its
weight in the last two months of pregnancy. As the child grows, its
metabolic waste matter is greatly increased, while all these poisonous
substances must finally be eliminated by the mother. Now, the mother's
waste matter is of itself considerably increased; and so, if the kidneys, the
liver, and the skin are already over-taxed in their work of normal
elimination—if they are already doing their full quota of work—we can
readily see that the additional waste matter of the unborn child will throw
much extra work on the already overworked eliminative organs, and this
results in a condition of toxemia. Certain symptoms accompany this state of
constitutional poisoning or auto-intoxication—the chief of which are:

1. Headache.
2. Dizziness.
3. Blurring of the vision.
4. Swelling of the feet and hands, or puffiness of the face.
5. Diminished urine.
6. Vomiting.
7. High blood-pressure.
8. Albumin and casts in the urine.

Any one of these symptoms may or may not indicate toxemia; but it should
be reported at once to the attending physician. In the presence of one or
more of these symptoms an expectant mother is always safe, while awaiting
the physician's advice, in carrying out the following program:

1. Drink more water or lemonade.
2. Take a mild cathartic.
3. Avoid eating much meat and other highly protein foods.

CONVULSIONS OF PREGNANCY

This serious complication of the last weeks of pregnancy demands
immediate attention. They may almost invariably be avoided if the blood-
pressure and the urine are studiously watched during the latter part of the
expectant period.
If you are unable to get your physician at once, the following treatment
should be administered immediately.
1. A hot colonic flushing (See Appendix).
2. A hot bath followed by the hot blanket pack (See Appendix).
3. One drop of croton oil on a bit of sugar may be placed on the back of the
tongue.
4. Chloroform may be administered, provided a competent nurse or other
medical person is present.
The appearance of convulsions which have been preceded by one or more
of the symptoms noted under the head of "toxemia," indicates that the
patient has become so profoundly intoxicated and poisoned by the
accumulating toxins, that the lives of both mother and child are jeopardized
by threatened eclampsia. At such a time, the attending physician will
immediately set about to bring on labor, and thus seek to empty the uterus
at the earliest possible moment.

CARDINAL SYMPTOMS OF TOXICITY

Since toxemia (eclampsia) is one of the complications of pregnancy most to
be dreaded, it is fortunate that it almost invariably exhibits early danger
signals which, if recognized and heeded, would enable the patient and
physician to initiate proper measures to avert danger and escape the
threatened disaster. The presence of this toxic danger is indicated by the
persistent presence of the following three symptoms:

1. Persistent, dull headache.
2. Presence of casts in the urine.
3. Persistent high blood-pressure, with tendency to increase.

Fig. 4. Taking the Blood Pressure.

Of course, albumin will probably appear in the urine along with the casts,
but it is the continued appearance of the casts that is of more importance as
a danger signal. Albumin is quite common in the urine of the expectant
mother, but casts—long continued—suggest trouble. Headache as an
indicator of toxemia is of special significance when coupled with the other

two cardinal symptoms of eclampsia—urinary casts and increasing high
blood-pressure. Therefore, the necessity for frequent urinary tests and
blood-pressure examinations during the last weeks of pregnancy—
especially, if the patient has suffered from headaches and has been running
albumin in the urine.

HIGH BLOOD-PRESSURE

Blood-pressure is a term used to indicate the actual pressure of the blood
stream against the walls of the blood vessels. The blood-pressure machine
tells us the same story about our circulatory mechanism, that a steam gauge
does about a high-pressure boiler (See Fig. 4). The normal blood-pressure
varies according to the age of the patient. For instance, the normal pressure
of a young person, say up to twenty years of age, runs from 100 to 120
millimeters of mercury; and then, as the age advances, the blood-pressure
increases in direct ratio; for every two years additional age the blood-
pressure increases about one point—one millimeter.
The average pregnant woman starts in her pregnancy with a blood-pressure
of say, 125 millimeters, but as pressure symptoms increase, and as
constipation manifests itself, and as the circulating fluids are further
burdened with the toxins which are eliminated from the child, the blood-
pressure normally increases to about 140 mm., and later, possibly to 150
mm. If the pressure goes no higher, we are not alarmed, for we have come
to recognize a blood-pressure of 140 as about the normal pressure of the
pregnant woman.
There are a number of factors which enter into the raising of the blood-
pressure. For instance, at any time during the pregnancy, if the eliminative
organs of the mother are doing inefficient work, if she falls a victim to a
torpid liver, diseased kidneys, decreased skin elimination, or sluggish
bowels, then, with the added and extra excretions from the child, there is
superimposed upon the mother far more than the normal amount of
eliminative work—and then, because of improper and incomplete
elimination, the blood-pressure is increasingly raised.

ECLAMPSIA PREVENTED

This whole subject can best be illustrated by relating a story, the actual
experience of Mrs. A. This patient came to the office with a history of
Bright's disease (albumin and casts in the urine), and chronic appendicitis.
While treating her for the kidney condition, preparatory to an operation for
the removal of the troublesome appendix—in the very midst of this
treatment—she became pregnant, and great indeed was our dismay. We
entertained little hope of getting both the mother and child safely through.
Frequent examination of urine was instituted, the albumin did not increase
and the blood-pressure remained at normal—about 124 mm. She paid
weekly or bi-weekly visits to the office and carefully followed the regime
outlined. She drank abundantly of water and strictly followed the dietary
prescribed. Weeks and months passed uneventful, until we approached the
last six weeks of pregnancy, and then we found to our surprise one day that
the blood-pressure had made a sudden jump up to 175 mm., while the urine
revealed the presence of numerous casts and albumin—in the meantime the
albumin had entirely disappeared. There were also other urinary findings
which showed that the liver was not doing its share in the work of burning
up certain poisons.
In her home we began the following program: Every day we had her placed
in a bathtub of hot water, keeping cold cloths upon her brow, face and neck,
and then, by increasing the temperature of the bath, we produced a very
profuse perspiration. She was taken out of this bath and wrapped in
blankets, thus continuing the sweat. All meat, baked beans, and such foods
as macaroni and other articles containing a high per cent of protein were
largely eliminated from her diet. At times she did not even eat bread. Her
chief diet was fruit, vegetables, and simple salads, and yet the albumin and
casts continued to increase in the urine and the blood-pressure climbed up
to 190 mm.
As we approached the last two weeks of pregnancy, this little woman was
taken to the hospital and systematic daily treatment with sweating
procedures was begun. Among other things, she had a daily electric light
bath. After each of these baths she was wrapped in blankets and the
sweating continued for some time. Careful estimations of albumin were
made daily and the blood-pressure findings noted three times a day. During
the last week of pregnancy she lived on oranges and grapes. Day by day she
was watched until the eventful hour arrived. She went into the delivery

room and gave birth to a perfectly normal child. The albumin and casts
quickly cleared up, the blood-pressure lowered, and today the little woman
is a fond mother of a beautiful baby boy.
It is hard to estimate what might have taken place had not her elimination
been stimulated. The blood-pressure was our guide. Had the albumin
(without casts) appeared in the latter weeks of pregnancy with a blood-
pressure of 140 or 150 mm., we would not have become excited, for the
reason that in every normal pregnancy there is often present a trace of
albumin in the latter weeks; but when the blood-pressure jumped to 170 or
190, then we knew that toxemia—eclampsia—convulsions—were
imminent. So we have in recent years, come to look upon the blood-
pressure as an exceedingly important factor—as an infallible indicator of
approaching trouble—as a red signal light at the precipice or the point of
danger; and it not only warns us of the danger, but it tells us about how near
the boilers are to the bursting point. The glassy eye, the headache, the full
bounding pulse and the blurring of vision, are all symptoms accompanying
this high blood-pressure, so that in these enlightened days no practitioner
can count himself worthy the name, or in any way fit to carry a pregnant
woman through the months of waiting, unless he sees, appreciates, and
understands the value of blood-pressure findings in pregnancy.

CHAPTER VII

PREPARATIONS FOR THE NATAL DAY

Two months before baby is to arrive, the expectant mother should pay
particular attention to the conservation of her strength. The woman who is
compelled to leave her home for the factory, the laundry, the office, or other
place of employment, should stop work during these last two or three
months. The active club woman should pass the burdens on to others, and
the woman of leisure should withdraw from active social life with its varied
obligations. During the final weeks of pregnancy, the prospective mother
needs the same hygienic care regarding fresh air, exercise, diet, and water
drinking, as outlined in a former chapter.

THE FINAL WEEKS

As the gravid uterus rises higher in the abdomen, increased pressure is
exerted on the stomach, the lungs, and upon the nerve centers of the back;
and it is because of this situation, that the duties and obligations of the
prospective mother should be reduced to a minimum, that she may feel at
liberty to lie down several times during the day on the porch or in a well-
ventilated room, in the midst of the best possible surroundings. Sexual
intercourse should be largely discontinued during the last months of
pregnancy.
I sometimes wish the prospective mothers in our dispensary districts might
have some of the care and the kind treatment which is bestowed upon an
ordinary prospective mother horse, which at least enjoys a vacation from
heavy labor, and whose food is eaten with calm nerves and in the quietness
of a clean stall. While the state of the mother's mind does not materially
influence the child; nevertheless, the state of the mother's body, the weary
over-worked muscles and nerves of hot, tired women, bending over cook
stoves, laundry tubs, or scrubbing floors, does materially derange the
mother's health and digestion, which in turn, reflexly interferes with the
growth and physical development of her child. Extra strength is required for

the day of labor, and since the baby doubles its weight during the last two
months, the mother is living for two, and should, therefore, avoid extreme
fatigue, over tiring, and irksome labor during these final weeks of watchful
waiting.

SELECTION OF THE HOME

It may or may not be within the province of prospective parents to
rearrange, rebuild, or otherwise change the home. Usually the size of the
pocketbook, the bank account, or the weekly pay envelope decide such
things for us. The home may be in the country or suburbs, with its wide
expanse of lawns, its hedges of shrubbery, and with its spacious rooms and
porches; or it may be a beautifully equipped, modern apartment on the
boulevard of a city, with its sun parlors, large back porches, conveniently
located near some well-kept city park, or it may be one of those smaller but
"snug as a bug in a rug" apartments, in another part of the city, where
usually there is a sunny back porch; or again some of my readers may
themselves be, or their friends may be, in a darkened basement with broken
windows, illy ventilated rooms, with no porches, no yards, no bright rays to
be seen coming in through windows—and yet into all of these varied homes
there come little babies—sweet, charming little babies, to be cared for,
dressed, fed, and reared. And we must now proceed to the subject of
making the most of what we have—to create out of what we have, as best
we can, that which ought to be.

SANITARY PREMISES

In both the country and city place, yards and alleys should be cleaned up.
Garbage—the great breeding place of flies—should be removed or burned.
The manure pile of the stable or alley should also be properly covered and
cared for. In this way breeding places for flies are minimized and millions
and billions of unhatched eggs are destroyed. In the large cities, provision is
made for the prompt disposal of garbage, and laws are beginning to be
enforced regarding the covering and the weekly removal of manure, and
thus in many of our large cities flies are diminishing in numbers each year.
Fly campaigns and garbage campaigns are teaching us all to realize the

dangers of infection, contagion, and disease as a result of filth; while
through the schools, the children of even our foreign tongued neighbors
take home the spirit of "cleaning up week." Even in the rural districts we
hope for the dawning of the day when filth, stagnant pools, open manure
piles, and open privies, will be as much feared as scorpions or smallpox.

ENGAGING THE DOCTOR

As suggested elsewhere, as soon as the expectant mother is aware that she
is pregnant, she should engage her physician. And since these are days of
specialists, he may or may not be the regular family doctor. The husband
and friends may be consulted, but the final choice should be made by the
prospective mother herself. "The faith which casts out fear, the indefinable
sense of security which she feels in her chosen physician, supports her
through the hours of confinement." Twenty-four hour specimens of urine
should be saved and taken to the physician twice each month and oftener
during later months of pregnancy. The chosen physician's instructions and
suggestions should be carried out and counsel should be sought of him as to
the place of confinement.

THE PLACE OF CONFINEMENT

There are a number of factors that enter into the selection of the place of
confinement. In the first place, if the home be roomy, bathroom convenient,
if the required preparation of all necessities for the day of labor can be
effected, and it is further possible to prepare a suitable delivery-room at
home with ample facilities for emergencies and complications, and you can
persuade your physician to do it—then the best place in the world for the
mother to be confined is within the walls of her own home. But such is the
case in but one home out of hundreds, and I regret that time and space will
not allow me to describe and portray the many untimely deaths that might
have been avoided if this or that supply had only been ready at the moment
of the unexpected complication of delivery. Why should we needlessly risk
the lives of prospective mothers, when, in every up-to-date hospital
delivery-room, all these life-saving facilities are freely provided? Here in
the modern hospital, the mothers from small homes and apartments, the

mothers who live in stuffy basements, as well as those from the average
home in the average neighborhood, can come with the assurance of
receiving the best possible care and attention. Every woman who can
arrange or afford it, should plan to avail herself of the benefits, comforts,
quietness, and calm of a well-equipped hospital and the surgical cleanliness
and safety of its aseptic delivery-room.
Fortunately, the mother of the basement home may have the same clean,
sterile dressings used upon her as does the mother of the boulevard
mansion. The maternity ward bed at $8.00 to $10.00 a week can be just as
clean as the bed of the $40.00 a week room. The methods and procedures of
the delivery-room can be just as good in the case of the very poor woman as
in the case of the magnate's wife. In no way and for no reason fear the
hospital. It is the cleanest, safest, and by far the cheapest way. The weekly
amount paid includes the board of the patient, the routine care, and all
appliances and supplies of every sort that will be used. Under no
circumstances should a midwife be engaged. Any reputable physician or
any intellectual minister will advise that. Let your choice be either the
hospital or the home; but always engage a physician, never a midwife.

THE NURSE

After selecting the place of confinement, the question of the nurse may next
be considered. If it is to be the hospital, you need give little further thought
to the nurse, for your physician will arrange for the nurse at the time you
enter the hospital. She will be a part of the complete service you may enjoy.
You will find her on duty as you, quietly resting in your room, awaken in
the sweet satisfaction that at last it is all over—at last your baby is here.
A competent nurse is a necessity, if the confinement takes place in the
home. She may be a visiting nurse, who, for a small fee, will not only come
on the day of labor, but will make what is known as "post-partum calls"
each day for ten or twelve days. These are short calls, but are long enough
to clean up the mother and wash and dress the babe. She is not supposed to
prepare any meals or care for the home. Then there is the practical nurse—
women who have prepared themselves along these lines of nursing, whose
fees range from $12.00 to $18.00 a week. If your physician recommends

one to you, you may know she is clean and dependable. The trained nurse,
who has graduated from a three years' course of training, is prepared for
every emergency, and will intelligently work with the physician for the
patient's welfare and comfort. Her fees range from $25.00 to $35.00 a week.
Both the practical and the trained nurses are human beings, and require rest
and sleep the same as all other women do. One nurse, after having faithfully
remained at her post of duty some sixty hours reminded the husband and
sister of the patient that she must now have five hours of unbroken rest and
they replied in a most surprised manner, "Why we are paying you $30.00 a
week, and besides, we understood you were a trained nurse."
The physician usually makes arrangement with the family for competent
relief for the nurse. She should have at least one to two hours of each day
for an airing, and six hours out of the twenty-four for sleep.

PREPARATIONS FOR A HOME DELIVERY

The supplies should all be in the home and ready, as the seventh month of
pregnancy draws near. In the first place, select the drawer or closet shelf
where the supplies are to remain, untouched, until your physician orders
them brought out. The supplies requiring special preparation and
sterilization are:

Three pounds of absorbent cotton. Twelve old towels or diapers.
One large package of sterile gauze One yard of strong narrow tape for
(25 yards). tying the cord.
Four rolls of cotton batting. Three short obstetrical gowns for the
patient.
Two yards of stout muslin for Two pairs of extra long white
abdominal binders. stockings.
Two old sheets. Four T-binders.

Other articles needed by physician, nurse, and patient are:

Fifty bichloride of mercury tablets One good sized douche pan.
(plainly marked "poison").

Four ounces of lysol. Three agateware bowls, holding two
quarts each.
Two ounces of powdered boric acid. Two agateware pitchers, holding two
quarts each.
One half ounce of 20% argyrol. Two stiff hand-brushes.
One quart of grain alcohol. One nail file.
One pound jar of surgeon's green One pair surgeon's rubber gloves.
soap.
One half pound of castile soap. One and one-half yards rubber
sheeting 36 inches wide.
One bottle white vaseline. Two No. 2 rubber catheters.
One drinking tube. Two dozen large safety pins.
One medicine glass. Small package of tooth picks, to be
used as applicators.
One two-quart fountain syringe. Six breast binders (Fig. 5).
One covered enamel bucket or slop Six sheets.
jar.

Just before confinement send for one ounce of fluid extract of ergot and an
original pint bottle of Squibb's Chloroform.

THE PREPARATION OF THE SUPPLIES

1. The sanitary pad is used to absorb the lochia after confinement, and
needs to be changed many times during the day and night; fully five or six
dozen will be required. They are usually made from cotton batting and a
generous layer of absorbent cotton. If made entirely from absorbent cotton
they mat down into a rope-like condition. They are four and one-half to five
inches wide and ten inches long. The sterile cheesecloth is cut large enough
to wrap around the cotton filling and extends at both ends three inches, by
which it is fastened to the abdominal binder. With a dozen or fifteen in each
package these vulva pads are wrapped loosely in pieces of old sheets and
pinned securely and marked plainly on the outside.

2. Delivery pads. These pads should be thirty-six inches square and about
five inches thick, three or four inches of which may be the cotton batting
and the remainder absorbent cotton. Three of these are needed. Each should
be folded, wrapped in a piece of cloth and likewise marked.
3. Gauze squares. Five dozen gauze squares about four inches in size may
be cut, wrapped and marked. These are needed for the nipples, baby's eyes,
etc.

Fig. 5. Breast Binder.

4. Cotton pledgets. These are cotton balls, made as you would a light biscuit
with the twist of the cotton to hold it in shape. They should be about the
size of the bottom of a teacup. These are thrown in a couple of pillow slips
and wrapped and marked.
5. The Bobbin. Cut the bobbin or tape into four nine-inch lengths and wrap
and mark.
6. The tooth picks are left in the original package and do not require
sterilization.
7. Sterilization. Before steaming and baking, wrap each bundle in another
wrapping of cloth and pin again securely. Mark each package plainly in
large letters or initials. These packages may be sent to the hospital for
sterilization in the autoclave or they may be steamed for one hour in the

large wash boiler, by placing them loosely into a hammock-like
arrangement made by suspending a firm piece of muslin from one handle of
the boiler to the other. The center of the hammock should come to within
five inches of the bottom of the boiler which contains three inches of
boiling water. The cover of the boiler is now securely weighed down and
the water boils hard for one hour, at the end of which time they are removed
and placed in a warm oven to dry out. The outer wrapping may be slightly
tinged with brown by this baking. After a thorough drying they are allowed
to remain in the same wrappings into which they were first placed and put
away in a clean drawer awaiting the "Natal Day."

REQUISITES FOR THE HOSPITAL

Each hospital has its own methods and regulations for caring for obstetrical
patients and it is well for the expectant mother to visit the obstetrical
section, the delivery-room and the baby's room, that she may personally
know more about the place where she is to spend from ten days to two
weeks. Here she may ascertain from the superintendent just what she will
need to bring for the baby. Many of the hospitals furnish all the clothes
needed for the baby while in the hospital; in such instances, the hospital
also launders them. Other hospitals require the baby's clothes to be brought
in, in which case the mother looks after the laundry. The mother always
takes her toilet articles, a warm bed jacket with long sleeves, several night
dresses and a large loose kimono or wrapper to wear to the roof garden or
porch in the wheel chair. Warm bedroom slippers and a scarf for the head
completes the outfit.

BABY'S NECESSITIES

Baby's basket on the day of confinement should contain:

One pound of absorbent cotton. A powder box containing powder
and puff.
One pint of liquid albolene. An old soft blanket in which to
receive the child after birth.

One half ounce of argyrol A soft hair brush.
(mentioned in the mother's list).
Safety pins of assorted sizes. Three old towels.
Small package of sterile gauze A pair of silk and wool stockings.
squares.
Scales. A flannel skirt.
Diapers. An outing flannel night dress.
A silk and wool shirt (size No. 2). A woolen wrapper.
An abdominal band to be sewed on
with needle and thread.

THE CONFINEMENT ROOM

By special preparation, the ordinary bedroom may be fashioned into a
delivery-room. Carpets, hangings and upholstered furniture must be
removed. Clean walls, clean floors, and a scrupulously clean bed must be
maintained throughout the puerperium. Bathroom, and if possible, a porch
should be near by. In the wealthy home, a bedroom, bathroom and the
nursery adjoining is ideal; but I find that real life is always filled with
anything but the ideal.
The dispensary doctor is compelled to depend upon clean newspapers to
cover everything in the room he finds his patient in. The only sterile things
he uses he brings with him, and should he have to spend the night, the floor
is his only bed. A student who was in my service told me that there was not
one article in the entire home, which consisted of but one room, that could
be used for the baby. He wrapped his own coat about it and laid it carefully
in a market basket and placed it on the floor at the side of the pallet on
which the mother lay and by the aid of a nearby telephone secured clothes
from the dispensary for the babe.
Always select the best room in the house for a home confinement. If the
parlor is the one sunny room, take it; remove all draperies, carpet, etc., and
make it as near surgically clean as possible. While sunshine is desirable,
ample shades must be supplied, as the eyes of both mother and babe must
be protected.

THE BED

A three-quarter bed is more desirable than a double bed. If it is low, four-
inch blocks should be placed under each leg, the casters having been
removed to prevent slipping. The bed should be so placed that it can be
reached from either side by the nurse and physician. The mattress may be
reenforced by the placing of a board under it if there is a tendency to sag in
the middle. Over this mattress is securely pinned the strip of rubber sheeting
or table oilcloth. A clean sheet covers mattress and rubber cloth and at the
spot where the hips are to lie may be placed the large sterile pad to absorb
the escaping fluids. The floor about the bed is protected by newspapers or
oilcloth. Good lighting should always be provided. Much trouble and
possible infection may be avoided by clean bedding, plenty of clean
dressings, boiled water, rubber gloves, and clean hands.

CHAPTER VIII

THE DAY OF LABOR

As the two hundred and seventy-three days come to a close, our expectant
mother approaches the day of labor with joy and gladness. The long, long
waiting days so full of varied experiences, so full of the consciousness that
she, the waiting mother, is to bring into the world a being which may have
so many possibilities—well, even the anticipated pangs of approaching
labor are welcomed as marking the close of the long vigil. These days have
brought many unpleasant symptoms, they have been days of tears and
smiles, of clouds and sunshine.

THE TIME OF WAITING

The prospective mother has thought many times, "Will my baby ever
come?" But nature is very faithful, prompt, and resourceful. She ushers in
this harvest time under great stress and strain, for actual labor is before us—
downright, hard labor—just about the hardest work that womankind ever
experiences—and, as a rule, she needs but little help—good direction as to
the proper method of work and the economical expenditure of energy. In the
case of the average mother this is about all that is needed, and if these
suggestions come from a wise and sympathetic physician—one who
understands and appreciates asepsis—she may count herself as fortunately
situated for the oncoming ordeal.
In the days of our grandmothers it was almost the exception rather than the
rule to escape "child-bed fever," "milk leg," etc.; but in these enlightened
days of asepsis, rubber gloves, and the various antiseptics, puerperal
infection is the exception, while a normal puerperium is the rule; and this
work of prevention lies in the scrupulous care taken by anyone and
everyone concerned in any way with the events of the day of labor.
On this day of labor, the mother, who has gone through the long tedious
days of waiting, should see to it that nothing unclean—hands, sponges,

forcep, water, cloth—is allowed to touch her. Above all things do not
employ a physician who has earned the reputation of being a "dirty doctor."
Puerperal infection is almost wholly a preventable disease and every patient
has a right to insist upon protection against it.
In a former chapter will be found a detailed description of the "delivery
bed." Beside this bed, or near by, are to be found the rack on which are
airing the necessary garments for the baby's reception—the receiving
blanket and other requisites for the first bath—together with numerous
other articles essential to safety and comfort.
There should be an easy chair in the room for the mother to rest in between
her walking excursions during the first stages of labor. The sterilized pads
and necessary articles mentioned in an earlier chapter are, of course, close
at hand.

FIRST SYMPTOMS OF LABOR

Regular, cramp-like pains in the lower portion of the abdomen which are
frequently mistaken for intestinal colic, often beginning in the lower part of
the back, and extending to the front and down the thigh, are often the first
symptoms of the approaching event. With each cramp or pain the abdomen
gets very hard and as the pain passes away the abdomen again assumes its
normal condition. These regular cramp-like pains are the result of the early
dilation of the cervix—the first opening of the door to the uterine room
which has housed our little citizen through the developmental stages of
embryonic life—and as a result of this stretching and dilating there soon
appears that special blood-tinged mucus flow commonly known as "the
show."

THE PRELIMINARY BATH

At this time a very thorough-going colonic flushing should be administered.
The patient takes the "knee-chest" position, or the "lying-down" position,
and there should flow into the lower bowel three pints of soapy water; this
should be retained for a few moments; and after its expulsion, a short, plain
water injection should be given. Now follows the preliminary general bath.

Just prior to the bath, the pubic hair should be clipped closely, or better
shaved. Then should follow a thorough soap wash, with patient standing up
in the tub, using plenty of soap, applied with a shampoo brush or rough
turkish mit. The rinsing now takes place by either a shower or pail pour. Do
not sit down in the tub. This is a rule that must not be broken, because of the
danger of infection in those cases where the bag of waters may have broken
early in the labor.
A weak antiseptic solution, prepared by putting two small antiseptic tablets
into one pint and a half of warm water, is now applied to the body from the
breasts to the knee. Put on a freshly laundered gown, clean stockings and
wrapper. The head should be cleansed and hair braided in two braids.

THE PROGRESS OF LABOR

If all the mothers who read this volume could bear children with the
comfort Mrs. C. does, I should be happy, indeed.
At four o'clock one morning a very much excited father telephoned me,
"Hurry, quick, Doctor, it's almost here." It was well that we did hurry, for
the first sign the little mother had was the deluge of the waters—at this
point the husband ran to telephone for the doctor—no more pains for thirty-
eight minutes (just as we entered the door) and the baby was there. But such
is not usually the case, nor will it be, as labor usually progresses along the
lines of conscious dilating pains, occurring at intervals twenty minutes apart
at first, later drawing nearer together until they are three to five minutes
apart. This "first stage of labor" lasts from one to fifteen hours—during
which time the tiny door to the uterine room which was originally about
one-eighth of an inch open—dilates sufficiently to allow the passage of the
head, shoulders and body of the fully developed child.
About this time the bag of waters usually bursts, and, as a rule, this marks
the beginning of the "second stage of labor." The amount of water passed
varies in amount. Should the rupture take place before the door is fully
open, then labor proceeds with difficulty and the condition is known as "dry
labor."

The head after proper rotation now begins the descent; and here the pains
begin to change from the sharp, lancinating, cramp-like pains which begin
in the back and move around to the front, to those of the "bearing down"
variety, while at the same time there begins to appear the bulging at the
perineum, which means that the head is about to be born. At this time great
stress is brought to bear upon the perineum and often, in spite of anything
that can be done to prevent it, the perineum is more or less lacerated.
As soon as the baby is born the "second stage of labor" has passed and
within thirty to fifty minutes the close of the third stage of labor is marked
by the passage of the placenta or "afterbirth."

FALSE LABOR PAINS

Sometimes, as long as two weeks before the birth of the child, certain
irregular, heavy, cramp-like pains occur in the abdomen and back. For a
half-dozen pains they may show some signs of regularity; but they usually
die down only to start up again at irregular intervals. These are known as
"false pains."
When the pains begin to take on regularity and gradually grow heavier and
it is near the appointed time for the labor, the patient should prepare to start
for the hospital; or, if it is to be a home delivery, the physician should be
called. As noted above, the first subjective symptom may be the rupture of
the bag of waters, and it is imperative to prepare at once for the labor. It is
far better to spend the day at the hospital, or even two days waiting, rather
than to run the risk of giving birth to the child in a taxicab or street car; or,
in the event of a home labor, to have the child born before the doctor
arrives.

WHAT TO DO IN THE ABSENCE OF A DOCTOR

It is often the case that when we need our physician the most, he is busy
with another patient and cannot come, or perhaps an automobile accident
detains the man of the hour. The hospital delivery always possesses this
advantage over the home—physicians are always on hand. We deem it wise

to relate in detail the method of procedure during the rapid birth of a child;
that the husband or nurse may give intelligent and clean service.
After the patient has been given the enema and has been shaved and the
bath has been administered as previously directed, the helper most
vigorously "scrubs up." There are three distinct phases to the "scrubbing
up": First, the three-minute scrubbing of the hands and forearms with a
clean brush and green soap; to be followed by, second, the trimming and
cleaning of the finger nails, for it is here, under the nails, that the micro-
organism lives and thrives that causes child-bed fever or septicemia; and,
third, the final five-minute scrubbing of the fingers, hands, and forearms.
An ordinary towel is not used to dry the well-cleansed hands, but they are
now dipped in alcohol and allowed to dry in the air.
And now if the pains are returning every three to five minutes or if the bag
of waters has broken, the patient should go to bed. She will lie down on her
back with the knees drawn up and spread apart. The patient, having had the
cleansing bath, is now washed with the disinfectant bath (2 antiseptic
tablets to 1½ pints of water), from the breasts to the knees. Another member
of the family takes the outer wrappings off the sterilized delivery pad and
the "clean" helper places the sterile delivery pad under the expectant
mother, who is directed to "bear down" when her pains come. She may be
supported during these pains by pulling on a sheet that has been fastened to
the foot of the bed.
The clean, helper then sits by her constantly until the baby is born but under
no circumstances should touch her until after the head appears. Immediately
after the birth of the head, the shoulders usually follow with the next pain,
which ought to occur within two or three minutes. Occasionally the face
turns blue, in such an instance, the mother is directed to strain vigorously
and presses down heavily on the abdomen with both her hands, this usually
hurries matters materially, and the body of the child follows quickly. The
baby should cry at once. If the child does not show signs of life, quick,
brisk slapping on the back usually brings relief. During the birth of the head
it is imperative that, in the event of liquid passing at the same time, no
water or blood be sucked into the mouth by the baby. Great care must be
exercised in this matter. Should the baby remain blue, lay it quickly upon its
right side near the mother, and after the pulse of the cord has stopped

beating the clean helper ties the cord twice, two inches from the child and
again two inches from this tying toward the mother, and then the cord is cut
between the two tyings with scissors that have been boiled twenty minutes.
Should there be more difficulty with the breathing of the new born child, if
slapping it on the back brings no relief, its back (with face well protected)
may be dipped first in good warm water, then cold, again in the warm, again
in the cold—this seldom fails. The child should then be kept very warm,
lying on its right side.

CARE OF THE MOTHER

All this time, a member of the family has been firmly grasping the mother's
abdomen, and within an hour the afterbirth passes out through the birth
canal. If the physician has not yet arrived, all dressings, the pad, the
afterbirth, must all be saved for his inspection.
The inside of the thighs and the region about the vagina is now washed with
bichloride solution, the soiled delivery pad removed, a clean delivery pad is
placed under her; an abdominal binder is applied and two sterile vulva pads
are placed between the legs, and hot water bottles are put to her feet, as
usually at this stage there is a slight tendency toward chilliness. She should
now settle down for rest. Fresh air should be admitted into the room. There
may be some hemorrhage, and if it is excessive, grasp the lower abdomen
and begin to knead it until you distinctly feel a change in the uterus from
the soft mass to a hard ball about the size of a large grape fruit; thus
contraction has been brought about which causes the hemorrhage to
decrease. If the doctor has not yet arrived put the baby to the breast, and
place an ice bag for ten or fifteen minutes on the abdomen just over the
uterus. Should there be lacerations, the doctor will attend to their repair
when he comes. One teaspoonful of the fluid extract of ergot is usually
given at this time, if possible get in touch with the physician before it is
administered.

CARE OF THE BABY

After the mother is comfortable, your attention is directed to the baby; the
condition of the cord is noted; should it be bleeding, do not disturb the
tying, but tie again, more tightly just below the former tying, and with the
long ends of the tape, tie on a sterile gauze sponge or a piece of clean
untouched medicated cotton, thus efficiently protecting the severed end of
the cord. No further dressing is needed until the doctor arrives.
Grave disorders have arisen from infection through the freshly cut umbilical
cord.
Should the doctor be longer delayed, one drop of twenty per cent argyrol
should be dropped in each of the infant's eyes and separate pieces of cotton
should be used for each eye to wipe the surplus medicine away.
This application must not be long neglected, for a very large per cent of all
the blindness in this world might have been avoided had this medicine been
placed in each eye soon after birth.
The warmed albolene is now swabbed over the entire body of the infant
(this is done with a piece of cotton), the arm pits, the groins, behind the
ears, between the thighs, the bend of the elbow, etc, must all receive the
albolene swabbing. In a few minutes, this is gently rubbed off with a piece
of gauze or an old soft towel, and the baby comes forth as clean and as
smooth as a lily and as sweet as a rose.
The garments are now placed on the child—first the band, then shirt, diaper,
stockings, flannel skirt, and outing flannel gown—and it is put to rest after
the administration of one teaspoonful of cooled, boiled water. In six to eight
hours it will be put to the breast.

CHAPTER IX

TWILIGHT SLEEP AND PAINLESS LABOR

In recent years much has appeared in both the popular magazines and the
medical press concerning the so-called "twilight sleep" and other methods
of producing "painless childbirth." Many of these popular articles in the lay
press cannot be regarded in any other light than as being in bad taste and
wholly unfortunate in their method and manner of presenting the subject;
nevertheless, these writings have served to arouse such a general public
interest in the subject of obstetric anesthetics, that we deem it advisable to
devote two chapters to the brief and concise consideration of the subjects of
pain and anesthetics in relation to the day of labor.

THE PAIN OF LABOR

First, let us briefly consider the question of pain in connection with
childbirth. Many women—normal, natural, and healthy women—suffer but
comparatively little in giving birth to an average-sized baby during an
average and uncomplicated labor. Like the Indian squaw, they suffer a
minimum of pain at childbirth—at least this is largely true after the birth of
the first baby; and so there is little need of discussing any sort of anesthesia
for this group of fortunate women; for at most, all that would ever be
employed in the nature of an anesthetic in such cases, would be a trifle of
chloroform to take the edge off the suffering at the height or conclusion of
labor.
But the vast majority of American mothers do not belong to this fortunate
and normal class of women who suffer so little during childbirth; they
rather belong to that large and growing class of women who have dressed
wrong; who have lived unhealthful and sometimes indolent lives; who are
more or less physically and temperamentally unfitted to pass through the
experiences of pregnancy and the trials of labor.

The average American woman shrinks from the thought and prospect of
suffering pain; she is quite intolerant with the idea of undergoing even the
few brief moments of physical suffering attendant upon childbirth. She
refuses to contemplate the day of labor in any other light than that which
insures her against all possible pain and other physical suffering.
And it is just this unnatural and abnormal fear of labor-pains—this
unwomanly dread of the slightest degree of physical suffering—that has
indirectly led up to so much discussion regarding the employment of
"twilight sleep" and other forms of obstetric anesthesia.
While the authors recognize the great blessing of anesthesia to the woman
in labor—and almost unfailingly make use of it in some form—
nevertheless, we also recognize that it would be a fine form of mental
discipline and mighty good moral gymnastics, if a great many self-centered
and pampered women would "spunk right up" and face the ordeal of labor
with natural courage and normal fortitude. It would be "the making of
them," it would make new women out of them, it would start them out on
the road to real living. At the same time we do not mean to advocate that
women should suffer unnecessary pain in childbirth any more than we
allow them to suffer in connection with surgery.

PREPARATION FOR LABOR

While so much is being written about "twilight sleep" and "painless labor,"
it might be well to remind the American mother that much can be done to
lessen the sufferings of the day of labor by one's method of living prior to
the confinement.
We believe that child-bearing is a perfectly normal physical function for a
healthy and normal woman—that it is even essential to her complete
physical health, mental happiness, and moral well-being. Theoretically,
child-bearing ought to be but little more painful than the functionating of
numerous other vital organs—stomach, heart, bladder, bowels, etc.—and,
indeed, it is not in the case of certain savage tribes and other aboriginal
people, such as our own North American Indian.

But we must face the facts. The average American woman does suffer at
childbirth; and she suffers more than we are disposed to allow her, or more
than she, as a general rule, is willing to suffer. So, while we discuss
appropriate methods of lessening the pain of labor and the pangs of
childbirth by the scientific use of anesthetics, let us also call attention to
certain things which may aid in decreasing the amount of pain which may
reasonably be expected to attend child bearing.
To assist in bringing about this preparation for decreased pain at childbirth,
mothers should teach their daughters how to develop, strengthen, and
preserve their physical, mental, and moral resistance. The young mother
should be taught by both her mother and her physician how to dress, how to
work, and how to eat. Every care should be given to the hygiene of
pregnancy and labor.
The expectant mother should have plenty of fruits and fruit juices, and if
not physically well endowed to give birth to a large babe, she should have
her diet restricted in meat, bread and milk, as well as the cereals.
Overeating during pregnancy should be carefully guarded against, as
emphasized in an earlier chapter. Deformities of the pelvis, etc., should rule
out a consideration of pregnancy.
While artificial painless childbirth by means of "twilight sleep" and other
similar methods all have their place; nevertheless, these procedures should
not lead to the neglect of those natural methods and preventive practices
which aid in preparing the normal expectant mother for nature's relatively
painless labor. When so much anesthesia has to be used in a normal labor, it
cannot but strongly suggest that both patient and physician have neglected
those common but efficient methods which contribute indirectly to
lessening the pangs of child bearing.

WHAT IS TWILIGHT SLEEP?

"Twilight sleep" is a recent term which has become associated in the public
mind with "painless labor." The reader should understand that "twilight
sleep" is not a new method of obstetric anesthesia. While this method of
inducing "painless labor" has been brought prominently before the public
mind in recent years by much discussion and by numerous magazine

articles—being often presented in such a way as sometimes to lead the
uninstructed layman to infer that a new method of obstetric anesthesia had
just been discovered—it has, nevertheless, been known and more or less
used since 1903. Later known as the "Freiburg Method," and as the
"Dammerschlaf" of Gauss, and still later popularized as "twilight sleep,"
this "scopolamin-morphin" method of obstetric anesthesia, has gained wide
attention and acquired many zealous advocates.
"Twilight sleep" is, therefore, nothing new—it is simply a revival of the old
combination of scopolamin and morphin anesthesia. While many different
methods of administering "twilight sleep" have been devised, the following
general plan will serve to inform the reader sufficiently regarding the
technic of this much-talked-of procedure.
The scopolamin must always be fresh, although different forms of the drug
are used. It tends quickly to decompose—forming a toxic by-product—and,
according to some authorities, this decomposed scopolamin is responsible
for many undesirable results which have attended some cases of "twilight
sleep." Various forms of morphin are also used, as also is narcophin.

TECHNIC OF "TWILIGHT SLEEP"

The "twilight-sleep" injections are not started until the patient is in the stage
of active labor. The initial injection consists of the proper dose of
scopolamin and morphin (or some of their derivatives), while the patient's
pupils, pulse, and respiration are carefully noted, as also are the character of
the uterine contractions and the character of the fetal heart action.
Usually within an hour, a second dose of scopolamin is given, while the
application of so-called "memory tests" serves to indicate whether it is
advisable to administer additional injections. Some leading advocates of
this method claim that the majority of the unfavorable results attendant
upon "twilight sleep" are the direct result of failure to control the dosage of
the drug by these "memory tests;" and they call attention to the large
percentage of "painlessness" as proof of probable overdosing. If the
patient's memory is clear and she is not yet under the influence of the drug,
a third dose is soon given. If, however, the patient is in a state of amnesia
(lack of memory), this third injection is not commonly given until about one

hour after the second injection. The amount of amnesia present is used as a
guide for repeated injections at intervals of one to one and a half hours. As a
rule, the morphin is not repeated.
It must be evident that the success of such a method of anesthesia must
depend entirely upon thoroughgoing personal supervision of the individual
patient by a properly trained and experienced physician; and it is for just
these reasons that "twilight sleep" is destined to remain largely a hospital
procedure for a long time to come.
Experience has shown that those cases of "twilight sleep" that are not under
the influence of scopolamin over five or six hours do vastly better than
those under a longer time. When employed too long before labor this
method seems to favor inertia and thus tends to increase the number of
forceps deliveries.
The number of injections may run from one to a dozen or more, and
patients have come through without accident with fifteen or more doses,
running over a period of twenty-four hours.

THE CLAIMS OF "TWILIGHT SLEEP"

While "twilight sleep" as a method of anesthesia is not altogether new,
many of the claims made for it by recent advocates are more or less new;
and, to enable the reader clearly to comprehend both the advantages and
disadvantages of this method, both the favorable and unfavorable facts and
contentions will be summarized in this connection. The favorable claims
made for "twilight sleep" are:
1. That eighty to ninety per cent of all women who use this method can be
carried through a practically painless labor.
2. That there is practically no danger to the mother (some degree of danger
to the child is admitted by most of its champions) other than those
commonly attendant on the older and better known methods in general use.
3. That "twilight sleep," being almost exclusively a hospital procedure,
would result in more women going to the hospital for their confinement—if

it were used more; and would, therefore, tend to bring about more careful
supervision and individual care on the part of the attending obstetrician.
4. That by lessening the dread of labor and the fear of painful childbirth,
there will probably occur an increase in the birth rate of the so-called
"higher classes of society"—the social circles which now show the lowest
birth rates.
5. That it is of special value in the cases of certain neurotic women and
those of low vital resistance; especially those patients suffering from certain
forms of heart, respiratory, kidney, and other organic diseases.
6. Some authorities maintain that "twilight sleep" is of value even in
threatened eclampsia, although they admit it tends to produce a rise in
blood-pressure.
7. It is supposed to shorten the first stage of labor—by facilitating the
dilation of the cervix—owing to the painless stretching; although the
majority of its special advocates admit that it lengthens the second stage of
labor, during which the patient must be very closely watched.
8. That even in those cases where the sense of pain is not entirely destroyed,
the patient seems to possess little or no subsequent memory of any physical
suffering or other disagreeable sensations.
9. That the method is of special value in sensitive, high-strung, nervous
women of the "higher classes," who so habitually shun the rigors of child
bearing—especially in the instance of their first child.
10. That the action of scopolamin is chiefly upon the central nervous system
—the cerebrum—that it diminishes the perception of pain without
apparently decreasing the contractile power of the uterus; labor may,
therefore, proceed with little or no interruption, while the patient is quite
oblivious to the accompanying pains.
11. That the physical and nervous exhaustion is quite entirely eliminated—
especially in the case of the first labor—that patients who have had this
method of anesthesia appear refreshed and quite themselves even the first
day after labor.

12. That there is decidedly less "trauma" (appreciable injury) to the nervous
system and therefore less "shock;" and that all this saving of nervous strain
tends greatly to hasten convalescence.
13. And, finally, that "twilight sleep" does not interfere with the carrying
out of any other therapeutic measures which may be deemed necessary for a
successful termination of the labor.

DANGERS OF TWILIGHT SLEEP

While we are recounting the real and supposed advantages of "twilight
sleep"—especially in certain selected cases—it will be wise to pause long
enough to give the same careful consideration to the known and reputed
dangers and drawbacks which are thought to attend this method of
anesthesia in connection with labor cases.
We desire to state that these expressions, both for and against "twilight
sleep," are not merely representative of our own experience and attitude;
but that they also represent, as far as we are able to judge at the time of this
writing, the consensus of opinion on the part of the most reliable and
experienced observers and practitioners who have used and studied this
method in both this country and Europe. The dangers and difficulties of
"twilight sleep" may be summarized as follows:
1. That this method tends to weaken the mental resistance of many women;
to lessen their natural courage and to decrease that commendable fortitude
which is such a valuable feature of the character endowment of the normal
woman.
2. That "twilight sleep" is essentially a hospital method and is, therefore,
inaccessible to the vast majority of women belonging to the middle and
lower classes of society, as well as to those women who live in rural
communities.
3. That in fifteen or twenty per cent, the method fails to produce the desired
results—at least, when administered in amounts which are deemed safe.
4. That this method does decrease the baby's chances of living; that the
second stage of labor is definitely prolonged; that from ten to fifteen per

cent of the babies are sufficiently under the influence of the anesthesia
when born as to be unable to breathe or cry without artificial stimulus.
5. That it is a method requiring special training and experience; that it will
be many years before the average practitioner will become proficient in its
use; and that the older methods are probably far safer for the average
physician.
6. That the method requires more care in its administration than can be
expected outside of the hospital in order to avoid the dangers of fetal
asphyxiation—which danger has led not a few obstetricians to abandon it.
7. That a satisfactory technic is almost impossible of development; that
every patient must be individualized; that the chief dangers are connected
with the over dosage of morphin; that the method is not adaptable to the
general practice of the average doctor.
8. That by prolonging the second stage of labor and by sometimes giving
too much morphin, the number of forceps deliveries is greatly increased,
with their attendant and increased dangers to both mother and child.
9. That the prospects of passing through labor which may be rendered
painless by artificial methods, tends to produce an attitude of carelessness
and indifference towards those natural methods of living and other hygienic
practices which so greatly contribute to naturally painless confinements.
10. That this method as sometimes practiced greatly increases the dangers
of a general anesthetic, if such should be found necessary later on during
the labor.
11. That "twilight sleep" is contra-indicated (should not be used) in the
following conditions: primary inertia (abnormally delayed and slow labor);
expected short labor—especially in women who have already borne
children; when the fetal head is known to be large and the mother's pelvis
small; placenta praevia (abnormal placental attachment); accidental
hemorrhage; absent or doubtful fetal heart beat; when labor is already far
advanced; and in threatened convulsions and eclampsia.

CONCLUSIONS REGARDING TWILIGHT SLEEP

Having presented the evidence both for and against "twilight sleep," it may
be of assistance to the lay reader to have placed before her the personal
conclusions and working opinions of the authors. We, therefore, undertake
to summarize our present attitude and outline our practice as follows:
1. "Twilight sleep" as a method of obstetric anesthesia in certain selected
cases and in well-equipped hospitals, and in the hands of careful and
experienced practitioners, has demonstrated that it is a scientific reality—
and has probably come to stay—at least until better and safer methods of
affecting a relatively painless confinement are discovered; although we are
compelled to state that it is not the panacea the lay press has led many of
our patients to believe. (That we believe a much better and safer method has
been devised, the next chapter will fully disclose.)
2. We do not expect this method ever to become general in its use; we do
not look for a chain of special "twilight hospitals" to stretch across the
continent and then to overrun the country. We expect much of the recent
forced enthusiasm to die down, while scopolamin-morphin anesthesia takes
it proper place among other scientific methods of alleviating the pangs of
labor.
3. We know that standard and fresh solutions—as already noted—are
absolutely essential for the success of this method.
4. We are certain that no routine method or technic can be developed. Each
patient must be individualized. The method does not consist in injecting
scopolamin every so often. The patient's mental and physical condition—as
also that of the unborn child—must control the administration of "twilight
sleep."
5. The patient must be in a quiet and partially darkened room. She must not
be disturbed; while the physician, or a competent trained nurse, must be in
constant attendance. well-appointed hospital, there is no real reason why it
cannot be fairly well carried out in a well-regulated private home, provided
the necessary preparations have been made, a trained nurse is present, and
provided, further, that the physician is willing to remain in the home with
the patient the length of time required properly to supervise the treatment.

6. While this method of treatment is best carried out in the well-appointed
hospital, there is no real reason why it cannot be fairly well carried out in a
well-regulated private home, provided the necessary preparations have been
made, a trained nurse is present, and provided, further, that the physician is
willing to remain in the home with the patient the length of time required
properly to supervise the treatment.
7. Even when the treatment is not instituted early in labor, it can, in certain
selected and appropriate cases, be utilized even in the second stage of labor
—thus saving these special cases much unnecessary pain; in fact, some
authorities regard it as a valuable adjunct in the management of "borderland
contractions" as it allows the patient a full test of labor.
8. In our opinion, this method has little effect on the first stage of labor if
properly administered; but it does undoubtedly prolong and tend to
complicate the second stage; in fact, we are coming to look upon "twilight
sleep" as being more distinctly a first stage procedure; that it bears the same
relation to the first stage of labor that chloroform bears to the second stage
—relieving the pain but not stopping the progress of labor.
9. That when safe amounts of the drug are used the pain is greatly lessened
in all cases—the subsequent memory of pain is absent in the majority of the
patients—but the labor is not always entirely painless as is popularly
supposed.
10. We do not believe that this method when properly administered
increases the number of forceps deliveries—at least not in the case of high
forceps operations. It undoubtedly does cover up the symptoms of a
threatened rupture of the uterus, and thus increases danger from that source;
nevertheless it may be safely stated that this method does not in any way
greatly interfere with any other measures which might be found necessary
to institute in order to bring about a successful termination of the labor.
11. The baby's heart beat must be carefully and constantly watched; sudden
slowing means that the treatment must be discontinued and the child
delivered as soon as possible; even then, difficulty may be experienced in
getting the baby's breathing started after it is born. In the vast majority of
cases where the baby does not cry or breathe at birth, the usual methods

employed in such cases serve quickly to establish normal respiration, and
the baby seems to be but little the worse for the experience.
12. While altogether too much has been claimed for "twilight sleep" at the
same time many false fears have also been suggested, among which may be
mentioned the fear of the mother losing her mind after the treatment; the
undue fear of asphyxiation on the part of the baby; the fear of post-partum
hemorrhage; and the fear that it will lessen the milk supply. We cannot deny
that the child's dangers are often increased; but in other respects, this
method (in properly selected cases) presents little more to worry us than the
older methods of anesthesia.
13. We are inclined to the belief that this method has but little influence on
the course of convalescence following labor. Certain nervous and highly
excitable women certainly seem to do better, as a result of experiencing less
pain and nervous shock; while other cases do not turn out so well. It
certainly does not retard repair and recovery during the puerperium.
14. This method seems to have its greatest field of usefulness in those cases
of highly intelligent but excessively neurotic women who have an abnormal
dread of pain and child bearing; or women who have suffered unusually at
the time of a previous confinement—perhaps in the case of the first baby—
or from other complications; women such as these, and other special cases,
are the ones to benefit most from the employment of "twilight sleep."
15. This method as has already been intimated, is most useful in the case of
the first baby, or in the case of women who have established a record of
tedious and painful labors. It has no place in normal and short labors;
although it may be used to great advantage in certain cases during the first
stage of labor—being carefully and lightly administered—while chloroform
or gas is utilized at the end of the second stage just as has been our custom
for a generation.
16. As noted under the special claims made for this method, it is (as also is
nitrous oxid) the ideal procedure in cases of heart, respiratory, kidney, and
other organic difficulties, the details of which have already been noted, and
their repetition here is not necessary.

17. It must be remembered that scopolamin and morphin are more or less
uncertain in their action; scopolamin is variable in its results, often
producing such marked nervous excitement in the patient as greatly to
interfere with the carrying out of an aseptic technic; while morphin has
been shunned by obstetricians for a whole generation, because of its well-
known bad effects on the unborn child as well as its interference with
muscular activity on the part of the mother.
In Germany, it is said, that a great many damage suits against prominent
physicians have resulted because of the alleged ill effects which have
followed the use of "twilight sleep."
18. In presenting these facts and opinions regarding "twilight sleep," the
reader should bear in mind that we are not only endeavoring to state our
own views and experience, but also to give the reader just as clear and fair
an idea of what other and experienced physicians think of the method, both
favorably and unfavorably; and we will draw these conclusions to a close
by citing the opinion of one or two who have had considerable experience
with the method and who, in summing up their observations, say:
The disadvantages of the method are entirely with the accoucheur and not
to the mother or child. It requires his presence at the bedside from the time
the treatment is undertaken until the completion of labor, not so much
because of any danger, but to keep the patient evenly under anesthesia on a
line midway between consciousness and unconsciousness, for if she is
allowed to go above that line in several instances she will have several so-
called "isles of memory," and will be able to draw a picture of her labor in
her mind and thus lose the benefit of the treatment.
These methods of anesthesia are very important and have merit. They
should be used when properly indicated. No one should limit himself to a
routine method. Each case should be individualized and the form of
anesthesia best suited to the case in hand should be employed. For instance,
in dealing with a primipara—one who is full of fear, who cannot stand pain,
who is of an hysterical nature—morphin-scopolamin anesthesia is best
suited in that particular case, because these drugs have a selective action
when it comes to allay fear and produce amnesia. On the other hand, in a
multipara who has had three or four children, whose soft parts are relaxed

and who has short labors, the anesthetic of choice would be a few whiffs of
chloroform as the head passes over the perineum. It is ridiculous to try to
give such women the "twilight sleep." Furthermore, take the cases you see
for the first time at the end of the first stage of labor, or during the second
stage; these cases are best treated with the nitrous oxid and oxygen method.
You have to individualize your cases. The prospective mother now consults
the obstetrician early to find out if her particular case is suitable for the
"twilight sleep." She has been informed that certain examinations—urine,
blood pressure, etc.—are necessary. She knows that these examinations
have to be made at regular intervals. In other words, we get the patients
early and we can give them good prenatal care.
This chapter has been devoted to "twilight sleep;" the following chapter will
consider "nitrous oxid" and other methods of anesthesia in connection with
labor, and should be read along with the foregoing discussion in order to
obtain an intelligent view of the whole subject of "painless labor."

CHAPTER X

SUNRISE SLUMBER AND NITROUS OXID

Since the public has already been told so much about obstetric anesthesia,
we deem it best to go into the whole subject thoroughly, so that the
expectant mothers who read this book will be able to form an intelligent
opinion regarding the question, and thus be in a position to give hearty
cooperation to the decision of their physician to employ, or not to employ,
any special form of anesthesia or analgesia in their particular case. In order
to give the reader a complete understanding of "painless labor," it will be
necessary to give attention to that newer and more safe method of obstetric
anesthesia called "sunrise slumber." This method of anesthesia consists in
the employment of nitrous oxid or "laughing gas," and will be fully
considered in this chapter.

OBSTETRIC FEAR

In this connection we desire to reiterate and further emphasize some
statements made in the preceding chapter concerning the unnatural fear and
abnormal dread of childbirth.
We feel that it is very important in connection with this new movement in
obstetrics to reduce the woman's pain and suffering to the lowest possible
minimum, that the trials of labor should not be overdrawn and the pangs of
confinement overestimated. We must not educate the normal woman to look
upon labor as a terrible ordeal—something like a major surgical operation
—which, since it cannot be escaped, must be endured with the aid of a deep
anesthesia.
The facts are that a very small per cent of healthy women suffer any
considerable degree of severe pain—at least not after the first child. We
often observe that judicious mental suggestion on the part of the physician
or nurse in the form of encouraging words and supporting assurances tends

to exert a marked influence in controlling nervousness and subduing the
sufferings of the earlier labor pains.
We must not allow the efforts of medical science to lessen the sufferings of
child-bearing, to rob womankind of their natural and commendable
courage, endurance, and self-reliance.
We do not mean to perpetuate the old superstition that pain and suffering
are the necessary and inevitable accompaniments of child-bearing—that the
pangs of labor are a divine sentence pronounced upon womankind—and
that, therefore, nothing should be done to lessen the sufferings of
confinement. Severe and unnatural pain is not at all necessary to childbirth,
and there exists no reason under the sun why women should suffer and
endure it, any more than they should suffer the horrors of a very painful
surgical operation without an anesthetic. In this connection, it should be
recalled that analgesic drugs have been introduced into obstetric practice
only during the last fifty years, while such methods of relieving pain have
been used in general surgery for a much longer period. It is now only sixty-
nine years since Simpson first employed anesthetic in obstetrics, while six
years afterwards Queen Victoria gave her seal of approval to the use of
chloroform in labor cases.
Thirty years ago, in speaking of the expectant mothers, Lusk warned us:
As the nervous organization loses in the power of resistance as the result of
higher civilization and of artificial refinement, it becomes imperatively
necessary for the physician to guard her from the dangers of excessive and
too prolonged suffering.

NITROUS OXID—"LAUGHING GAS"

Nitrous oxid, or "laughing gas," was first used in labor cases in 1880 by a
Russian physician. During the last twenty-five years it has been used off
and on by numerous practitioners in connection with confinement, but not
until the last few years has this method of relieving labor pain come into
prominent notice.

While the "laughing gas" method of obstetric anesthesia did not gain
notoriety and publicity from being exploited in magazines and other lay
publications, it did get its initial boost in a very unique and unusual manner.
A gentleman who manufactured and sold a "laughing gas" and oxygen
mixing machine for the use of dentists, insisted that this method of
anesthesia should be used in the case of his daughter, who was about to be
confined. This patient was kept under this nitrous oxid anesthetic for six
hours—came out fine—no accidents or other undesirable complications
affecting either mother or child, and thus another and safe method of
reducing the sufferings of childbirth has been fully demonstrated and
confirmed, although it had previously been known and used in labor cases
to some extent.
Starting from this particular case in 1913, many obstetricians began
experimental work with "gas" in labor cases; and, at the time of this writing,
it has come to occupy a permanent place in the management of labor,
alongside of chloroform, ether, and "twilight sleep."

ANALGESIA VS. ANESTHESIA

The reader should understand the difference between analgesia and
anesthesia. Anesthesia refers to the condition in which the patient is more or
less unconscious—wholly or partially oblivious to what is going on, and, of
course, entirely insensible to all pain. Analgesia is a term applied to the loss
of pain sensation. The patient may not be wholly or even partially
unconscious—merely under the influence of some agent which dulls,
deadens, or otherwise destroys the realization of pain. This is the condition
aimed at by the proper administration of any form of "twilight sleep,"
whether by the scopolamin-morphin method, or by the nitrous oxid
("sunrise slumber") method.
Any method of treatment which can more or less destroy the pain of labor
without in any way interfering with its progress, and which in no way
complicates its course or leaves behind any bad effects on either mother or
child, must certainly be hailed with joy by both the patient and the
physician. While chloroform has served these purposes fairly well, there
have been numerous drawbacks and certain dangers; and it was the

knowledge of these limitations in the use of both chloroform and ether, that
has led to further experimentation and the development of these newer
methods of producing satisfactory analgesia—freedom from pain—without
bringing about such a state of profound anesthesia as accompanies the
administration of the older methods.
It should be borne in mind that in using "sunrise slumber" (nitrous oxid) for
labor pains, the gas is so administered that the patient is just kept on the
"borderline"—in a typical "twilight" state—and not in the condition of deep
anesthesia which is developed when nitrous oxid is employed by physicians
and dentists as an anesthetic for major and minor surgical operations.
Analgesia is the first stage of anesthesia—the "twilight zone" of
approaching unconsciousness—in which the sense of pain is greatly dulled
or entirely lost, while even that which is experienced is not remembered. It
seems to the authors that "gas" is the ideal drug for producing this condition
whenever it is necessary, as nitrous oxid is the most volatile of anaesthetics,
acts most quickly, and its effects pass away most rapidly, while its
administration is under the most perfect control—it may be administered
with any desired proportion of oxygen—and may be discontinued on a
moment's notice. It is practically free from danger even when continued as
an analgesic for several hours. Nitrous oxid never causes any serious
disturbance in the unborn child, as chloroform sometimes does when used
too liberally.

EFFECTS OF NITROUS OXID

It will not be necessary to compare the favorable and unfavorable claims for
nitrous oxid as we did the contentions for and against "twilight sleep."
Whatever service "laughing gas" or "sunrise slumber" can render the cause
of obstetrics we can accept, knowing full well that, in competent hands, it
can do little or no harm; and this we know from the facts herewith recited
and from the further fact that we have gained a wide experience with this
agent in the practice of both dentistry and surgery. In a general way, the
influence of "sunrise slumber" on mother and child may be summarized as
follows:

1. It can accomplish its purpose—can quite satisfactorily relieve the mother
of severe pain—when employed as an analgesic. It is not necessary to
administer the gas to the point of anesthesia except at the height of suffering
at the end of the second stage of labor, when the head of the child is passing
through the birth canal.
2. This method can be stopped at any moment—the patient ran be brought
out from under its influence entirely and almost instantaneously. It is not
like a hypodermic injection of a drug which may exert a varying and
unknown influence upon the patient, and which, when once given, cannot
be recalled.
3. It is a method which may be used in the patient's home just as safely as in
a hospital; the only drawback being the inconvenience of transporting the
gas-containing cylinders back and forth. This is even now partially
overcome by the improved combination gas and oxygen form of apparatus
which has been devised.
4. The administration of nitrous oxid analgesia or anesthesia does not
interfere with or lessen the uterine contractions or expulsive efforts on the
part of the mother—at least not to any appreciable extent.
5. Just as soon as a severe uterine contraction—attended by its severe pain
—begins to subside, the gas inhaler is immediately removed, and in a few
seconds the patient is again conscious. It is not necessary to keep the patient
continuously under the influence of the drug, as in the case of the
scopolamin-morphin method of "twilight sleep."
6. This method ("sunrise slumber") is certainly far more safe in ordinary
and unskilled hands than the "twilight sleep" procedure. The patient is more
safe with this method in the hands of the average doctor or trained nurse.
7. It has been our experience that nitrous oxid in the smaller, interrupted and
analgesic doses, actually tends to stimulate the uterine pains and
contractions, while at the same time rendering the patient quite oblivious to
their presence. When properly administered, the freedom from pain is
perfect.
8. Under the influence of "gas," patients often appear to "bear down" with
increased energy. It certainly does not lessen their cooperation in this

respect.
9. We have not observed, nor have we learned of, any cases of inertia (weak
and delayed contractions), post partum hemorrhage, or shock, as a result of
"laughing gas" or "sunrise slumber" analgesia.
10. This method lends itself to perfect control—it may be decreased,
increased, or discontinued, at will; it may be given light now and heavy at
another time; while, at the height of labor, it may be pushed to the point of
complete anesthesia, if desired.
11. We have found "sunrise slumber" (nitrous oxid) analgesia to be the ideal
obstetric anaesthetic, and have adopted it quite to the exclusion of both
chloroform and "twilight sleep." We find that this form of analgesia has all
the advantages of "twilight sleep" without any of its dangers or
disadvantages.
12. A possible objection to the nitrous-oxid method is the cost, especially in
the private home. The average cost in the hospitals where we are using this
method runs about $2.00 for the first hour and $1.50 for each hour
thereafter. This is the cost when using large tanks of gas, and is, of course,
somewhat increased when the smaller tanks are used in the patient's home.

METHOD OF ADMINISTRATION

Since it was thought best to give the reader some idea of the technic for the
administration of "twilight sleep," it may not be amiss to explain how
"sunrise slumber" is usually employed in labor cases. The technic is very
simple. The administration of the gas is generally begun about the time the
patient begins seriously to complain of the severity of the second stage
pains; although, of course, the gas can be given during the first stage pains
if desired. In the vast majority of cases, however, we think it is best to
encourage the patient to endure these earlier and lighter pains without
resorting to analgesic procedures.
The form of apparatus used is the same as that employed by dentists and
contains both nitrous oxid and oxygen cylinders. A small nasal inhaler is
best, although the ordinary mouthpiece will do very well. The gasbag

attached to the tank should be kept under low pressure and, as a pain
begins, the patient is told to breathe quietly, keeping the mouth closed. As a
rule this sort of light inhalation serves to produce the desired analgesic
effect. It is not necessary to put the patient deeply under in order to relieve
the pain.
It is our custom to begin "sunrise slumber" as soon as the uterine
contractions become painful. The earlier the gas is started, the more oxygen
should be used. Two or three inhalations will suffice to take the "edge" off
the earlier and lighter pains. When the pains grow heavier we use less
oxygen and permit three or four deep inhalations just before a bearing-down
pain. At the first suggestion of a contraction, the patient must begin to
inhale the gas; while after the patient has pulled hard on the traction strops
—just as the contraction pain is passing—she is given an inhalation
containing a larger percentage of oxygen.
At the beginning of a pain, pure nitrous oxid is administered, and the patient
is instructed to breathe deeply and rapidly through the nose. The gasbags
should be about half filled. The mixture of gas and oxygen must be
determined by the severity of the pains and individual behavior of the
patient.
Four to six inhalations of the gas are sufficient to produce the required
analgesia in the average case. Following the first few deep inspirations
through the nose, the patient can be instructed to breathe through the mouth,
while the gas is well diluted with oxygen and continued until the end of the
pain. In this way a satisfactory analgesia is maintained throughout the
"pain" with a minimum of "gas." The proportion of oxygen used will run
from nothing up to ten per cent. This procedure is repeated with the
occurrence of each pain.
The use of the "mask" is just as effective as a nasal inhaler, but wastes more
gas and so is more costly.
When the head is passing the perineum the gas should be pushed to the
point of anesthesia, while the patient's color will suggest the amount of
oxygen to be used as well as serve to control the administration of the
nitrous oxid.

CHLOROFORM AND ETHER

For many years chloroform and ether have been used to alleviate the pains
of women in labor. Valuable as these agents are when deep anesthesia is
required for the carrying out of operative procedures, they have not proved
satisfactory as analgesic agents. If administered in small quantities at the
commencement of a strong uterine contraction, the patient does not usually
inhale sufficient to abolish pain. She is then apt to be irritated and is certain
to insist on being given a larger quantity. If a sufficient amount be
administered to satisfy the woman, the continued repetition gradually
inhibits the power both of the uterus and of the accessory muscles, so that
labor is unnecessarily prolonged, and, possibly, the life of the fetus
endangered. Physicians have, therefore, been accustomed to employ these
drugs very sparingly, restricting their use to the very end of the second
stage, during the painful passage of the head through the vulva. The results
of the administration at this time are also uncertain. If delivery be rapid the
woman may not be able to inhale sufficient to abolish her consciousness of
pain. If it be slow she may take too much and weaken the muscular powers,
thereby prolonging labor and, often, necessitating forceps delivery. It is not
surprising, therefore, that the medical profession has long been hoping that
a more satisfactory method of relieving the pain of labor would be found.

CONCLUSIONS

In summing up our conclusions regarding analgesia and anesthesia in labor
cases, the authors would state their present position as follows:
1. That anesthetics or analgesics are a necessary accompaniment of
confinement in this day and age; that the average labor case demands some
sort of pain-relieving agent at some time during its progress; but that
intelligent efforts should be put forth to limit and otherwise control their
use. While we recognize the necessity for avoiding needless suffering, at
the same time we must also avoid turning our women into spineless
weaklings and timid babies.
2. That we should seek to develop, strengthen, and train our girls for a
normal and natural maternity; that we should study to attain something of

the naturalness and the painlessness of the labors of Indian tribes; and, even
if we partially fail in this effort, we shall at least leave our women with
ennobled characters and strengthened wills.
3. That the scopolamin-morphin method of inducing "twilight sleep" has its
place—in the hands of experts—and in the hospital; and that in many cases
it probably represents the best method of obstetric anesthesia which can be
employed.
4. That as a general rule and in general practice, the safest and best method
of inducing the "twilight" state of freedom from severe pain, is by the use of
nitrous oxid or "laughing gas"—the "sunrise slumber" method. It has been
our practice to start all general ether anesthetics with "gas" for a number of
years, while we have been doing an increasing number of both minor and
major operations with "gas" alone.
5. That we still employ general ether or chloroform anesthesia in Cesarean
sections and other major obstetric operations, although several operators are
beginning to use "gas" in even these heavy cases.
6. That the intelligent and careful use of pituitary extract in certain cases of
labor serves greatly to shorten the second stage; that it is of great value in
certain "slow cases," and serves greatly to reduce the use of low forceps.
We have treated the subject of obstetric anesthesia in this full manner,
because of the fact that so much has appeared in the public press on these
subjects, and, further, because we desired that our readers should have
placed before them the facts on all sides of the question just as fully as a
work of this scope would permit.

CHAPTER XI

THE CONVALESCING MOTHER

Popularly spoken of as the "lying-in period," and medically known as the
puerperium, this time of convalescence immediately following childbirth is
usually occupied by two important things: the restoration of the pelvic
organs to their normal condition before pregnancy, and the starting of that
wonderfully adaptative mechanism concerned with the production of the
varying and daily changing food supply of the offspring.
The uterus, now more than fifteen times its normal size and weight, begins
gradually to contract and assume its normal weight of about two ounces;
and it requires anywhere from four to eight weeks to accomplish this
involution. In view of all this it is obvious that there can be no fixed time to
"get up." It may be at the end of two weeks, or it may not be until the close
of four or five weeks, in the case of the mother who cannot nurse her child;
for the nursing of the breast greatly facilitates the shrinking of the uterus.
Extensive lacerations may hinder the involution as well as other accidents
of childbirth, so it must be left with the physician to decide in each
individual case when the mother may enter into the activities of life and
assume the responsibilities of the care of the baby and the management of
her home.

THE NURSE

During this period of the puerperium a member of the family, a neighbor, a
visiting nurse, a practical nurse, or a trained nurse, looks after the mother
and gives to the babe its first care; whoever it may be, certain laws of
cleanliness must be carried out if infection is to be guarded against. If there
are daily or semi-daily calls made by the physician, a member of the family
may be trained to care for the mother with proper cleanliness and asepsis;
but it is far better for the mother, if possible, to secure the services of a
trained nurse, or the visiting nurse, in which instance she will call each day,
wash and dress the baby, clean up the mother and care for the breasts. She is

not supposed to clean the room, make the bed or prepare the food. If a
trained nurse can be in charge, the convalescing time is usually shortened as
the responsibilities are taken from the mother, her mind freed from care and
it is her's to improve, rest, and wait for the restoration of the pelvic organs,
when she may again go forth among her family.
The nurse may have to sleep in the same room; but, if it be possible, she
should occupy an adjoining room, she should have a regular time each day
for an hour's walk in the fresh air, she should be served regular meals, and
be allowed some time out of the twenty-four hours for unbroken slumber. In
return she will intelligently cooperate with the physician in bringing about
the restoration of body and upbuilding of the mother's nerves.

REST AND EXERCISE

From a monetary standpoint there can be nothing so wasteful or
extravagantly expensive in the home as to allow the mother to drag about
from day to day and week to week with chronic weakness or invalidism
because she did not have proper care during her already too short
puerperium, or because she got up too soon.
Having a baby is a perfectly normal, physiological procedure. It is also,
usually, downright hard work; and, beside the hard laborious work, there is
not only a wearied and severely shocked nervous system to be restored, but
there is also a certain amount of uterine shrinkage which must take place—
and this requires from four to eight weeks; and so our mother must be
allowed weeks or even a month or two to rest, to enjoy a certain amount of
well-directed exercise, to have an abundance of fresh air, to be wheeled or
lifted out of doors if possible into the sunshine, that she may be the better
prepared for the additional duties and responsibilities the little new comer
entails. Sunshine and fresh air are wonderful health restorers as is also a
well-directed cold water friction bath administered near the close of the
second week of a normal puerperium. During the second week a few
carefully selected exercises such as the following are not only beneficial,
but tend to increase circulation and thus to promote the secretion of milk
and the shrinking of the uterus.

1. Head raising, body straight and stiffened.

2. Arm raising, well extended.
3. Leg stretching, with knees stretched and toe extended.
4. Massage, administered by the nurse.

A splendid tonic circulatory bath may be administered at the close of the
second week (in normal puerperium), known as the "cold mitten friction,"
which is administered as follows: The patient is wrapped in a warm blanket,
hot water bottle at feet, and each part of the body—first one arm then the
other; the chest, the legs, one at a time—is briskly rubbed with a coarse mit
dipped in ice water. As one part is dried it is warmly covered, while the next
part is taken, and so on until the entire body has been treated. The body is
now all aglow, the blood tingling through the veins, and the patient
refreshed by this wide-a-wake bath. Properly given, the cold-mitten friction
bath is one of the most enjoyable treatments known and under ordinary
conditions, if intelligently administered, may be given as early as the eighth
day.

AFTER PAINS

After the birth of the first baby the uterus usually is in a state of constant
contraction, hence there are no "after pains;" but after the birth of the
second or third child, the uterine muscle has lost some of the tone of earlier
days—there is a tendency toward relaxation—so that when the uterine
muscle does make renewed efforts at contraction, these "after pains" are
produced. They usually disappear by the third day. Nothing should be done
for them, indeed they should be welcomed, for their presence means good
involution (contraction) of the uterus.

THE TEMPERATURE

Careful notations of the temperature should be made during the first week.
A temperature chart should be accurately kept and if the temperature should
rise above 100° the physician should be notified at once. The third day
temperature is watched with expectancy, for if an accidental infection
occurred at the time of labor, it is usually announced by a chill and sudden
rise of temperature on the third day. This may be as good a place as any to
mention the commonly met night sweating. This is due to a marked

accentuation of the function of the skin. It is not at all unusual for a sleeping
mother in the early puerperium to wake up in a sweat with night gown very
nearly drenched. The gown should be changed underneath the bedding,
while alcohol is rubbed over the moistened skin surface.
These sweats will disappear as soon as the mother begins to regain her
strength. A vinegar rub administered on going to bed may often prevent
these sweats.

THE TOILET OF THE VULVA

Immediately after the birth of the baby and the expulsion of the afterbirth,
the thighs and vulva are cleansed as follows: Into a basin of warm, boiled
water are dropped four small antiseptic tablets of bichlorid of mercury; this
gives a proper antiseptic wash. Into this solution are placed four pieces of
sterile cotton Two of these are used, one at a time, without being returned to
the solution to wash each inside of the thigh, the remaining two to cleanse
the vulva. Without drying the vulva, two sterile pads are applied and pinned
to the binder. These pads are changed every hour during the first day or two
because of the profuse lochial flow.
After each urination and bowel movement, a lysol solution (prepared by
putting one teaspoonful of lysol in a quart of sterile water) is poured from a
clean pitcher over the vulva into the bed pan, and fresh pads applied. This
toilet continues until the close of the second week or longer, if there is a
lochial flow.
These sterile pads not only absorb the lochia but also, among ignorant or
thoughtless mothers, prevent contamination by the patient's hands.

URINATION

The patient should be encouraged to urinate during the first few hours after
labor; catheterization should not take place until every effort has been made
to bring about normal urination; or, until there is a well marked tumor
above the bony arch of the pelvis in the lower part of the abdomen. It is far
less harmful to the patient for her to sit up on the jar placed on the edge of

the bed, than to undergo the risk of inflammation of the bladder which so
often follows catheterization.

THE LOCHIA

The first few days the lochia is very red because of the large amount of
blood which it contains. After the third or fourth day it is paler and after the
tenth it assumes a whitish or yellowish color. During the three changes it
should always smell like fresh blood. Any foul, putrifying odor should be
promptly reported to the physician.
If on getting up at the close of the second week the lochia should resume its
red color, the patient should return to bed and notify her physician.

THE ABDOMINAL BINDER

After the tenth day, the abdominal binder may be pinned as tightly as the
patient desires, but prior to the tenth day many physicians believe the
exceedingly tight binder causes misplacements of the enlarged, softened,
and boggy uterus. It should be pinned snugly; but not drawn as tight as
possible with the idea of keeping the uterus from relaxing, for at best, it
does not do it; while tight constriction may produce a serious turning or
flexion of the uterus. The breast binder is applied during the first twenty-
four hours to support the filling breasts, loosely at first, and as they increase
in size, as the glands become engorged, the binder is drawn more tightly. A
sterile piece of gauze is placed over the nipples.

THE BOWELS

On the morning of the second day a cathartic is usually given—say one
ounce of castor oil or one-half bottle of citrate of magnesia. The bowels
should move at least once during each twenty-four hours; if they are
obstinate, a simple laxative may be nightly administered. Certain
constipation biscuits, sterilized dry bran, or agar-agar may be eaten with the
breakfast cereal. Prunes and figs should be used abundantly. Bran bread
should be substituted for white bread. The enema habit is a bad one and

should not be encouraged; however, the enema is probably less harmful
than the laxative-drug habit. Mineral oil is useful as a mild laxative, and
does not produce any bad after results.

CARE OF THE NIPPLES

Fissures of the nipples should be reported to the physician at once. There
are many good remedies which the physician may suggest; in his absence,
Balsam Peru may be advantageously applied. Boracic acid solution should
be applied before and after each nursing from the very first day; in this way
much nipple trouble may be prevented through cleanliness and care. The
nipples should be kept thoroughly dry between nursings Nipple shields
should be used where fissures persist.

THE DIET

For the first three days a liquid and soft diet is followed such as hot or cold
milk, gruels, soups, thin cereals, eggnog (without whiskey), eggs, cocoa,
dry toast, dipped toast, or cream toast. There should be three meals with a
glass of hot milk at five in the morning (if awake) and late at night; nothing
between meals except plenty of good cold water. After the third day, if
temperature is normal, a semi-solid diet may be taken, such as baked,
mashed, or creamed potatoes, soups thickened with rice, barley or flour,
vegetables (peas, corn, asparagus, celery, spinach, etc.); eggs, light meats,
stale breads, toast, bland or subacid fruits (sweet apples, prunes, figs, dates,
pears, etc.); macaroni, browned rice (parched before steaming), etc.; ice
cream, custards, and rice puddings for desserts after the seventh day. Three
good meals a day, at eight and one and six, with a couple of glasses of hot
milk or cocoa or an eggnog at five a. m., to be repeated at 9 or 10 p. m., with
plenty of cold water between the meals, will abundantly supply the
necessary milk for the growing babe. Tea and coffee are not of any special
value in encouraging a flow of milk.
The constant coaxing of the mother with "Do drink this," and "You must
drink this, or you won't have any milk," not only saddens her but seriously
upsets digestion and thus indirectly interferes with normal lactation.

GETTING UP

Everybody should stay at home and away from the mother and her new
born child until after the seventh day, and then, if our patient is normal,
visitors may call, but should not stay longer than five minutes. The
convalescing mother will improve faster without the neighborhood gossip,
or the tales of woe so often carried by well-meaning, but woefully ignorant
acquaintances.
When the hard ball-like mass can no longer be felt in the lower abdomen,
when the lochia has passed through the three changes already mentioned,
and the flow is whitish or yellowish, scanty and odorless, the patient may sit
up in a chair increasingly each day. Such conditions are usually found
anywhere from the tenth to the fifteenth day. The patient first sits up a little
in a chair—she has already been exercising some in bed—and this enables
her to sit up with ease for a half-hour the first day, increasing one-half hour
each day during the week following. At the end of three weeks, she may be
taken down stairs providing there is ample help to carry her back up stairs.
After another week (at the close of the fourth), if the lochia is entirely white
or yellow, with no blood, she may begin carefully to go about the house.
There should be no lifting, shoving, pulling, wringing, sweeping, washing,
ironing, or other heavy exercise for at least another two weeks, better four
weeks. Any variance from this program usually means backache, lassitude,
diminished milk supply, and frequently a general invalidism for weeks or
months—sometimes years.

COMPLICATIONS

Cystitis, or painful urination, is avoided by tardy "getting up;" quietly,
slowly moving about; abundant water drinking; and the avoidance of
catheterization.
Hemorrhage. Notify the physician if it occurs at any time. The treatment is
heavy kneading of the abdomen until the uterus again becomes like a hard
ball. Cold compresses over the lower abdomen may sometimes help.
Infection is manifested by chilly sensations or a distinct chill followed by
fever, usually on the third day. Take a cathartic; notify the physician at once

and follow his directions.
Mastitis, inflammation or caking of the breasts. Very hot fomentations
wrung out of boiling water, alternating with ice-cold compress, should be
applied to the breast for an hour or more, three or four times a day.
Cathartics should be administered, and eliminative measures instituted such
as the hot-blanket pack.
Pneumonia. Keeping the arms and chest well protected by a long-sleeved
coat of warm texture, should help in preventing this serious complication.
Pneumonia complicating labor is usually the result of carelessness and
exposure.

PART II

THE BABY

PART II

THE BABY

CHAPTER XII

BABY'S EARLY DAYS

Happy is the mother and fortunate is the home that possesses the intelligent
services of a trained attendant during the early days of the baby's career. A
century or more ago skilled nurses were unheard of, and both mothers and
babies seemed to thrive on the unskilled but faithful and sympathetic care
given by the willing neighbor who "thought I'd just run over and help out."
Who of us cannot remember the days when mother was "gone to a
neighbor's" to give this same willing but unskilled care at the time of
"confinement."

MODERN METHODS

And why are we so concerned today about asepsis, sterilization, etc., when
a generation ago they were not? We used to live more slowly than we do
now. Then it took the entire day to do the marketing for the week, now we
take a receiver from the hook and a telephone wire transmits the verbal
message. Our days are literally congested with events that were almost
impossibilities a century ago. The ease and leisure of former days are
unknown and unheard of today. The artificial way in which we live exerts
more or less of a strain upon the present generation; the average woman's
nervous system is keyed up to a high pitch; her general vital resistance is
running at a low ebb; while child-bearing brings a certain added stress and
strain that requires much planning to avoid and overcome.
For many days and ofttimes weeks the mother is unfit—physically unable
—properly to care for her child, and so whether it be the trained assistant in
constant attendance or the visiting nurse in her daily calls, or the kind,
willing, but unskilled neighbor—each helper must acquaint herself, in
varying degrees, with the physical, nervous, and mental needs of the child,
as well as take into account and anticipate the numerous habits and wants of
the new born babe, such as urination, bowel movement, pulse, respiration,
temperature, etc.

THE HEAD

At birth, the head is remarkably large as compared to the rest of the body,
for, surprising as it may seem, the distance from the crown to the chin is
equal to the length of the baby's trunk; and, too, if birth has been prolonged
this large head has also been pressed or squeezed somewhat out of shape.
This state of affairs, however, need give no cause for either alarm or
anxiety, for the head will shape itself to the beautiful rotundity of the
normal baby's head within a few days.
The general shape of the baby's head, as seen from above is oval. Just back
of the forehead is formed a diamond-shaped soft spot known as the anterior
fontanelle which should measure a little more than one inch from side to
side. On a line just posterior to this soft spot and to the back of the head, is
found another soft spot somewhat smaller than the one in front. Gradual
closure of these openings in the bones occurs, until at the end of six or eight
months, the posterior fontanelle is entirely closed; while eighteen months
are required for the closure of the anterior fontanelle.
These "soft spots" should not be depressed neither should they bulge. The
head is usually covered with a growth of soft, silky hair which will soon
drop out, to be replaced, however, by a crop of coarser hair in due season.
The scalp should always be perfectly smooth. Any rash or crusts or
accumulation of any kind on the scalp is due to uncleanliness and neglect,
and should be carefully removed by the thorough application of vaseline
followed by a soap wash. The vaseline should be applied daily until all
signs of the accumulation are entirely removed. The eyes of all babies are
generally varying tints of blue, but usually change to a lighter or darker hue
by the seventh or eighth week. The whitish fur which often is seen on the
baby's tongue is the result of a dry condition of the mouth which disappears
as soon as the saliva becomes more abundant.

CHEST, ABDOMEN, AND LEGS

The baby's chest, as compared to the size of the head and abdomen, appears
at a disadvantage, while the arms are comparatively short and the legs
particularly so, since they measure about the same as the length of the

trunk. They naturally "bow in" at birth so that the soles of the feet turn
decidedly toward each other. All these apparent deformities, as a rule, right
themselves without any help or attention whatsoever.

PULSE AND RESPIRATION

The pulse may be watched at the anterior fontanelle or soft spot on top of
the head while the child quietly sleeps and should record, at varying ages,
as follows:

At birth 130 to 150
First month 120 to 140
One to six months about 130
Six months to one year about 120
One to two years 110 to 120
Two to four years 90 to 110

The above table is correct for the inactive normal child. Muscular activity,
such as crying and sucking, increases the pulse rate from 10 to 20 beats per
minute.
The respiration of the baby often gives us no small amount of real concern
at the first. The baby may be limp and breathless for some few moments at
birth, and this condition calls for quick action on the part of the nurse and
doctor.
The utmost care to avoid the "sucking in" of any liquid or blood during its
birth must be exercised, for this often seriously interferes with the
breathing. Sometimes this condition is not relieved until a soft rubber
catheter is placed in the throat and the mucus is removed by quick suction.
When you are reasonably sure that there is no more mucus in the throat,
then sudden blowing into the baby's lungs (its lips closely in touch with the
lips of the nurse or physician) often starts respiration. Slapping it on the
back also helps, while the quick dip into first hot then cold water seldom
fails to give relief.

A quiet-sleeping infant breathes as shown below at varying ages. An
increase of six to ten breaths per minute may be allowed for the time it is
awake or otherwise active.

At birth and for the first two or three 30 to 50
weeks
During the rest of the first year 25 to 35
One to two years about 28
Two to four years about 25

THE WEIGHT

The normal weight of the average baby is seven to seven and one-half
pounds. Its length may range anywhere from sixteen to twenty-two inches.
There is an initial loss of weight during the first few days; however, after
the milk has been established the child should make a weekly gain of four
to eight ounces until it is six months old, after which time the usual gain is
from two to four ounces per week.
If the weight has been doubled at six months and the weight at one year is
three times the birth weight, the child is said to have gained evenly and
normally.

THE SKIN

At birth the skin of the baby is red and very soft owing to the presence of a
coating of fine down. A blue-tinged skin may be occasioned by unnecessary
exposure or it may be due to an opening in the middle partition of the heart
which should close at birth. As soon as the baby is born, it should be placed
on its right side while the cord is being tied, as this position facilitates
closure of this embryonic heart opening. With the provision for a little
additional heat the blue color should disappear, if it is not due to this heart
condition. At the close of the first week the red color of the skin changes to
a yellow tint due to the presence of a small amount of bile in the blood. This
sort of jaundice is very common and is in no wise evidence of disease. The

"down" falls off with the peeling of the skin which takes place during the
second week; by the end of which time, the skin is smooth and assumes that
delightful "baby" character so much admired.

THE CORD DRESSING

The cut end of the tied umbilical cord is swabbed and squeezed with a
sterile sponge saturated with pure alcohol. It is then wrapped in a sterile
dressing made as follows: Four or five thicknesses of sterile cheese cloth
are cut into a four-inch square with a small hole cut in the center and one
side cut to this center. This is slipped about the stump of the cord and
wrapped around and about in such a manner as entirely to cover the stump
of the cord. The wool binder is then applied and sewed on, thus avoiding
both pressure and the prick of pins. If it remains dry this dressing is not
disturbed until the seventh or eighth day, when the cord ordinarily drops off.
Should it become moistened the dressing is removed and the second
dressing is applied exactly like the first.

THE EYES

The closed eyes of the newly born child are generally covered with mucus
which should be carefully wiped off with a piece of sterile cotton dipped in
boracic acid solution, in a manner not to disturb the closed lid. A separate
piece of cotton is used for each eye and the swabbing is done from the nose
outward. The physician or nurse drops into each opened eye two drops of
twenty per cent argyrol, the surplus medicine being carefully wiped off with
a separate piece of cotton for each eye. The baby should now be placed in a
darkened corner of the room, protected from the cold.
The eyes are washed daily by dropping saturated solution of boracic acid
into each eye with a medicine dropper. Separate pieces of gauze or cotton
are used for each eye.

THE FIRST OIL BATH

As soon as the cord and the eyes have received the proper attention and the
mother has been made comfortable, the baby is given its initial bath of oil.
This oil may be lard, olive oil, sweet oil, or liquid vaseline. The oil should
be warmed and the baby should be well covered with a warm blanket and
placed on a table which is covered with a thick pad or pillow. The
temperature of the room should be at least eighty degrees Fahrenheit.
Quickly, thoroughly, and carefully the entire body is swabbed with the
warmed oil—the head, neck, behind the ears, under the arms, the groin, the
folds of the elbow and knee—no part of the body is left untouched, save the
cord with its dressing. This oil is then all gently rubbed off with an old soft
linen towel.

THE FIRST CLOTHING

After the oil bath, the silk and wool shirt (size No. 2), the diaper and
stockings are quickly put on to avoid the least danger of chilling. The band
having been applied at the time of the dressing of the cord, our baby is now
ready for the flannel skirt. This should hang from the shoulders by a yoke of
material adapted to the season, cotton yoke without sleeves if a summer
baby, and a woolen yoke with woolen sleeves if a winter baby. The outing-
flannel night dress completes the outfit and should be the only style of dress
worn for the first two weeks. Loosely wrapped in a warm shawl, the baby is
about ready for its first nap, save for a drink of cooled, boiled water.
This cooled, boiled, unsweetened water should be given in increasing
amounts every two hours until the child is two or three years of age. It is
usually given the child in a nursing bottle. In this way it is taken
comfortably, slowly, can be kept clean and warm, and should the babe be
robbed of its natural food and transferred to the bottle as a substitute for
mother's milk, it will already be acquainted with the bottle and thus one-half
of a hard battle has already been fought and won.

BABY'S FIRST NAP

The baby's bed should be separate and apart from the mother's. It may be a
well-padded box, a dresser drawer, a clothes basket, or a large market
basket. A folded comfortable slipped in a pillow slip makes a good mattress.

A most ideal bed may be made out of a clothes basket; the mattress or pad
should come up to within two or three inches of the top, so the baby may
breathe good fresh air and not the stale air that is always found in a deeply
made bed. Into this individual bed the baby is placed as soon as it is
dressed; and a good sleep of four to six hours usually follows.
Frequent observations of the cord dressing should be made as occasionally
hemorrhage does take place, much to the detriment of the babe. If bleeding
is at any time discovered the cord is retied just below the original tying. By
the time baby has finished a six- or eight-hour nap the mother is
wondrously refreshed and is ready to receive it to her breast.

PUTTING TO THE BREAST

During the first two days the baby draws from the breasts little more than a
sweetened watery fluid known as the colostrum; but its intake is essential to
the child in that it acts as a good laxative which causes the emptying of the
alimentary tract of the dark, tarry appearing stools known as the meconium.
On the third day this form of stool disappears and there follows a soft,
yellow stool two or three times a day.
The child should be put to the breast regularly every four hours; two things
being thus encouraged: an abundant supply of milk on the third day and the
early shrinking of the uterus. More than once a mother has missed the
blessed privilege of suckling her child because some thoughtless person
told her "why trouble yourself with nursing the baby every four hours,
there's nothing there, wait until the third day;" and so when the third day
came, there was little more than a mere suggestion of a scanty flow of milk,
which steadily grew less and less.

THE URINE

The urine of the very young child should be clear, free from odor and
should not stain the diaper, nor should it irritate the skin of the babe. Often
urination does not take place for several hours, sometimes not at all during
the first twenty-four hours. If the infant does not show signs of distress,
there is no cause for alarm; the urine should pass, however, within thirty

hours. As a rule there are usually between ten and twenty wet diapers
during each twenty-four hours. The following table shows about the
amounts of urine at different ages:

Birth to two years 8 to 12 ounces
Two to five years 15 to 25 ounces
Five to ten years 25 to 35 ounces

GENITALS OF THE MALE CHILD

The foreskin of the male child is often long, tight, and adherent, and is often
the direct cause of irritability, nervousness, crying, and too frequent
urination. It should be closely examined by both physician and nurse and
when the foreskin does not readily slip back over the acorn-like head of the
organ, circumcision is advised early in the second week. This simple
operation will start the child out on his career with at least one moral
handicap removed and one desirable possibility established—that of being
able to keep himself clean.

POST-OPERATIVE CARE OF CIRCUMCISION

The dressings that are loosely applied at the time of the operation should
remain untouched (especially those next to the skin), unless otherwise
directed by the physician, until the seventh or eighth day when the babe is
placed in a warm soap bath, at which time the dressings all come off
together. Clean sterile gauze is so placed as entirely to protect the inflamed
skin from the diaper at all times before this bath, and these same dressings
should be continued for at least another week. Sterile vaseline (from a tube)
should be applied twice a day after the original dressings are removed in the
bath at the end of the first week. There should be little or no bleeding
following the operation, neither should the penis swell markedly; if either
complication should occur, the physician should be promptly notified.

Fig. 6. How to Hold the Baby.

CARE OF THE FEMALE GENITALS

The girl baby is often neglected in respect to the proper care of the genitals.
The lips of the vulva should be separated and thorough but careful cleaning
should be the daily routine. The foreskin or covering of the clitoris should
not be adherent; while the presence of mucus, pus, or blood in the vulva
should be at once reported to the physician; in his absence, the application
of twenty per cent argyrol should be made daily.

HANDLING THE BABY

Let us thoroughly come to understand the very first day the little one's life,
that it was not sent to us because the family needed something to play with;
it is not a ball to toss up, neither is it a variety show. It is a tiny individual,
and your responsibilities as parents and caretakers are very great. The child
was sent to be fed, clothed, kept warm, dry, and otherwise cared for by you,
until such a time as it will become able to care for itself. Remember, what
we sow, that shall we also reap. If we sow indulgence we shall reap anger,
selfishness, irritability, "unbecomingness"—the spoiled child. At two or
three days the baby learns that when it opens its mouth and emits a holler,
someone immediately comes. If we do it on the second and third day, why
should we object to run, bow, and indulge on the one hundredth and second
day?
Handle the baby as little as possible. Turn occasionally from side to side,
feed it, change it, keep it warm, and let it alone; crying is absolutely
essential to the development of good strong lungs. A baby should cry
vigorously several times each day. If the baby is to be handled, support the
back carefully (Fig. 6).

THE EARLY BATHS

During the first week the baby is oiled daily over his entire body, with the
exception that the cord dressing remains untouched. The face, hands, and
buttocks are washed in warm water. After the third week the bathroom is
thoroughly warmed and the small tub is filled with water at temperature of
100 F. The baby having been stripped and wrapped in a warm turkish towel,
is placed on a table protected by a pillow, while the caretaker stands by and
vaselines the creases of the neck, armpits, folds of the elbows, knees,

thighs, wrists, and genitals; and then, with her own hands, she applies soap
suds all over the body—every portion of which is more quickly and readily
reached—than by the use of a wash cloth. And now, with the bath at 100 F.,
with a folded towel on the bottom of the small tub, the soapy child is placed
into the water and after a thorough rinsing is lifted out again to a warm
fresh towel on the table and the careful drying is quickly begun. After the
bath all the folds and creases are given a light dusting with a good talcum.
During hot weather the bath should be given daily, soap being used twice a
week. On the other days there should be the simple dipping of the child into
the tub. During the cold weather the full bath is given but twice a week,
while on the other days a sponge bath or an oil rub may be administered.
A weak, delicate child should not be exposed to the daily full bath, but
rather the semi-weekly sponge bath and the daily oil rub should be
administered. We have found the late afternoon hour to be better than the
early morning hour for baby's bath. It requires too much vital resistance to
react to an early morning bath, especially when the house is cool.

REGARDING SOAP

The use of soap is very much abused with young babies. I recall one mother
who came into the office with her poor little baby which was constantly
crying and fretting because of a greatly inflamed body—all a result of the
too frequent use of soap. I said, "I am afraid you do not keep your baby
clean." "O Doctor!" she replied, "I wash him with soap every time I change
him; I am sure he is clean." And come to find out, the poor little fellow's
tender skin had been subjected to soap several times a day. We ordered the
use of all soap discontinued, vaseline and talcum powder to be used instead,
and the child's skin got well in a very short time.

CARE OF THE UMBILICUS

Tight bands should not be placed about the babe. If the umbilicus protrudes,
do not endeavor to hold it in by a tight band, but consult your physician
about the use of a bit of folded cotton and adhesive plaster, and then allow
the child the freedom of the knitted bands, with skirts suspended from

yokes. The day of tight bands and pinning blankets with their additional and
traditional windings is over. After the complete healing of the cord, the need
for a snug binder to hold the dressings in place is over. Should the baby cry
violently, the umbilicus should be protected in the manner described above
—the fold of cotton and the adhesive plaster.
The diaper, stockings, shirt, skirt, and dress with an additional wrapper for
cold days completes the outfit at this age.

BIRTH REGISTRATION

"One of the most important services to render the newborn baby is to have
his birth promptly and properly registered."
In most states the attending physician or midwife is required by law to
report the birth to the proper authority, who will see that the child's name,
the date of his birth, and other particulars are made a matter of public
record. Birth registration may be of the greatest importance when the child
is older, and parents should make sure this duty is not neglected.
A public health official some time ago epitomized some of the uses of birth
registration as follows:
There is hardly a relation in life from the cradle to the grave in which such a
record may not prove to be of the greatest value. For example, in the matter
of descent; in the relations of wards and guardians; in the disabilities of
minors; in the administration of estates; the settlement of insurance and
pensions; the requirements of foreign countries in matters of residence,
marriage, and legacies; in marriage in our own country; in voting and in
jury and militia service; in the right to admission and practice in the
professions and many public offices; in the enforcement of laws relating to
education and to child labor, as well as to various matters in the criminal
code; the irresponsibility of children under ten for crime or misdemeanor;
the determination of the age of consent, etc., etc.

CHAPTER XIII

THE NURSERY

We wish it were possible for every mother who reads this book to have a
special baby's room or nursery. Some of our readers have a separate
nursery-room for the little folks, and so we will devote a portion of this
chapter to the description of what seems to us a model arrangement for such
a room; but, realizing that ninety-five per cent of our readers can only
devote a corner of their own bedroom to the oncoming citizen, we have also
carefully sought to meet their needs and help them to take what they have
and make it just as near like the ideal nursery as possible.

THE SEPARATE NURSERY

The nursery should be a quiet room with a south or southwesterly exposure.
The bathroom should adjoin or at least be near. A screened-in porch is very
desirable.
Draperies that cannot be washed, and upholstered furniture, do not belong
in the baby's room. A hardwood floor is better than a carpet or matting;
while a few light-weight rugs, easily cleaned, are advisable. Enameled walls
are easily washed and are, therefore, preferable to wall paper or other
dressings.
The windows should be well screened, for by far the greatest dangers to
which the baby is exposed, are flies and mosquitoes—carriers of filth and
disease. Flies, mosquitoes, cockroaches, bed bugs, cats, dogs, lice, and mice
are all disease carriers and must therefore be kept out of baby's room.

NURSERY EQUIPMENT

At each window should be found dark shades, and if curtains are desired
they should be of an easily washable material, such as mull, swiss, lawn,
voile, or scrim. The hardwood floor may be covered where necessary with

easily handled rugs which should be aired daily. The other necessary
articles of furniture are a crib of enameled iron whose bedding will be
described elsewhere in this chapter, a chest for baby's clothes and other
necessary supplies, a screen or two, a low table and a low rocker, a small
clothes rack on which to air the clothes at night, a pair of scales, and a
medicine chest placed high on the wall.
If the room will conveniently admit it, a couch will add greatly to the
mother's comfort; and, if possible, it should be of leather upholstery;
otherwise, it should possess a washable cover, for all articles that promote
the accumulation of dust are not to be allowed in the nursery. In these early
weeks and months baby will not benefit from pictures or other wall
decorations, and so let him have clean walls that are easily washed and
quickly dusted.
The necessities for baby's personal care are:

Talcum powder. Sterile cotton balls in covered glass jar.
Castile soap. Safety pins of different sizes.
Soft wash cloths. Hot water bag with flannel cover.
Soft linen towels. Baby scales.
Bottle of plain vaseline. Drying frames for shirt and stockings.
Boracic acid, oz. iv (Saturated Solution).
Olive oil.

BABY'S BED

Since the days of Solomon, accidents have occurred where mother and babe have
occupied the same bed. Not only is there the ever-present danger of smothering the babe,
but there are also many other reasons why a baby should have its own bed. The constant
tendency to nurse it too often and the possibility of the bed clothing shutting off the fresh
air supply, are in and of themselves sufficient reasons for having a separate bed for baby.
The first bed is usually a basinet—a wicker basket with high sides—with or without a
hood. A suitable washable lining and outside drape present a neat as well as sanitary
appearance. The mattress of the basinet is usually a folded clean comfort slipped into a
pillow slip; this is to be preferred to a feather pillow, as it is cooler and in every way
better for the babe.
Drapes about the head of the basinet are not only often in the way, shutting out air, etc.,
but they also gather dust and are unsanitary. Screens are movable—they may be used or
put away at will—and are, therefore, very convenient about the nursery.
The basinet may be dispensed with entirely if the sides of the enameled crib are lined to
cut off draughts and the babe is properly supported by pillows. After the baby is four to
six months of age it is transferred to the crib. The basinet has an advantage over the crib
during those early weeks in that its high sides protect the babe from draughts, and the
comforts and blankets can be more easily tucked about the little fellow to keep him
warm. The sides should not extend more than four inches above the lying position of the
child.

THE CRIB

The enameled iron crib should be provided with a woven-wire mattress, over which is
placed a mattress; hair is best as a filling for the mattress, wool next, and cotton last.
Over the mattress should be placed a rubber sheet, and over all a folded sheet.
A pillow of hair or down is not to be discarded; for recent investigation has shown that
the pillow favors nasal drainage, while lying flat encourages the retaining of mucus in
the nose and nasal chambers—the sinuses. The pillow slip should be of linen texture.

During the winter a folded soft blanket over the rubber sheet increases both softness and
warmth. No top sheet is used during the first months, particularly if the first months are
the winter months. The baby is wrapped loosely in a light weight clean blanket or shawl,
and other blankets—as many as the season demands are tucked about the child. These
blankets should be aired daily, and the one next to the baby changed, aired, or washed
very often.

Fig. 7. Making the Sleeping Blanket.

THE SLEEPING BLANKET

To prevent baby from becoming uncovered the sleeping blanket has been devised. The
blanket is folded and stitched in such a way as completely to envelop the sleeping babe,
and at the same time afford the utmost freedom (Fig. 7). The babe may turn as often as
he desires, but cannot possibly uncover himself. Bed clothes fasteners are also used—an
elastic tape being securely fastened to the head posts and then by means of clamps or
safety pins attachment is made to the blankets on either side. The elasticity allows
considerable freedom to the child in turning (See Fig. 8).

NURSERY HEATING AND VENTILATION

The subject of ventilation has been so fully discussed by the authors in another work that
we refer the reader to The Science of Living, or the Art of Keeping Well.
For the first two or three weeks the nursery temperature should be maintained at seventy
degrees Fahrenheit by day and from sixty degrees to sixty-five degrees by night. In the
third week the day temperature should be sixty-eight degrees Fahrenheit measured by a
thermometer hanging three feet from the floor. After three months the night temperature
may go as low as fifty-five degrees Fahrenheit, and after the first year it may go as low
as forty-five degrees.
The heating of the nursery is usually controlled by the general heating plant, and no
matter what system of heating is maintained, humidifiers must be used, the necessity for
which is doubled when the system is that of the hot-air furnace.
These shallow pans of water with large wick evaporating surfaces will evaporate from
three to four quarts during the twenty-four hours. The humidity should be fifty
throughout the seasons of artificial heating.
Many colds may be entirely avoided by the use of humidifiers or evaporators. The open
grate is one of the very best means of nursery heating. Gas and oil heaters should not be
depended upon for nursery heat. Only in an emergency should they be used at all, and the
electric heater is by far the best device for such occasions.

Fig. 8. In the Sleeping Blanket.

BABY'S CORNER IN MOTHER'S ROOM

It is probably a conservative estimate to say that ninety-five per cent of all the babies
occupy a corner of mother's and father's bedroom for the first two or three years. And
believing this estimate to be correct, it is advisable to give the matter some consideration.
To begin with, a lot of the non-essentials, ruffles and fluffles of the average bedroom,
must go. The good father's chiffonier may have to be put in the bath room; heavy floor
coverings must be discarded, to be replaced by one or two small, light-weight rugs; wall
decorations and the usual bric-a-brac of dressers, tables, etc., should be carefully packed

away. In fact, there should be nothing in the room save the parents' bed, dresser (several
drawers of which must be devoted to baby's necessities), table, low rocker, a stool, baby's
bed and a good big generous screen, made out of a large clothes horse enameled white
and filled with washable swiss.
Window draperies must be taken down and packed away, while they are replaced with
simple muslin which can go to the laundry twice a month. If it be within the means of the
family purse, it is well to renovate the walls just prior to the advent of the little stranger.
And now the baby's bed is placed in the corner most protected from draughts and the
glare of the sunlight. If it can be so arranged that baby looks away from the light, and not
at it, we are guarding it from defective vision in the future.

CRIB SUBSTITUTES

Many a beautiful artistic creation so much admired in this world is found to be, on closer
inspection, a very ordinary thing which has received an artistic touch; and so, many
convenient, sanitary, and beautiful cribs are fashioned from market baskets fastened to
tops of small tables whose legs are sawed off a bit; from soap boxes fastened to a frame,
and from clothes baskets. A can of white enamel, a paint brush and the deft hand of a
merry, cheery-hearted expectant mother can work almost miracles. Remember, please,
that all draperies must be washable and attached with thumb tacks so as to admit of easy
and frequent visits to the laundry.
A medium-sized clothes basket will take care of our baby for four or five months. The
same general plan for the mattress and bedding is followed as before described.

EXTRA HEAT TO THE CRIB

If necessary—and it usually is, especially during the winter months—a hot-water bottle
may be placed underneath the bedding on top of the mattress. This insures a steady, mild,
uniform warmth and it not only saves the baby from the danger of being burned, but it
also obviates the temporary overheating of the child which usually occurs when the
bottle is placed inside the bed, next to the baby. If the bed is properly made—the blankets
coming from under the babe up and over—there is little or no need for extra heat for well
babies after the first month.

LIGHTING BABY'S ROOM

If electric lighting is not an equipment of the home neither gas or oil lamps should be
allowed to burn in the room for long periods. For emergency night lighting a well-
protected wax candle should be used. However, don't go to sleep and allow a candle to
burn unprotected as did one tired, exhausted mother. The father, suddenly aroused from
his sleep, saw a large flame caused by the overturning of a wax candle into a box of

candles, while the lace drapery of the basinet was within a few inches of the flame and
the baby just beyond. Grabbing a pillow he smothered the flames and saved baby and all.

FRESH AIR

Plenty of fresh air and lots of sunshine should enter baby's room. The large screen amply
shields from draughts, and when thus protected there need be no unnecessary concern
about cool fresh air, especially after two or three months, as it is invigorating and
prevents "catching cold." Warm, stuffy air is devitalizing and even during the early
weeks when the fresh air must be warm, an electric fan should be advantageously placed
so that many times each day the warm fresh air may be put in motion without creating a
harmful draught.
Warm stuffy air makes babies liable to catch cold when taken out into the open.
Throw open the windows several times each day and completely change the air of baby's
room. In the absence of the large screen, a wooden board five or six inches high is fitted
into the opening made by raising the lower window sash. Then as the upper sash is
lowered the impure air readily escapes while fresh air is admitted.

THE BATH EQUIPMENT

Make early preparations for bathing the baby in the easiest possible manner; in fact, the
young mother should seek to attend to all her duties—the family, the home, and the baby
—in the easiest way. For the administration of a bath during the early months, a table is
needed, protected by oilcloth on which is placed a roomy bathtub with a folded turkish
towel on the bottom for baby to sit on. In addition to the tub, have:

An enameled pitcher for extra supply of A medicine dropper for washing baby's
warm water. eyes.
A small cup for boracic acid solution. Talcum powder.
Castile soap. Oil or vaseline.
A soft wash cloth. Sterile cotton.
Several warmed soft towels. Tooth picks.
A bath thermometer. A needle and thread for sewing on the
band.
All of the clean clothing needed.

See that the bathtub is clean and enamel unbroken, and if it has been used by another
babe, freshen it with a coat of special enamel sold for that purpose.

BATH TEMPERATURES

During the first eight weeks Temperature 100
F.
From two to six months Temperature 98 F.
From six to twenty-four months Temperature 90—
97 F.

A bath at ninety-eight degrees is a neutral bath, and after the baby is six months and over,
the bath may be given at this temperature, and at the close quickly cooled to ninety
degrees.

NURSERY CLEANLINESS

The nursery should furnish the baby's first protection from contagious diseases. It must
be a veritable haven of safety. Therefore, no house work of any kind should be done in
the room, such as washing or drying the baby's clothes. The floors and the furniture
should be wiped daily with damp cloths. A dry cloth or feather duster should never be
used to scatter dust around the room.
All bedding and rugs should receive their daily shaking and airing out of doors,
remembering that particles of dust are veritable airships for the transportation of germs.
In every way possible avoid raising a dust. So much of the lint which commonly comes
from blankets may be avoided with the daily shaking out of doors.
Soiled diapers should not accumulate in a corner or on the radiator; their removal should
be immediate, and if they must await a more opportune time, soak them in a receptacle
filled with cold water. Even those diapers slightly wetted should never be merely dried
and used again, but should be properly washed and dried. No washing soda should be
used in the cleansing of diapers—just an ordinary white soap, a good boil, and plenty of
rinse water, with drying in the sun if possible. They require no ironing. Hands that come
in contact with soiled or wet diapers must be thoroughly cleansed before caring for the
baby or preparing his food.
As before mentioned, and it will bear repetition often, all windows and doors must be
well screened, for flies and mosquitoes are dreaded foes in any community and in
babyland in particular. All used bottles and nipples as well as used cups, pitchers, bits of
used cotton, should be removed at once. The washcloth is a splendid harbinger of germs.
There should be one for the face, and one for the body and bath, and both should receive
tri-weekly boiling. Bath towels should not be used more than twice, better only once.
The technic of bathing, together with the location, furnishings, and cleanliness of the
baby's sick room, will be taken up in later chapters.

CHAPTER XIV

WHY BABIES CRY

It is surprising how soon even a young and inexperienced mother will learn to distinguish
between the pain cry and the plain cry of her baby; for most crying can easily be traced
to some physical discomfort which can be relieved, or to some phase of spoiling and
indulgence which can be stopped.

NORMAL HEALTHY CRYING

The young baby can neither walk, talk nor engage in gymnastics, except to indulge in
those splendid physical exercises connected with a good hearty cry. To be good and
healthy, an aggregate of an hour a day should be spent in loud and lusty crying. He
should be allowed to kick, throw his arms in the air and get red in the face; for such
gymnastics expand the lungs, increase general circulation and promote the general well-
being of the normal child. As the child grows older and is able to engage in muscular
efforts of various sorts, these "crying exercises" should naturally decrease in frequency
and severity. When baby cries, see that the abdominal band is properly applied, that
rupture need not be feared.

THE BIRTH CRY

The sound most welcomed by both doctor and nurse is the cry of the newly born child,
for it shows that the inactive lungs have opened up and the baby has begun to use them,
for all the time baby was living in the uterine room he did not breathe once, the lungs
having been in a constant state of collapse; and not until now, the very moment the air
comes in contact with his skin, do the lungs begin to functionate as he emits his first
lusty holler.

ABNORMAL CRYING

The cry is said to be abnormal when it continues too long or occurs too often. It may be
strong and continuous, quieting down when he is approached or taken up; or it may be a
worrying, fretful cry, a low moan or a feeble whine. And now as we take up the several
cries, their description, cause, and treatment, we desire to say to the young mother: Do
not yourself begin to fret and worry about deciding just which class your baby's cry
belongs to; for help, knowledge, and wisdom come to every anxious mother who desires
to learn and who is willing to be taught by observation and experience.

THE HUNGER CRY

The continuous, fretful cry, accompanied by vigorous sucking of the fists, both of which
stop when hunger has been satisfied, is without question the hunger cry.
If this cry is constant with regular feedings, then the quantity of the food must be
increased, or the quality improved. The tired, fretful hunger cry must not be neglected;
the cause must be removed, for it points to malnutrition.

THE CRY OF THIRST

One day when lecturing at an Iowa chautauqua, I remained in the beautiful park for the
noonday meal. It was a warm day and the tables in the well-screened dining tent were
filled with mothers who, like myself, preferred the cool shade of the park to the hot ride
through the city to the home or hotel dinner. At my table a baby was pitifully crying. The
mother had offered the little child seated in a small uncomfortable go-cart, milk, bread,
and a piece of cake—all of which were ruthlessly pushed aside. My little son, then only
four and a half, said "Mamma, maybe the baby's thirsty," and up he jumped, hurried to
the mother's side with his glass of water, saying, "I haven't touched it, maybe the baby's
thirsty." The mother brushed the boy aside, saying, "No, I never give the baby water." In
spite of the mother's remonstrance, the baby cried on and on, and finally on "trying" the
water, the child drank fully one-half the glass and the crying was hushed.
Babies should be given water regularly—many times every day—from birth, in varying
amounts from two teaspoons to one-half cup, according to the age of the child. The water
should be boiled for the first few months, and longer if there is any suspicion of
impurities.
Milk to the nursing infant is like beefsteak and potatoes to the adult; and many times the
milk bottle or the breast is just as nauseating to the thirsty babe, as meat would be to the
very thirsty adult whose hunger has previously been fully satisfied.

THE FRETFUL CRY

The babe who is wet, soiled, too hot, or is wrapped too tightly, or who has on a tight,
uncomfortable belly band, or whose clothing is full of wrinkles, has only one way to tell
us of his discomfort, and that is to cry. It is a fretful cry and should command an
immediate investigation as to the possible cause. It takes but a moment to discover a wet
diaper; to run the hand up the back under the clothes; to sprinkle with talcum if
perspiring; to straighten out the wrinkled clothing; to find the unfastened pin that pricks;
or to loosen the tight band. Acquire the art of learning to perform these simple tasks
easily, and any or all of these services should be rendered without taking the child from
its bed.

Let the child early learn to rest happily and quietly in his own bed. The pillow or
mattress may be turned or perhaps the mattress be raised nearer the edge of the basinet.
One poor youngster instantly stopped his fretful cry when his mattress was raised four or
five inches so he could get the air, at the same time taking him out of his hot room to a
cooler room with raised windows. Babies like cold air. They cry when the air is hot, or
even warm and close. Every day—rain or shine, wind or sleet—babies should nap out of
doors on the porch, in a well-sheltered corner. A screen or a blanket protects from the
wind, sleet, or rain; and if the baby's finger tips are warm, you can rest assured the feet
and body are warm. Scores of babies will sleep out on the porch, on the protected fire
escape, or in a room with opened windows, from one bottle or feeding to another; being
aroused at the end of the three or four hour interval just enough to nurse, when back they
go to their delightful, warm nest in the cool, fresh air to sleep for another period. Babies
should never sleep in a room with closed windows.
One of the incidents that surprised me most in my early work with dispensary babies was
the utter misconception of the purpose of the belly band. Invariably it was put on so
tightly that I could not slip a finger between it and the babe. It is not a surgical
instrument, neither is it a truss. These tight belly bands are a source of much fretting and
crying.

THE PAIN CRY

The little pinched look about the face, the drawing up of the legs, the jerking of the head,
arms, or legs, associated with a strong, sharp, unceasing or intermittent cry, demands
immediate attention Our first work should be to go about quietly, painstakingly, and
systematically to locate the cause of this "cry of pain."
There are often some accompanying symptoms to the cry of pain which demand skilled
medical advice and attention, such as the arching of the body backward, the drawing of
the head strongly to one side, the inability to use one side of the body, or the presence of
fever. There may be an earache, an abdominal complication, or a sore throat, any one of
which will be detected by the skilled doctor.
Earache frequently occurs in young babies who have been taken out of doors without
proper protection to the ears; or, it may be associated with a cold in the head, which is
not detected until the mischief has already been done, while the resulting running ear
tells the tale of woeful suffering. Earache must always be thought of as a possible cause
when the cry of pain accompanies a cold in the head, and if medical aid is secured early,
the abscess may be aborted and the deafness of later years entirely avoided. There is only
one home remedy for earache, and that is the application of external heat, either by a hot-
water bottle or hot-salt bag. Medical advice should be sought before anything whatsoever
is dropped into the baby's ear.
In this connection should be mentioned the wild cry at night which so often accompanies
tuberculosis of the bone. A careful X-Ray examination will reveal the disease, and proper

medical measures should be instituted at once. Other fretful night crying will be
mentioned further on.

HABIT CRYING

By the frequent repetition of actions, habits are formed. When the baby is two or three
days old, he is so new to us and we have waited for him so long, and it is such a great big
world that he has come into, that we jump, dance, and scramble to attend to his every
need and adequately to provide for his every want. At this very early, tender age
whenever he opens his mouth to cry or even murmur—some fond auntie or some overly
indulgent caretaker flies to his side as if she had been shot out of a gun, grabs him up and
ootsey tootsey's him about as she endeavors to entertain and quiet him. The next time and
the next time and the succeeding time he whimpers—like a flash someone dashes to the
side of the basket, and baby soon learns that when he opens his mouth and yells,
somebody comes. In less than a week the mischief has been done and baby is badly
spoiled. No other factor enters so largely into the sure "spoiled" harvest as picking a new
baby up every time he cries. Often in the early days some indulgent parent will say, "Oh,
don't turn out the light, something might happen to the dear little thing"—and old Mother
Nature sees to it that a constant repetition of "leaving the light on" brings its sure harvest
of "he just won't go to sleep without the light." And then, "just once" he had the pacifier
—perhaps to prevent his crying disturbing some sick member of the family—and so we
go on and on. If a thing is bad, it is bad, and a supposedly good excuse will not lessen the
evil when the habit has been thus started and acquired.
The rocking of babies to sleep may be a beautiful portrayal of mother love, but we all
pity the child who has to be rocked to sleep as much as we do the mother who sits and
rocks, wanting, Oh, so much! to do some work or go for a walk—but she must wait till
baby goes to sleep.

THE TEMPER CRY

And so now we come to the temper cry—that lusty, strong outburst of the cry of
disappointment when he finds that all of a sudden people have stopped jumping and
dancing for his every whim. The baby is not to blame. We began something we could not
keep up, and he—the innocent recipient of all our indulgences—is in no sense at fault. It
is most cruel to encourage these habits of petty indulgence, which must cause so much
future disappointment and suffering on the part of the little fellow as he begins to grow
up.
Nobody is particularly attracted to the spoiled baby. After the over-indulgent parent and
caretaker have completed their thoughtless work, they themselves are ashamed of it and
not infrequently begin to criticise the product of their own making—the formation of
these unpleasant bad habits. More than anything else, the spoiled child needs a new
environment, new parents, and a new life.

THE SPOILED BABY

Seek to find out if possible—and it usually is possible—just what he is crying for. It may
be for the pacifier, for the light, or to be rocked, jolted, carried, taken up and rocked at
night, or a host of other trifles; and if he is immediately hushed on getting his soul's
desire—then we know he is "spoiled."
The unfortunate thing about it all is that the one who has indulged and spoiled the baby
usually does not possess the requisite nerve, grit, and will power to carry out the
necessary program for baby's cure. And the pity of it all is that overindulgence in
babyhood so often means wrecked nerves and shattered happiness in later life. So, fond,
indulgent parents, do your offspring the very great kindness to fight it out with them
while they are young, even if it takes all summer, and thus spare them neurasthenia,
hysteria, and a host of other evils in later life.
This sort of "spoiled baby crying" can be stopped only through stern discipline—simply
let the baby "cry it out." The first lesson may require anywhere from thirty minutes to an
hour and thirty minutes. The second lesson requires a much shorter time, and, in normal
babies with a balanced nervous system, a third or fourth lesson is not usually required.

THE CRY OF SERIOUS ILLNESS

The cry of the severely sick child is the saddest cry of all. The low wail or moan strikes
terror to the saddened mother-heart. It is often moaned out when the child is ill with
"summer complaint" or other intestinal disturbances. Instant help must be secured, and, if
medical help is not obtainable, remember, with but one or two exceptions, you are safe in
carefully washing out the bowels, in applying external heat and giving warmed, boiled
water to drink.
Another cry which demands immediate attention, and the faithful carrying out of the
doctor's orders, is the hoarse, "throaty" cry indicative of croup or bronchitis.

THE COLICKY CRY

Perhaps the greatest cause of the most crying during infancy, next to that of over-
indulgence, is ordinary colic which—
... manifests itself in every degree of disturbance from mere peevishness and fretfulness
to severe and intensely painful attacks in which restlessness passes into grunting,
writhing, and kicking; the forehead becomes puckered and the face has an agonized
expression; the baby tends to scream violently and draws his thighs up against his belly,
which will usually be found to be hard and more or less distended.

A colicky baby completely upsets the household and greatly disturbs the mother, who
requires both quiet and rest that she may the better produce the life-sustaining stream so
much needed for the upbuilding and development of the growing child.

COLIC IN THE BREAST-FED

While colic is so often seen in the bottle-fed babe, it often occurs in the breast-fed child,
and is usually traceable to some error in the mother's diet or to some other maternal
nutritional disturbance. One mother who was sure she had eaten nothing outside the diet
suggestions she had received, was requested to bring to the office a fresh voiding of her
own urine which was found to be highly acid. The administration of an alkaline such as
simple baking soda or calcined magnesia to the mother, corrected this acidity, and the
colic in the baby entirely disappeared. I recall the case of one mother who ate her dinner
in the middle of the day, with a light meal in the evening and thereby stopped the colic in
her babe.
Another source of colic in the breast-fed baby is the unclean nipple. The nipples should
be washed with soap and water and rinsed in boracic acid solution before each nursing. If
the mother worries greatly, or thoughtlessly "gets very angry" just before the nursing
hour, there is a substance known as "epinephrin" secreted by the glands located just
above the kidneys which is thrown into the blood stream and which raises the blood
pressure of the mother and often produces not only colic in the babe, but many times
throws him into severe convulsions.

COLIC IN BOTTLE-FED BABIES

There are many opportunities for colic in the bottle-fed baby; for instance, dirty bottles,
dirty nipples, careless cleansing of utensils used in the preparation of baby's food,
improper mixtures, too much flour, the wrong kind of sugar, too much cream or too little
water—all these things help to produce wind under pressure in the intestine, which is
commonly known as colic. Underfeeding or overfeeding, too rapid feeding or too
frequent feeding also contribute their mite in producing colic.
As a rule, the bottle-fed child is fed too often. In the new born, the interval between feeds
should be three hours from the start; after six months the interval may be lengthened to
four hours.

COLIC AND CHILLINESS

Hiccough—a spasm of the diaphragm—often accompanies colic, and, in the case of
infants, is usually due to the swallowing of air or over-filling the stomach; gentle
massage, external heat, and a few sips of very warm water usually corrects the condition.

The chilling of the skin very often produces a temporary intestinal congestion with colic
as the result. Cold feet, wet diapers, and loitering at bath are all very likely to produce
colic; and when it is thus caused by chilling, quickly prepare a bath at 100 F., and after
immersing the child for five minutes, wrap up well in warm blankets.

THE TREATMENT OF COLIC

Those of my mother readers who have electric lights in their home, will find the
photophore to be a source of great comfort and convenience; for this simple contrivance
is usually able to banish colic in a few moments. The photophore is simply radiant heat
—heat plus light (See Fig. 3)—and as this heat is applied to legs and buttocks of the
crying child the diaper is warmed, the abdomen relaxes, gas is expelled, intestinal
contractions relieved, and the baby is soon fast asleep.
Occasionally with the aid of the photophore, and even without it, the warm two-ounce
enema containing a level teaspoon of baking soda and a level teaspoon of salt to a pint of
water when allowed to flow into the bowel, will soon bring down both gas and feces to
the great relief of the baby. Warm water to drink is also very helpful. Putting the feet in
very warm water is also quieting to the crying colicky babe.
It is often necessary in cases of repeated and persistent colic, Do not jolt or bounce the
baby, do not carry him about, and don't walk the floor with him.
Heat him up inside and outside, warm his clothing and his bedding, and thus bring about
relief without sowing seeds for future trouble—the sorrow of a spoiled child.
One very quiet little baby was one day brought to the dispensary whose mother said:
"Doctor, I didn't bring him 'cause he's sick, but 'cause he looks so pale; he's as quiet as a
mouse; he never cries any more since I got to giving him medicine." On examination of
the baby and on inquiring about the medicine, we found that the baby was dead drunk all
the time. Some "neighbor friend" had told the tired out mother, "Give him a teaspoon of
whiskey at each feeding and that'll fix him all right." If a few more states go dry maybe it
will not be so easy for the ignorant mother to dope and drug her helpless baby.
And neither is paregoric to be administered wholesale for colic. It contains an opiate, and
should not be given without definite orders from a physician. And so as a parting word
on "Why Babies Cry," we ask each mother to run over the following summary of the
chapter, and thus seek to find out why her baby cries.

BABY CRIES BECAUSE:

He is hungry. He is too cold.
He is thirsty. He is in pain.
He has been given a dirty bottle. He is very sick.

His mother has failed properly to cleanse His throat is sore.
the nipples.
His food is not prepared right. His ear aches.
His food is too cold. He has been rocked, carried, or bounced.
His bowels are constipated. He has been given a pacifier.
His band is too tight. He has had too much excitement.
His clothes are wrinkled. His mother has eaten the wrong food.
His diaper is wet.
He is too hot.
He wants fresh air.

CHAPTER XV

THE NURSING MOTHER AND HER BABE

Happy is the mother, and thrice blessed is the babe when he is able to enjoy the supreme
benefits of maternal nursing. The benefits to the child are far reaching; he stands a better
chance of escaping many infantile diseases; the whole outlook for health—and even life
itself—is greatly improved in the case of the nursing babe, as compared with the
prospect of the bottle-fed child. Maternal nursing lays the foundation for sturdy manhood
and womanhood.
Out of every one hundred bottle-fed babies, an average of thirty die during the first year,
while of the breast-fed babies, only about seven out of every one hundred die the first
year. At the same time, nursing the babe delivers the mother from all the work and
anxiety connected with the preparation of the artificial food, the dangers and risks of
unclean milk, and the ever-present fear of disease attendant upon this unnatural feeding.
The mother who nurses her child can look forward to a year of joy and happiness;
whereas, if the babe is weaned, she is compelled to view this first year with many fears
and forebodings. Mother's milk contains every element necessary for the growth and
development of the child, and contains them in just the proportions required to adapt it as
the ideal food for that particular child.
A dirty baby, properly fed, will thrive. A baby deprived of fresh air, but wisely fed, will
survive and even develop into a strong healthy man or woman. But the baby raised
according to the latest and most approved rules of sanitation and hygiene, if improperly
fed, will languish and die.

HYGIENE OF NURSING MOTHERS

Outings and Exercise. It is most highly important that the nursing mother should be able
thoroughly to digest her food; otherwise the flow of milk is likely to contain irritants that
will disturb the baby's digestion, even to the point of making him really sick. In order to
avoid these complications, exercise and outings are absolutely essential for the mother. A
vigorous walk, gardening, light housework or other light athletics, greatly facilitate
digestion and increase the bodily circulation, as well as promote deep breathing, all of
which are of paramount importance to a good appetite and good digestion.
The Bowels. The bowels should move regularly and normally once or twice during the
twenty-four hours. Unfortunately, this is not usually the case: and in this connection we
would refer our reader to the chapter on "The Hygiene of Pregnancy," particularly those
sections relative to the care of the bowels, recipes for bran bread, lists of laxative foods
and other suggestions pertaining to the hygiene of the nursing mother.

Sleep. Nothing less than eight hours sleep will suffice for the nursing mother, and during
the day she should take at least one nap with the baby.
Care of the Skin. Salt-rub baths are very beneficial taken once a week. The daily cold-
friction rub described elsewhere, will tone up the system and increase digestion and
improve the general well being. The soap wash may be taken once a week. The thorough
cleansing of the breasts, and the frequent changing of the undergarments, will help to
keep the baby happy; for oftentimes it is the odor of perspiration as well as the smell of
soiled clothing that spoils the appetite of the baby, causing it to refuse food.
Recreation. Pleasant diversion is very essential for the mother, and should be indulged in
at least once a week. The bedtime hours, however, should not be interfered with and the
recreation should be selected with a view to amuse, refresh and create a harmless
diversion for the mother's mind. Under no circumstances should the mother settle down
to the thought: "No, I can't go out any more. I can't leave my baby." You should get away
from the baby a short time each day, and go out among your former friends and
acquaintances. Many a wrecked home—a shattered domestic heaven—dates its
beginnings back to the days when the over-anxious young mother turned her back on her
husband and looked only into the face of her (their) child. Nothing should come in
between the filial friendship of husband and wife, not even their child. So, dear mother, if
you can, go out occasionally, away from the baby, and enjoy the association of your
husband and keep in touch not only with his interests, but with the outside world. You
will come back refreshed and wonderfully repaid, and the face of the adored infant will
appear more beautiful than ever.

DIET OF THE NURSING MOTHER

The general suggestions on diet which we made to the expectant mother are also valuable
for the nursing mother. The food should be appetizing, nutritious, and of a laxative
nature. Three meals should be eaten: one at seven a. m., one at one p. m. and one about
six-thirty at night, with the heaviest meal usually at one p. m. As the mother usually
wakens at five o'clock, or possibly earlier, she should be given a glass of milk, cocoa, or
eggnog. If she awakens at six, nothing should be taken until the breakfast, which should
consist of a good nourishing meal, such as baked potatoes with white sauce, poached
eggs, cereal, milk or cocoa, prunes, figs, or a baked sweet apple, with bread and butter,
etc.
From that hour until one p. m. only water is taken, and several glasses are urged during
this interval. With nothing between meals but water and a little outdoor exercise, a good
appetite is created for the one p. m. meal which should abundantly supply and satisfy the
hungry mother; and then again, nothing is to be taken between dinner and supper but
water. And after the supper hour, a walk out into the cool night air should be enjoyed
with the husband and on going to bed about ten p. m., an eggnog or glass of milk may be

taken. At the close of the other meals a cup of oatmeal gruel or milk or any other
nourishing liquid may be enjoyed.
The eating of food or the drinking of nourishing drinks between the meals not only
interferes with digestion and disturbs the mother, but it also upsets the baby; and it is
often the reason why the appetite of the mother is so deranged at the meal time, her
spirits depressed, and her milk diminished. Plenty of good nourishing food, taken three
times a day with an abundance of water drinking between the meals, together with a free
happy frame of mind occasioned by the recreation before mentioned, usually produces
good milk and plenty of it. A nap between meals will probably produce more milk than
eating between meals.

OBJECTIONABLE FOODS

All foods that cause indigestion in the mother or babe should be avoided.
Some mothers continue to eat tomatoes, peaches, sour salads, acid fruits, and it appears
in no way to interfere with baby's comfort; but they are the exception rather than the rule.
Usually tomatoes, acid salad dressings, and mixed desserts must be avoided. Each
mother is a law unto herself. Certainly none of our readers will selfishly continue any
food she feels will make her baby cry. All acid fruits, rich desserts, certain coarse
vegetables, concoctions of all descriptions such as rarebit, condiments, highly seasoned
sauce, etc., should be avoided.
Acid fruitades, such as lemonade, limeade and orangeade, can be taken by a small per
cent of nursing mothers; and, since fruit acids are neutralized and alkalized in the process
of digestion and assimilation, and since they are the very fruit-drinks we prescribe for
patients suffering with an increased acidity, it would appear that they were in every way
wholesome for the mother—if they in no way interfere with the baby. Practically, they do
as a rule disturb the baby's digestion and should be avoided by those mothers who have
found this to be the case.

CAKED BREASTS

During the first week of lactation the milk tubes of the breasts very often become
blocked and the breasts become engored with milk, this condition being known as "caked
breasts." At this particular time of the baby's life, he takes little more than an ounce of
milk at a feed; so, beside the incoming engorgement of milk, an additional burden is
thrown upon the milk tubes of the breasts in that they are not entirely emptied each
nursing time by the young infant. When the breasts threaten to "cake," immediate steps
must be taken to relieve the condition—to empty the breasts—and this is usually
accomplished in the following manner: with hands well lubricated with sweet oil or olive
oil the nurse begins gentle manipulation of the breasts toward the nipple in circular
strokes, with the result that the milk soon begins to ooze out. This massage should be

continued until relief is obtained; or the breast pump may be applied. Hard nodules
should not be allowed to form or to remain in the breasts. Hot compresses (wrung from
boiling water by means of a "potato ricer") may be applied to the caked breast which is
protected from the immediate heat by one thickness of a dry blanket flannel. These hot
compresses should be removed every three minutes until three have been applied, then an
ice water compress is quickly applied, to be followed by more hot ones and then a cold;
and so on, until as many as four sets each have been administered.
Gentle massage may again be administered and it will be found that they empty now
with greater ease because of the preceding heat. After the breasts have been emptied, and
thoroughly washed with soap suds and carefully dried, they should be thickly covered
with cotton batting and firmly compressed against the chest wall by a snug-fitted breast
binder, which serves the double purpose of relieving pain by not allowing the breasts to
sag downward, at the same time preventing an over-abundant secretion of milk by
diminishing the blood supply to the glands of the breast. In case the persistent
manipulation of the breast and the use of the breast pump do not relieve the condition,
and if the repeated effort day after day seems to avail nothing; then, as a rule, we must
look for a breast abscess to follow if the breasts are not immediately "dried up." In all
such cases of engorgement, the attending physician should be notified at once.

SORE NIPPLES

The nipple must be kept dry between nursings, which should be limited to twenty
minutes. Regularity should be maintained. The nipples should never be touched or
handled by hands that have not been scrubbed with soap and a nail brush. During the
early nursing days they are wet much of the time and are subject to much stress and
strain in the "pulling effort" of the baby, as a result of which they become very tender,
chapped, cracked, and often bleed. Allowing the baby to go to sleep with the nipple in his
mouth also exposes the nipple to unnecessary moisture which increases the possibility of
painful cracking. The pain occasioned by nursing at this time is truly indescribable, and
is most often the cause of absolute refusal on the part of the mother to nurse her babe—
with the result that it is put on the bottle. Again, the fear and dread of being hurt so often
tends to diminish the flow of milk. It is entirely possible so to prepare the nipple for this
exposure, during the last months of pregnancy, that all this discomfort and pain may be
entirely avoided (See chapter, "The Hygiene of Pregnancy").
Before the mother is put to rest after the birth of the baby the breasts are prepared as
follows: A thorough cleansing with soap and water is followed by a careful disinfection
with alcohol which leaves the nipple perfectly dry. A soft sterile pad is then applied and
held in place by a breast binder. Before and after each nursing the nipple and surrounding
area is swabbed with boracic acid (saturated solution) and carefully dried by applying a
clean, dry, sterile pad.

Painful cracks and fissures are nearly always due to lack of the care described above, and
are almost wholly preventable. When the first crack appears and nursing becomes
painful, the baby's mouth should not touch the nipple again until healing has taken place.
A thorough cleansing with boiled water should be made and then the sterile nipple shield
should be applied through which baby will get abundant satisfaction, while the mother is
spared the pain, and the nipple has an opportunity to get well.
In the case of sore and cracked nipples, thorough cleansing with boiled water and boracic
acid solution follows each nursing seance; and, after careful drying, balsam peru—equal
parts with glycerine—may be applied with a tiny piece of sterile gauze or cotton; a sterile
cotton pad is then applied to each breast which is held in place by a breast binder.
The nipple shield, when employed, is boiled after each nursing and washed in boracic
acid solution just before each nursing. The strictest cleanliness must be observed, and
then we hope to bring relief and comfort to the mother, and effect the saving of nature's
best food for the baby.

CONSTITUENTS OF MOTHER'S MILK

Mother's milk—that wonderfully adaptable, ever-changing food, so accurately and
scientifically suited to the hourly and daily needs of the growing child—is composed of
five different parts, totally unlike in every particular, and each part exactly suited to the
needs which it supplies. The cream of the milk, as well as the lactose or sugar, builds up
the fatty tissues of the body as well as helps provide the energy for crying, nursing,
kicking, etc. The proteins (the curd of the milk) are exceedingly important; they are
especially devoted to building up the cells and tissues of the body of the growing child.
The salts form a very small part of the baby's food, but an important one, for they are
needed chiefly for the bones and the blood. The fats, sugars, proteins, and salts, taken
together, form the solids of mother's milk, and are held in solution in the proportion of
thirteen parts of solids to eighty-seven parts of water; which so holds these solids in
solution that the baby can digest and assimilate these necessary food elements. The
mother's milk increases in strength day by day and month by month as the baby grows,
and is the only perfect infant food on earth.

THE TIME OF THE FIRST FEEDING

Soon after the birth of the baby the wearied mother seeks rest—she usually falls into a
quiet, restful slumber; the baby likewise goes to sleep and usually does not awaken for
several hours. After six or eight hours the child is put to the breast and he begins to nurse
at once, without any special help. This first nursing should be discontinued after four or
five minutes, while he is put to the other breast for the same length of time.
If there is difficulty in sucking, a bit of milk may be made to ooze out on the clean
nipple, while the baby's lips are pressed to it, after which the nurse gently presses and

rubs the breasts toward the nipple. After the nursing, the nipples should be elongated, if
necessary, by rubbing, shaping, or breast pump.
The baby gets but little nourishment during the first two days, but that which he does get
is essential; for the colostrum—the first milk—is highly laxative in nature and serves the
important purpose of cleaning out the intestinal tract of that first tarry, fecal residue, the
meconium. This early sucking of the child accomplishes another purpose besides the
obtaining of this important laxative—it also reflexly increases the contractibility of the
muscles of the womb, which is an exceedingly important service just at this time.
Should the mother or caretaker feel that baby will starve before the milk comes, or that it
is necessary to provide "sweetened water;" let us assure them that nothing is needed
except what nature provides. Nature makes the babe intensely hungry during these first
two days, so that he will suck well, and if he is fed sweetened water, gruel, or anything
else, he will not suck forcefully; and so nature's plan for securing extra or increased
uterine contractions and the stimulation of the breast glands will be seriously interfered
with.

WATER DRINKING

As soon as the new born babe is washed and dressed he is given two teaspoons of
warmed, boiled water; and this practice is continued every two hours during the day,
until as much as two to four ounces of unsweetened water is taken by the tiny babe
during the twenty-four hours. Inanition fever—the fever that sometimes follows a failure
to give water to the new born infant—is thus avoided. The bottle from which the water is
given should be scalded out each time, the nipple boiled, and just before the "water
nursing" the nipple should be swabbed with boracic acid solution.

REGULARITY IN FEEDING

From earliest infancy the baby should be nursed by the "clock," and not by the "squawk."
Until he reaches his sixth-month birthday, he is fed with unerring regularity every three
hours during the day. Asleep or awake he is put to the breast, while during the night he is
allowed to sleep as long over the three-hour period as he will. Babies are usually nursed
at night: during the early weeks, at nine o'clock in the evening, at midnight, and at six
o'clock in the morning. After four months all nursing after ten p. m. may be omitted.
The baby is ordinarily allowed to remain at the breast for about twenty minutes. He may
often be satisfied with one breast if the milk is plentiful; if not, he is given both breasts;
and may we add the following injunction? insist that nothing shall go into your baby's
mouth but your own breast milk and warm or cool-boiled water; no sugar, whiskey,
paregoric, or soothing syrup should be given, no matter how he cries. Never give a baby
food merely to pacify him or to stop his crying; it will damage him in the end. More than

likely he is thirsty, and milk to him is what bread and meat are to you, neither of which
you want when you are thirsty.

POSITION OF MOTHER DURING THE NURSING

A perfectly comfortable position during nursing for both mother and babe is necessary
for satisfactory results. During the lying-in period the mother should rest well over on
her side with her arm up and her hand under her head, the other hand supports the breast
and assists in keeping the nipple in the baby's mouth, as well as preventing the breast
from in any way interfering with baby's breathing. A rolled pillow is placed at the
mother's back for support.
After the mother leaves the bed, she will find a low chair most convenient when nursing
the baby, and if an ordinary chair be used, she will find that a footstool adds greatly to
her comfort. Once during the forenoon and once during the afternoon the nursing mother
will find it a wonderful source of rest and relaxation if she removes all tight clothing,
dons a comfortable wrapper, and lies down on the bed to nurse her babe; and as the babe
naps after the feed, she likewise should doze and allow mother nature to restore, refresh,
and fit her for restful and happy motherhood.
Worry, grief, fatigue, household cares, loss of sleep, social debauches, emotional sprawls
—all debilitate the mother, and usually decrease the flow of milk.

NURSING WHEN ANGRY AND OVERHEATED

Overheating, irritability, and sudden anger, almost invariably tend to raise the blood-
pressure, which means the entry into the blood stream of an increased amount of
epinephrin, which disturbs the baby greatly, often throwing him into convulsions or other
sudden, acute illness.
Menstruation often interferes with the nursing mother, the milk becoming weaker at this
time; however, if the infant continues to gain and the mother feels comparatively well, no
attention need be paid to this fact.
Another pregnancy demands a drying up of the breast at once, as the tax is too great on
the mother.

THE STOOLS

The stools of the breast-fed baby do not require as much attention as those of the bottle-
fed child. In cases of constipation, after four months, from one teaspoon up to one-half
cup of unsweetened prune juice may be given one hour before the afternoon feed.

In instances of colic with signs of fermentation in the stool, the mother may take several
doses (under her physician's orders) of common baking soda; or, if she is constipated,
calcined magnesia will usually right the condition. Nature's mother milk is so beautifully
adapted to the baby's needs that it is the rule for baby to have perfectly normal stools.

SYMPTOMS OF SUCCESSFUL NURSING

A happy baby is a satisfied baby. He lies quietly in a sleepy, relaxed condition if he has
enough to eat, provided he is otherwise comfortable and dry. He awakens at the end of
two hours and perhaps cries; but plain, unsweetened, warm, boiled water quenches his
thirst, and he lies content for another hour, when he is regularly nursed. He gains on an
average of about one ounce a day.

EARMARKS OF UNSUCCESSFUL NURSING

Constant discomfort, vomiting, fretful crying, passing and belching of gas, colicky pain,
disturbed sleep, greenish stools with mucus, are among the more prominent earmarks of
unsuccessful nursing. These symptoms appearing in a pale, flabby, listless, indifferent or
cross baby, with steady loss of weight continued over a period of three or four weeks,
point to "nursing trouble;" which, if not corrected, will lead to that much dreaded
infantile condition—malnutrition.
Bolting of food or overeating results in vomiting and gas, and thus interferes with normal
nursing, as also may tongue-tie. A condition in the mouth, medically known as
"stomatitis," and commonly known as "thrush," often gives rise to a fretful cry when
nursing is attempted. In the first place, the baby cannot "hold on" to the nipple; while, in
the second place, it hurts his inflamed mouth when he makes an effort to nurse.
Long continued nursing covering three-fourths of an hour or more, seizing of the nipple
for a moment and then discarding it, apparently in utter disgust, are the earmarks of very
scanty milk supply and should receive immediate attention.

AIDS TO THE MILK SUPPLY

Believing that many more mothers than do so should nurse their babies, we have
carefully tabulated a number of aids to the milk supply, which we hope will be most
earnestly tried before the baby is taken from the breast—for so many, many more bottle-
fed babies die during the first year than the breast fed. The dangers of infection, the
worry of the food preparation, the uncertainty of results, all call for a most untiring effort
on the part of every doctor, nurse, and mother, in their endeavors to secure maternal
nursing. The following is a summary of "aids to the milk supply:"
1. Regular periodical sucking of the breasts from the day of baby's birth.

2. Systematic applications of alternate hot and cold compresses, followed by massage to
the breasts.
3. Three good nourishing meals each day, eaten with merriment and gladness of heart.
4. A glass of "cream gruel," milk, cocoa, or eggnog at the close of each meal, with a glass
just before retiring.
5. Three outings each day in the open air.
6. Nurse the baby regularly and then turn its care over to another, you seek the out of
doors and engage in walking, rowing, riding and other pleasurable exercise.
7. Take a daily nap.
8. You can bank on fretting and stewing over the hot cook stove to decrease your milk. It
seldom fails to spoil it.
9. Regular body bathing, with cold friction rubs to the skin.
10. A happy, carefree mental state. Nothing dries up milk so rapidly as worry, grief, or
nagging.
11. The administration, preferably in the early days, of desiccated bovine placenta;
although it may be given at any time during the period of nursing.

WHEN THE BABY SHOULD NOT BE NURSED

As much as we desire maternal nursing for the babe, there do occur instances and
conditions which demand a change to artificial feeding, such as the following:

1. A new pregnancy.
2. Mothers with uncontrollable tempers.
3. Cases of breast abscess.
4. Prolonged illness of the mother with high fever.
5. Wasting diseases such as tuberculosis, Bright's disease, heart disease, etc.
6. Maternal syphilis.
7. When maternal milk utterly fails, or is wholly inadequate.

When a maternal anesthetic is to be administered, or in case of inflammation of the
breast or during a very short illness not covering more than two or three days, then the
breast pump may be used regularly every three hours to both breasts; the baby may be
artificially fed and then returned to the breast after the effects of the anesthetic has worn
off or the temperature has been normal for twenty-four hours.
There may also appear definite indications in certain children which make it imperative
that the nursing child should early be weaned. These manifestations of disordered

nutrition and failing health admonish us to put the baby on properly modified milk, or to
transfer it to a wet nurse.
These conditions are:
1. Progressive loss in weight.
2. A bad diarrhea of long standing; one which does not yield to the usual remedies, at
least not as long as the baby continues to feed from the breast. These diarrheas are
especially serious when accompanied by a steady loss in weight.
3. Excessive vomiting accompanied by progressive loss in weight.

THE WET NURSE

Because of the rarity of good, healthy wet nurses, it is always better to attempt to feed
the baby with scientifically modified milk (not proprietary foods), good, clean, cow's
milk properly modified to suit the weight and age of the child. We put weight first, for
we prepare food for so many pounds of baby rather than for the number of months old he
is.
If modified food has failed and the best specialist within your reach orders a wet nurse;
she must have the following qualifications:

1. She must be free from tuberculosis and syphilis.
2. She should be between twenty and thirty years of age.
3. She should abstain from all stimulants.
4. She should be amiable, temperate, and should sense her responsibility.

If an unmarried mother of her first child is engaged as a wet nurse, she should not be
"stuffed" or allowed to overeat, which is commonly the result of moving her from her
lower life into more comfortable surroundings, or given ale or beer to increase her milk.
She should continue her normal eating, take light exercise, which does not mean the
scrubbing of floors or doing the family washing, and live under the same hygienic
regime outlined for the nursing mother. Should she be the mother of the second or third
illegitimate child, then she is quite likely to be mentally deficient and she should not be
engaged. Her own babe will have to be fed artificially as very few mothers can endure
the strain of two suckling children.
The baby's own mother should keep general supervision and not turn her babe entirely
over to the care of the wet nurse. Remember always that no one in the wide world will
ever take the same mother interest in your offspring that can spring from your own
mother heart.

CHAPTER XVI

THE BOTTLE-FED BABY

In taking up the subject of the bottle-fed baby, we must repeat that the only perfect baby
food on earth is the milk that comes from the breast of a healthy mother.
But sudden illness, accident, chronic maladies, or possibly the death of the mother, often
throw the helpless babes out into a world of many sorts and kinds of artificial foods—
foods that are prepared by modifying cow's, ass', or goat's milk; foods arranged by the
addition to the milk of various specially prepared cereals, albumens or malted
preparations, otherwise known as "proprietary foods." We shall endeavor, then, in this
chapter and in that on "the feeding problem," to lay down certain general suggestions to
both the nurse and the mother, which may assist them in their effort to select the food
which will more nearly simulate nature's wondrous mother-food, and which will, at the
same time, be best suited to some one particular baby.

THE HOURLY SCHEDULE

The normal baby, from birth to six months, should receive properly prepared
nourishment every three hours, beginning the day usually at six a. m., the last feeding
being at nine p. m. During the early weeks an additional bottle is given at midnight, but
this is usually discarded at four months, at which time the last feeding should be given at
about ten instead of at nine at night.
Should the baby continue to awaken during the night before six in the morning, unless he
is under weight, a bottle of warm, boiled, unsweetened water should be given.

QUANTITY OF FOOD

The quantity of food to be given is always determined by the size of the baby's stomach,
which, of course, depends somewhat upon the age of the child; for instance, the stomach
of the average baby one week old holds about one ounce, while at the age of three
months the stomach holds five ounces; so it would not only be folly to give two ounces
at one week and seven ounces at three months, but it would also be very detrimental to
the babe, causing severe symptoms due to the overloading of the stomach.
Careful study of the size of the stomach at different ages in infancy, together with the
quantity of milk drawn from the breast by a nursing baby, has led to the following
conclusions regarding the capacity of the baby's stomach:

AGE QUANTITY

1—4 weeks 1—2 ounces
4 weeks—3 months 2½—4 ounces
3 months—6 months 4—6 ounces
6 months—1 year 6—8 ounces

REFRIGERATOR NECESSITY

It is highly important that the day's feedings be kept in a cold place, free from the odors
of other foods as well as free from dust, flies, and filth. In order that this may be
accomplished, the well-protected bottles, each containing its baby-meal, are placed in a
covered pail containing ice and water. This covered receptacle is now put in an ice box;
and, in order that our most economical reader—one who may feel that she cannot afford
to keep up the daily expense of the family refrigerator—may herself prepare a simple
home refrigerator, the following directions are given (Fig. 9).

HOMEMADE ICE BOX

Procure a wooden box about eighteen inches square and sixteen or eighteen inches deep
and put four inches of sawdust into the bottom; now fill in the space between a ten-quart
pail, which is set in the middle of the box with more sawdust. A cover for the box is now
lined with two or three inches of newspaper, well tacked on, and is fastened to the box by
hinges. We are now ready for the inside pail of ice, into which is carefully placed the
well-protected bottles of milk, all of which is then set into the ten-quart pail in the box.
Five cents worth of ice each day will keep baby's food cool, clean, and provide
protection against the undue growth of germs.

Fig. 9. Homemade Ice Box.

PREPARING THE BOTTLE

At each feeding hour, one of baby's bottled meals is taken from the ice box and carefully
dipped in and out of a deep cup of hot water. A very convenient receptacle is a deep,
quart aluminum cup, which may be readily carried about. The hot water in the cup should
amply cover the milk in the bottle (Fig. 10).
To test the warmth allow a few drops to fall on the inner side of the arm, where it should
feel quite warm, never hot. A baby's clean woolen stocking is now drawn over the bottle,
which keeps it warm during the feeding. No matter how great the danger of offending a

fond grandparent or a much adored friend never allow anyone to put the nipple in her
mouth to make the test for warmth of baby's food.
There are many contrivances, both electrical and alcoholic, for heating baby's bottle,
many of which are both convenient and inexpensive.

POSITION DURING FEEDING

And now we realize that we are about to advise against the time-honored injunction
which has been handed down from "Grandma This" and "Mother That" to all young
mothers who have lived in their neighborhoods: "My dear young mother, if you can't
nurse your precious infant, you can at least 'mother it' at the nursing time by holding it in
your arms and gently rocking it to and fro as you hold the bottle to its lips." This so-
called "mothering" has resulted in regurgitation, belching, and numerous other troubles,
as well as the formation of the "rocking habit."
A young mother came running into my office one day saying: "Doctor, it won't work, the
food's all wrong; my baby is not going to live, for he throws up his food nearly all the
time." We arranged to be present when the next feeding time came and watched the
proceedings. A dear old friend had told her "she must 'mother' her baby at the nursing
time," and so she had held the child in a semi-upright position as she endeavored to hold
the bottle as near her own breast as was possible. The hole in the nipple was a bit large,
which occasioned the subsequent bolting of the food, and then to continue the
"mothering" she swayed him to and fro, all of which was interrupted suddenly by the
vomiting of a deluge of milk.

Fig. 10. Heating the Bottle.

I drew the shade in an adjoining room, opened the windows, and into a comfortable
carriage-bed I placed the baby on his side. Seating myself beside him I held the warm,
bottled meal as he nursed. Several times I took it from his mouth, or so tipped it that
"bolting" was impossible. Gradually, carefully, and slowly, I took the empty bottle away
from the sleepy babe, and as I closed the door the mother said in anxious amazement:
"He won't forget I'm his mother if I don't hold him while he nurses?" You smile as I
smiled at this girl-mother's thought; but, nevertheless there are many like her—anxious,
well-meaning, but ignorant.
The infant stomach is little more than a tube, easily emptied if the baby's position is not
carefully guarded after nursing. No bouncing, jolting, patting, rocking, or throwing
should take place either just before, during, or immediately after meals.

TIME ALLOWANCE FOR ONE FEEDING

From twelve to twenty minutes is long enough time to spend at a bottle meal. The nipple
hole may have to be made larger, or a new nipple with a smaller hole may have to be
purchased. When new, you should be able to just see a glimmer of light through the hole,
and if the infant is too weak to nurse hard, or the hole too small, it may be made larger by
a heated hatpin run from the inside of the nipple out; great care must be taken, else you
will do it too well. If the nipple hole is too large, bolting is the sure result; while too
small a hole results in crying and anger on the part of the hungry child, because he has to
work too hard to get his meal.

AFTER THE FEED

We have seen some mothers, in their anxiety to prevent the sucking in of air from the
emptied bottle, rush in and jerk the nipple from the going-to-sleep babe so forcibly that
all thoughts of sleep vanished and a crying spell was initiated. The tactful mother is the
quiet one who slowly, quietly, draws the empty bottle with its "much loved nipple" from
the lips. If you observe that the babe is going to sleep, with an occasional superficial
draw at the nipple, wait a moment; he will drop it himself, and you can pick it up as you
quietly leave the room. In all instances, whether it be indoors or out of doors, arrange the
babe in a comfortable sleeping position, remembering that nursing is warm exercise and
the babe gets uncomfortably sweaty if overbundled, especially about the head and neck.
No one should unnecessarily touch the babe immediately after feeding; even his diaper
may be changed without awakening him while he is thus lying quietly in his bed.

INTERVALS BETWEEN MEALS

The three-hour interval is reckoned from the beginning of the meal, and not from its
close. More than two hours is spent in the stomach digestion, and any food or sweetened
water which may enter between meals only tends to cause indigestion and other
disturbances. And that this important organ may have a bit of rest, we fix the interval at
three hours, which in our experience and that of many other physicians, has yielded good
results. As a rule we have no regurgitation and no sour babies on the three-hour schedule.
Sick babies, very weak babies, and their feeding time, will be discussed in a later chapter.

ADDITIONAL FOODS

At six months, and often as early as four, in cases of constipation, unsweetened, well-
strained prune juice may be given, beginning with one-half teaspoon one hour before the
afternoon feed and increasing it daily until two tablespoons are taken. At six months,
both orange juice and vegetable broths are given, whose vegetable salts add a very
important food element to the baby's diet—an element which our grandmothers thought
could only be obtained through the time-honored "bacon rind" of by-gone days.
Orange juice is also unsweetened and well strained, and is administered in increasing
amounts, beginning with one-half teaspoon one hour before the afternoon feeding, until
the juice of a whole orange is greedily enjoyed by the time of the first birthday. The
vegetable juices are obtained from cut-up spinach, carrots, tomatoes, and potatoes,
strained, with a flavor of salt and onion—really a bouillon—and is given just before the
bottle at the six p. m. feeding. They are also begun in teaspoon amounts.

FOOD FOR THE TRAVELING BABE

Baby travel should be reduced to a sheer necessity; never should the babe be subjected to
the exposure of disease germs, the change of food, the possibilities of draughts and
chilling, for merely a pleasure trip—the risks are too great and the possibilities of future
trouble too far reaching.
If you are in touch with the milk laboratory of a large city, you will find that they make a
specialty of preparing feedings which are good for a number of days for the traveling
baby, and we strongly advise that their preparations be accepted; but in the event of not
being in touch with such a laboratory we suggest the making of a carrying ice-box
covered with wicker, which must be kept replenished with ice. Food kept in such a
device may be kept fresh for twenty-four to forty-eight hours. Plans other than the
laboratory preparations or the ice-box are risky, and should not be depended upon.
Many of our railway dining cars now pick up fresh, certified milk at stations along the
line for use on their tables, and where such is the case fresh preparations of milk may be
made on a trans-continental trip by the aid of an alcohol stove. Malted milk may also be
used, provided you have accustomed the baby to its use a week before leaving home, by

the gradual substitution of a fourth to a half ounce each day in the daily food; all of
which, of course, should be done under your physician's direction.
If possible, leave baby at home in his familiar, comfortable environment in the care of a
trained nurse and a trusted relative, and under the supervision of the baby's own
physician. He is much better off, much more contented, and we are all aware of the fact
that contentment and familiarity of sights and people promote good appetite, good
digestion, and happiness—the very essentials of success in baby feeding. We speak
touchingly and sympathetically to the mother who must leave her babe; and likewise we
wish to cheer her as we remind her that by wireless messages and night letters it is
possible to keep in touch with loved ones though a thousand miles away.
The sanitation and modification of cow's milk, as well as stools, etc., are taken up in later
chapters.

RULES FOR THE BOTTLE-FED

1. Never play with a baby during or right after a meal.
2. Lay the baby on his side when nursing the bottle.
3. Three full hours should intervene between feedings.
4. Don't give the food too hot—it should just be warm.
5. Make the test for warmth on the inner side of your arm.
6. Give a drink of water between each meal if awake.
7. Never save the left-overs for baby.
8. If possible, give three feedings each day in the cool air, with baby comfortably warm.
9. Do not jump, bounce, pat, or rock baby during or after meals.
10. Never coax baby to take more than he wants, or needs.
11. No solid foods are given the first year.
12. Orange juice may be given at six months; while, after four months, unsweetened
prune juice is better than medicine for the bowels.

CHAPTER XVII

MILK SANITATION

Cow's milk, like mother's milk, is made up of solids and water. In a previous chapter we
learned that in one-hundred parts of mother's milk, eighty-seven parts were water and
thirteen parts were solid. These thirteen parts of solids consist of sugar, proteins, and
salts; this is likewise the case with cow's milk, except that in the case of the cow's milk,
the sugar is decreased while the proteins are increased as will be noted by the
accompanying comparative analysis:
MOTHER'S MILK
Fat % 4.00
Sugar 7.00
Proteins 1.50
Salts 0.20
Water 87.30
———
% 100.00
COW'S MILK
Fat % 4.00
Sugar 4.50
Proteins 3.50
Salts 0.75
Water 87.25
———
% 100.00

Mother's milk is absolutely sterile, that is, free from the presence of germs; on the other
hand, cow's milk is anything but sterile—the moment it leaves the udder it begins to
accumulate numerous bacteria, all of which multiply very rapidly. Cow's milk is
generally twenty-four to forty-eight hours old before it can possibly reach the baby. It is
just as important to keep in mind these facts of milk contamination—dirt, filth, flies, and
bacteria—as it is to plan for the modification of cow's milk for the purpose of making it
more nearly resemble mother's milk. While mother's milk has about the same percentage
of fat as cow's milk, it is almost twice as rich in sugar, and has only one-fourth to one-
third as much protein. This protein is vastly different from that found in cow's milk,

which you recall has a tough curd, as seen in cottage cheese. While mother's milk
contains a small amount of casein similar to that found in the cheese of the cow's milk,
the principal protein constituent is of another kind (lactalbumin), and is much more easy
of digestion than the casein of cow's milk.
This is a most important point to remember, because the baby's stomach is not at first
adapted to the digestion of the heavier and tougher protein curds of cow's milk. It
requires time to accustom the infant stomach to perform this heavier work of digestion.
There are a number of factors which must be borne in mind in the modification of milk,
whether it be cow's milk, or goat's milk (for many European physicians use goat's milk
entirely in the artificial feeding of infants): namely, the cleanliness of the milk, the
acidity of milk, the difference in the curd, the percentage of sugar, and the presence of
bacteria.

SUGAR

In the modification of cow's milk, sugar must be added to make up for the sugar which is
decreased when the water was added to reduce the protein. There are several sorts of
sugar used in the modification of milk. These sugars are not added to sweeten the milk
alone, but to furnish a very important element needed for the growth of the baby. Sugar is
the one element which the infant requires in the largest amount.
Milk sugar is probably most universally used in the modification of milk, but a good
grade of milk sugar is somewhat expensive, costing from thirty to sixty cents a pound,
and this places it beyond the reach of many mothers. It is added to the food mixtures in
the proportion of one ounce to every twenty ounces of food. Cane sugar (table sugar)
may also be used, but it must be clean and of good quality. It is used in rather less
quantity than that of milk sugar, usually from one-half to one-third of an ounce by
measure to each twenty ounces of food. Dextri-maltose (malt sugar) is very easy of
digestion and may be used in the modification of milk. Maltose seems to help the
children to gain more rapidly in weight than when only milk or cane sugar is used. It is
also exceedingly useful in constipation, as its action is more laxative than any of the
other sugars; but it should not be given to children who vomit habitually or have loose
stools.

ACIDITY

Like mother's milk, the cow's milk is neutral as it comes from the udder; but, on
standing, it quickly changes, soon becoming slightly acid, as shown by testing with blue
litmus paper. In fact, what is known as ordinarily fresh milk, if subjected to the litmus
paper test, always gives an acid reaction. This acidity is neutralized by adding lime water
to the formula in the proportion of one ounce to each twenty-ounce mixture. Ordinary
baking soda is sometimes prescribed by physicians in place of the lime water. In the

event of obstinate constipation, milk of magnesia is sometimes added to the day's
feedings.

CREAM

There may be procured in any large city an instrument called the cream gauge, which
registers approximately (not accurately) the richness of milk. Some milk, even though
rich, parts with its cream very slowly; while some poor milk allows nearly all the cream
quickly to rise to the surface. We know of no way for the mother to determine the
amount of cream (without the cream gauge) except by the color and richness of the milk.
In cities it is very convenient to send a specimen of the milk to the laboratories to be
examined by experts, who will gladly render a report to both physician and mother.

Fig. 11. A Sanitary Dairy.

The lactometer is a little instrument used to estimate the specific gravity of milk. An
ordinary urinometer such as used by physicians in estimating the specific gravity of urine
may also be used. The specific gravity of cow's milk should not register below 1028 or
above 1033.

HERD MILK

Milk from a single cow is not to be desired for baby's food because of its liability to vary
from day to day, not to mention the danger of the cow's becoming sick. Authorities have

agreed that herd milk of Holstein or ordinary grade cows is best for infant feeding. This
mixed-herd milk contains just about the proper percentage of fat; whereas, if Jersey milk
must be used, some of the cream should be taken away. Our milk should come from
healthy cows which have been tested for tuberculosis at least every three months.
Annatto is sometimes added to milk to increase its richness of color. To test for annatto
proceed as follows: To a couple of tablespoons of milk add a pinch of ordinary baking
soda. Insert one-half of a strip of filter paper in the milk and allow it to remain over
night. Annatto will give a distinct orange tint to the paper. The commonly used milk
preservatives are boracic acid, salicylic acid, and formaldehyde, any of which may be
readily detected by your health officials.

SANITARY DAIRIES

In close proximity to most large cities there is usually to be found one or more sanitary
dairies. It is a joy indeed to visit a farm of this kind with its airy stables and concrete
floors, which are washed with water coming from a hose. The drainage is perfect—all
filth is immediately carried off (Fig. 11). The cows are known to be free from
tuberculosis, actinomycosis (lumpy jaw), and foot and mouth disease. The milkmen on
this farm wear washable clothes at the milking time, and their hands are painstakingly
cleansed just before the milking hour. Previous to the milking the cattle have been
curried outside the milking room and their udders have received a careful washing. The
milkman grasps the teat with clean hands, while the milk is allowed to flow through
several thicknesses of sterilized gauze into the sanitary milking pail. This milk is at once
poured into sterile bottles, is quickly cooled and shipped in ice to the substations where
the delivery wagon is waiting. In the ideal delivery wagon there are shallow vats of ice in
which the bottles are placed, thus permitting the milk to reach the baby's home having all
the while been kept at a temperature just above the freezing point.
And why all this trouble? Why all this worry over temperature and cleanliness? Babies
were not so cared for in the days of our grandmothers. The old-fashioned way of milking
the cows with dirty clothes and soiled hands, while cattle were more or less covered with
manure, with their tails switching millions of manure germs into the milking pail,
produced a milk laden not only with manure germs—the one great cause of infantile
diarrhea—but also swarming with numerous other mischief making microbes. Even
tuberculosis, that much dreaded disease germ of early infancy, may come from the dairy
hands as well as from infected cows.
There used to be many dairymen like the old farmer who, when interrogated by the
health commissioner concerning the cleanliness of his milk, laughed as he reached down
into the bottom of a pail of yellow milk and grabbing up a handful of manure and straw,
said: "That's what makes the youngsters grow." But it does not make them grow; it often
causes them to die, and even if they do live, they live in spite of such contaminated food,

for the germ which is always found in the colon of the cow (coli communis), probably
kills more babies every year than any other single thing.
It is possible to reduce the growth of these germs by keeping the milk at a very low
temperature from the time it leaves the cow until the moment it gets to the home
refrigerator. Those which survive this process of refrigeration may be quickly rendered
harmless by pasteurizing or sterilizing at the time of preparing baby's food.
In the absence of the modern sanitary dairy, we would suggest that the milk supply be
improved by giving attention to the following:
The cattle should be tested for tuberculosis every three months. The walls of the
cowhouse should be whitewashed three times a year. The manure should be stored
outside the barn. The floor of the cowhouse should be sprinkled and swept each day. The
cattle should be kept clean—curried each day, and rubbed off with a damp cloth before
milking. The udders should be washed before each milking. The milker can wear a clean
white gown or linen duster which should be washed every two days, while his hands
should be washed just before the milking. The milking pail should be of the covered
sanitary order. The barn should be screened.

CERTIFIED MILK

Immediately after leaving the cow, the milk should be cooled to at least 45 F. It should at
once be put into bottles that have been previously sterilized and then be tightly covered,
and should be kept in ice water until ready for consumption. No matter how carefully the
milk is handled, it is infected with many bacteria, but if it is quickly cooled, the increase
of the bacteria is greatly retarded. Under no circumstances buy milk from a grocery store
out of a large can. Go to your health officer and encourage him in his campaign for
sanitary dairies and certified milk.
Such milk as we have described under the head of sanitary dairies, when it has been
tested by the board of health and has received the approval of the medical profession, is
known as "certified milk;" and, although the price is usually fifteen to twenty cents a
quart, when compared with the cost of baby's illness it will prove to be cheaper than the
dirty milk which sickens and kills the little folks.
There is no doubt that the increased use of "certified milk" has been a great factor in the
reduction of deaths from infant diarrhea in recent years.

BOILING THE MILK

When certified milk cannot be had, it is absolutely dangerous to give raw, unboiled, or
unpasteurized milk to the baby, particularly in warm weather; for the countless millions
of manure germs found in each teaspoon of ordinary milk not only disturbs the baby's
digestion, but actually makes him sick, causing colic, diarrhea, and cholera infantum.

The only way this milk can be rendered safe is by cooking it—actually killing the
bacteria. This process of boiling, however, does not make good milk out of bad milk nor
clean milk out of that which is dirty, it simply renders the milk less dangerous.
There are two methods of killing bacteria—sterilization and pasteurization. By
sterilization is meant the process of rendering the milk germ free by heating, by boiling.
Many of the germs found in milk are comparatively harmless, merely causing the souring
of milk; but other microbes are occasionally present which cause serious diseases, such
as measles, typhoid and scarlet fever, diphtheria, tuberculosis, and diarrhea. It is always
necessary to heat the milk before using in warm weather, and during the winter it is also
important when infectious or contagious diseases are prevalent.
Milk should be sterilized when intended for use on a long journey, and may be eaten as
late as two or three days afterward.
To sterilize milk, place it in a well-protected kettle and allow to boil for one hour and
then rapidly cool. This process renders it more constipating, and for some children many
of its nutritive properties seem to be destroyed, as scurvy is often the result of its
prolonged use. When a child must subsist upon boiled milk for a long period, he should
be given the juice of an orange each day. Children are not usually strong and normal
when fed upon milk of this character for indefinite periods. All living bacteria (except the
spores or eggs) may be destroyed by boiling milk for one or two minutes.

PASTEURIZATION

When baby is to use the milk within twenty-four hours, "pasteurization" is better than
boiling as a method of destroying microbes.
There are many pasteurizers on the market which may be depended upon, among which
are the Walker-Gordon Pasteurizer, and Freeman's Pasteurizer; but in the absence of
either of these pasteurization may be successfully accomplished by the following
method:
On the bottom of a large kettle filled with cold water, place an ordinary flatiron stand
upon which is put a folded towel. On this place the bottle of milk as it comes from the
dairyman, with the cap of the bottle loosened. The cold water in the kettle should come
up to within an inch of the top of the bottle of milk. Heat this water quickly up to just the
boiling point—until you see the bubbles beginning to rise to the top. The gas is then
turned down or the kettle is placed on the back of the range and held at this near-boiling
point for thirty minutes, after which it is taken to the sink and cold water is turned into
the water in the kettle, until the bottle of milk is thoroughly cooled. It is now ready to be
made up into the modified food for baby.
Never let pasteurized milk stand in the room, nor put it near the ice when warm. It must
be cooled rapidly, as described above; that is, within fifteen or twenty minutes.

The "spores" of the milk are not killed by pasteurization and they hatch out rapidly
unless the milk is kept very cold, and, as already stated, it should be used within twenty-
four hours after pasteurization.

THE CARE OF BOTTLED MILK

The certified milk or the ordinary milk that has been delivered to your home and is to be
used without pasteurization or sterilization, should receive the following care:
1. It should be placed at once in a portion of the ice box that is not used to store such
foods as radishes, cabbage, meats or any other open dishes of food whose odors would
quickly be absorbed by the milk. The milk should never be left standing on the doorsteps
in the sun, for many reasons: the sun heats the milk, encourages the growth of bacteria,
and a passing cat or dog, whose mouth often contains the germs of scarlet fever,
tonsilitis, and diphtheria, should it be hungry, laps the tops of the bottles, particularly in
the winter when the cream has frozen and is bulging over the edge.
2. It should never be kept in the warm kitchen, as when visiting her sick baby we
discovered one young mother doing. In answer to my question, she explained; "Doctor,
we do not take ice in the winter time, everything is ice outdoors, so I just set the bottle
outside the window bringing it in whenever I need to give the baby some food. I forget to
put it out sometimes, but really now, does it matter?" It really matters much, for you see,
reader, the milk is first freezing then thawing and it is rendered entirely unfit for the
baby.
3. Milk should be kept covered and protected from dust and flies; it should be kept in
glass jars which have been sterilized by boiling before being filled, and then placed in the
refrigerator. If the milk is sour, or if there is any sediment in the bottle, it is unfit for
baby's use.

CHAPTER XVIII

HOME MODIFICATION OF MILK

In a previous chapter it was found from comparing the analysis of mother's milk with
that of cow's milk, that they widely differed in the proteins and sugar. The art of so
changing cow's milk that it conforms as nearly as is possible to mother's milk is known
as "modification." Where protein, sugar, and fat are given in proper amounts, healthy
infants get along well; but when either the fats or proteins are given in excess, or when
the digestion of the child is deranged, there is often no end of mischief.
There are two groups of milk formulas that are useful. First, those in which the fats and
proteins are about the same, known as "whole milk," or "straight" milk mixtures; second,
those in which the fats are used in larger proportions than proteins, and known as "top
milk"—milk taken from the upper part of the bottle after the cream has risen. And since
the larger proportion of babies take the lower fats or "whole milk" formulas, and seem to
get along better than the babies who have the "top milk" formulas, we will first take up
the consideration of the modification of whole milk.

PREPARATION FOR MODIFICATION

To begin with, everything that comes in contact with the preparation of baby's food must
be absolutely clean. The table on which the articles are placed, and any towel that comes
in contact with the articles or the mother's hands, or those of the nurse, must be
thoroughly scrubbed.
There is only one way to prepare the utensils that are to be used in making the baby's
food, and that is to put them in a large kettle and allow them to boil hard for fifteen
minutes just before they are to be used. The articles needed are (Fig. 12):

1. As many bottles as there are feedings in 10. A bottle of lime water.
one day.
2. A nipple for each bottle. 11. A fine-mesh, aluminum strainer.
3. Waxed paper for each bottle top. 12. A square of sterile gauze for straining
the food (should be boiled for fifteen
minutes with the utensils).
4. Rubber bands for each bottle. 13. One plate, and later a double boiler
(14).
5. A two-quart pitcher. 15. The sugar.
6. A long-handled spoon for stirring the 16. The milk.
food.

7. A tablespoon. 17. Ready for the ice box.
8. A fork. 18. Refrigeration.
9. An eight-ounce, graduated measuring
glass.

BOTTLES AND NIPPLES

There is but one bottle which can be thoroughly washed and cleaned, and that is the
wide-mouthed bottle. It should hold eight ounces and should have the scale in ounces
blown in the side (Fig. 10). The nipple for this bottle is a large, round breast from which
projects a short, conical nipple, which more nearly resembles the normal breast than do
the old-fashioned nipples so frequently seen on the small-necked nursing bottles. There is
a great advantage in this, in that the baby cannot grasp the nipple full length and thus
cause gagging. These bottles and nipples are known as the "Hygeia," and have proven to
be a great source of comfort to the baby as well as to the mother or nurse whose duty it is
to keep them clean. There are a number of other nursing bottles on the market, which, if
they are used, must be thoroughly cleansed with a special bottle brush each day. The
neck is small and the nipple is small and great care must be taken in the cleansing of both
of them.

Fig. 12. Articles Needed for Baby's Feeding.

CARE OF BOTTLES AND NIPPLES

When there is a bottle for each individual feeding in the day, immediately after each
nursing both bottle and nipple should be rinsed in cold water and left standing, filled with
water, until the bottles for one day's feeding have all been used. The nipples should be
scrubbed, rinsed, and wiped dry and kept by themselves until their boiling preparation
for the following day's feeding.
If the same bottle is to be used for the successive feedings during the day, it should be
rinsed, washed with soap and water, and both bottle and nipple placed in cold water and
brought quickly to the boiling point and allowed to boil for fifteen minutes. No bottles or

nipples must ever be used after a mere rinsing; boiling, preceded by a thorough washing
in soap and water, must take place before they are used a second time.
New nipples are often hard and need to be softened, which is readily done by either
prolonged boiling or rubbing them in the hands.
All new bottles should be annealed by placing them on the stove in a dishpan of cold
water and allowing them to boil for twenty minutes, and then allowing them to remain in
the water until they are cold. When bottles are treated in this manner they do not break so
readily when being filled with boiling water or hot food.

PREPARING THE FOOD

In a large preserving kettle place all the utensils needed in the preparation of the food—
pitcher, spoon, fork, measuring glass, bottles, nipples, cheesecloth for straining, agate
cup, wire strainer, in fact everything that is to be used in the preparation of the food.
Now fill the kettle with cold water and place over the gas and allow to boil for fifteen
minutes. On a well-scrubbed worktable place a clean dish towel, and on this put the
utensils and the bottles right side up. The nipples on being taken out of the boiling water
will dry of themselves; they should be placed in a glass-covered jar until they are needed
for each individual feeding, the nipples not being placed on the bottles as they go to the
ice box.
Having been given your formula by your physician, proceed in the following way.
Suppose we were preparing the food for a normal two-months old baby that weighed ten
pounds, with the prescription as follows:
Baby Smith.
Rx
Whole Milk ounces 11
Cane Sugar level
tablespoons 2
Boiled Water ounces 12½
Lime Water ounces 1
Amount at Each Feeding ounces 3½
Number of Bottles 7
Interval Between Feedings hours 3

DETAILS OF PREPARATION

Two level tablespoons of cane sugar are placed in the agate cup and dissolved in a small
amount of boiling water. The solution should be perfectly clear, and if it does not clear up
put it over the heat for a few moments.
This is now turned into the eight-ounce measuring glass which is then filled with boiling
water and emptied into the two-quart pitcher. We need four and one-half more ounces of
boiling water to complete the prescription requirement of twelve and one-half ounces.
The bottle of milk, if properly certified, need not be pasteurized; but if it is not, it should
have been previously pasteurized while the utensils were boiling according to the
suggestions found in the chapter on "milk sanitation." The top of the milk bottle should
be thoroughly rinsed and wiped dry, and after a thorough shaking of the milk, the cover
is removed with the sterile fork and eleven ounces are measured out by measuring glass
and poured into the pitcher. All is now stirred together with an ounce of lime water,
which should never look murky, but should be as clear as the clearest water and should
always be kept in the ice box when not in use.
The sterile cheesecloth which has been boiled for fifteen minutes is now put over the
nose of the pitcher, the contents of which is accurately measured into the seven clean,
empty bottles, each containing three and one-half ounces. Over the top of each of the
nursing bottles is placed a generous piece of waxed paper which is held down by a
rubber band. Each meal for the day is now contained in a separate bottle, and all are
placed in a covered pail of water containing ice, and put in the ice box.
If the prescription for the baby's food contains gruel, it is prepared in the following
manner:
Suppose the baby is eight months old and the prescription called for two level
tablespoons of flour and eight ounces of boiled water. The two level tablespoons of flour,
whether it be wheat (ordinary bread flour), or barley flour, are put into a cup and stirred
up with cold water, just as you would stir up a thickening for gravy; now measure out
eight ounces of water and allow it to come to a boil in the inner pan of the double boiler,
into which the thin paste is stirred until it comes to a boil. After boiling for twenty
minutes, remeasure in the measuring glass and what water has been lost by evaporation
must be added to complete accurately the prescription requirement of eight ounces; this
is now added to the other ingredients of the prescription.

TABLE FOR INFANT FEEDING

We now offer a monthly schedule—a table which is the result of our experience in
feeding hundreds of babies in various sections of Chicago. It is not a schedule for the
sick baby, but it is a carefully tabulated outline for the normal, healthy, average child
ranging from one week to one year in age. In offering this table we remind the mother, if
the baby is six months old and not doing well on the food it is getting and a change is
desired by both mother and physician, that it is far better to begin with the second or

third month's prescription and quickly work up to the sixth month's. This change may
often be accomplished in two or three days.
In all large cities there are to be found milk laboratories which make it their business to
fill prescriptions for the modification of milk under the direction of baby specialists. This
milk can be absolutely relied upon. In specialized diet kitchens in many large hospitals,
these feeding prescriptions also may be filled.

ARTIFICIAL FEEDING SCHEDULE
Amount Number Interval Soups Total
Baby's Whole Cane Wheat Boiled Lime Fruit
Age at of Between and Daily
Weight Milk Sugar Flour water Water Juices
Feeding Feedings Feedings Broths Calories
Level Level in 24
Pounds Ounces Ounces Ounces Ounces Hours
Tablespoon Tablespoon Hours
1 week 7½ 2½ 1 5 ½ 1 8 3 112
2
7½ 4½ 1½ 9 ½ 2 7 3 184
weeks
3
7¾ 7 2 10 ½ 2½ 7 3 267
weeks
4
8 9 2 11 1 3 7 3 309
weeks
2
10 11 2 12½ 1 3½ 7 3 351
months
3
12 15 2 ½ 15 1 4½ 7 3 447
months
4
13 18 2½ 1 13½ 1½ 5½ 6 3 553
months
5
14 21 2½ 1½ 13½ 1½ 6 6 3½ 628
months
6 one one
15 23 2½ 1½ 10½ 1½ 7 5 4 680
months teaspoon teaspoon
7 two
16 25 2 1½ 8½ 1½ 7 5 4 ¼ cup 732
months teaspoon
8 one­half
17 27 1½ 2 8 1½ 7¼ 5 4 ¼ cup 767
months orange
9 one
18 29 1 2 8 2 7¾ 5 4 ½ cup 854
months orange
10 one
19 30 ¾ 2 8 2 8 5 4½ ¾ cup 875
months orange
11 one
20 31 ½ 2 8 2 9 5 5 1 cup 906
months orange
1 cup
12 one
21 32 7 2 9 5 5 arrowroot 950
months orange
cracker
18 toast, gravies, baked potato
24 36 12 3 6
months and apple, etc.
Note 1 ounce of whole milk equals 21 calories 1 level tablespoon of flour equals 25 calories
1 level tablespoon of cane sugar 60 calories The juice of 1 average orange 75 calories
equals equals
1 level tablespoon of milk sugar 45 calories 1 cup of average bouillon equals 100
equals about calories

(This table is calculated on the basis of about 45 calories for each pound of baby
weight)

TOP-MILK FORMULA

Top milk is the upper layer of milk which has been removed after standing a certain
number of hours in a milk bottle or any other tall vessel with straight sides. It contains
most of the cream and varying amounts of milk. It may be removed by a small cream
dipper which holds one ounce, or it may be taken off with a siphon, but it should never
be poured off. To obtain seven per cent top milk which is the one most ordinarily used in
the preparation of top milk formulas, we take off varying amounts—according to the
quality of the milk—which Doctor Holt describes as follows:
From a rather poor milk, by removing the upper eleven ounces from a quart, or about
one-third the bottle.
From a good average milk, by removing the upper sixteen ounces, or one-half the bottle.
From a rich Jersey milk, by removing the upper twenty-two ounces, or about two-thirds
the bottle.
Cream is often spoken of as if it were the fat in milk. It is really the part of the milk
which contains most of the fat and is obtained by skimming, after the milk has stood
usually for twenty-four hours; this is known as "gravity cream." It is also obtained by an
apparatus called a separator; this is known as "centrifugal cream," most of the cream now
sold in cities being of this kind. The richness of any cream is indicated by the amount of
fat it contains.
The usual gravity cream sold has from sixteen to twenty per cent fat. The cream removed
from the upper part (one-fifth) of a bottle of milk has about sixteen per cent fat. The
usual centrifugal cream has eighteen to twenty per cent fat. The heavy centrifugal cream
has thirty-five to forty per cent fat.
The digestibility of cream depends much upon circumstances. Many serious disturbances
of digestion are caused by cream.
It is convenient in calculation to make up twenty ounces of food at a time. The first step
is to obtain the seven per cent milk, then to take the number of ounces that are called for
in the formula desired.
One should not make the mistake of taking from the top of the bottle only the number of
ounces needed in the formula, as this may be quite a different per cent of cream and give
quite a different result.
There will be required in addition, one ounce of milk sugar and one ounce of lime water
in each twenty ounces. The rest of the food will be made up of boiled water.

These formulas written out would be as follows:
FORMULA FROM SEVEN PER CENT MILK
I II III IV V VI VII VIII IX
Oz. Oz. Oz. Oz. Oz. Oz. Oz. Oz. Oz.
7 per cent milk 2 3 4 5 6 7 8 9 10
Milk sugar 1 1 1 1 1 ¾ ¾ ¾ ¾
Lime water 1 1 1 1 1 1 1 1 1
Boiled water 17 16 15 14 13 12 11 10 9
— — — — — — — — —
20 20 20 20 20 20 20 20 20

The approximate composition of these formulas expressed in percentages are as follows:

Formula Fat Sugar Proteins
I 0.70 5.00 0.35
II 1.00 6.00 0.50
III 1.40 6.00 0.70
IV 1.75 6.00 0.87
V 2.00 6.00 1.00
VI 2.40 6.00 1.20
VII 2.80 6.00 1.40
VIII 3.10 6.00 1.55
IX 3.50 6.00 1.75

It is necessary to make the food weak at first because the infant's stomach is
intended to digest breast milk, not cow's milk; but if we begin with a very
weak cow's milk the stomach can be gradually trained to digest it. If we
began with a strong milk the digestion might be seriously upset.
Usually we begin with number one on the second day; number two on the
fourth day; number three at seven to ten days; but after that make the
increase more slowly. A large infant with a strong digestion will bear a
rather rapid increase and may be able to take number five by the time it is
three or four weeks old. A child with a feeble digestion must go much
slower and may not reach number five before it is three or four months old.
It is important with all children that the increase in the food be made very
gradually. It may be best with many infants to increase the milk by only half
an ounce in twenty ounces of food, instead of one ounce at a time, as
indicated in the tables. Thus, from three ounces the increase would be to
three and one-half ounces; from four ounces to four and one-half ounces,
etc. At least two or three days should be allowed between each increase in
the strength of the food.

PEPTONIZED MILK

Another modification which at times may be ordered by your physician is
peptonized milk. Since it is infrequent for the proteins of milk to be the
cause of indigestion, peptonized milk has only a limited use, chiefly in
cases of acute illness. The milk is peptonized in the following manner:
Place the peptonizing powder (it is procurable in tubes or tablets from the
drug store) in a small amount of milk, and after being well dissolved, put
into the bottle or pitcher with the plain or modified milk, after which the
whole is shaken up together. The bottle is then put into a large pitcher
containing water heated to about 110° F. or as warm as would bear the hand
comfortably, and left for ten or twenty minutes (if the milk is to be partially
peptonized). To completely peptonize the milk, two hours are required.
Either of these formulas is only used on the advice of a physician.

BUTTERMILK

In many cases of chronic intestinal indigestion, buttermilk is used in place
of the milk. It is prepared as follows: After the cream has been taken from
the milk and it has been allowed to come to a boil, it is cooled to just blood
heat. A buttermilk tablet, having first been dissolved in a teaspoonful of
sterile water, is now stirred into the quart of warmed, skimmed milk and
allowed to stand at room temperature for twenty-four hours at which time it
should look like a smooth custard. With a sterile whip this is now beaten
and is ready for the sugar and the boiled water which is added according to
the written prescription from the doctor.

CONDENSED MILK

Under no circumstances should condensed milk be used as the sole food of
the baby for more than one month. Children often gain upon it, but as a rule
they have little resistance, and they are very prone to develop rickets and
oftentimes scurvy; and, as noted elsewhere, orange juice should always be
administered at least once during the twenty-four hours as long as
condensed milk is used.
Of all the brands of condensed milk, those only should be selected which
contain little or no cane sugar. Perhaps the "Peerless Brand" of evaporated
milk is the most reliable and in the preparation of food from this evaporated
milk the same amount of sugar, etc., should be added as we do in the
preparation of "whole milk" or "top milk."
We do not in any way advise the use of condensed milk. Fresh milk should
always be used where it is obtainable, but in traveling it sometimes has to
be used. Holt says, "It should be diluted twelve times for an infant under
one month and six to ten times for those who are older."
Malted milk is a preparation suitable in some cases where fresh cow's milk
is not obtainable. Even better than condensed milk, this food will be found
serviceable in traveling, or in instances where only very bad cow's milk is
within reach.

SPECIAL FOODS

Most patent foods are made up of starches and various kinds of sugars, and
some of them have dried milk or dried egg albumin added. Many flours
under fanciful names are sold on the market today. For instance, one flour
with a very fanciful name is simply the old fashioned "flour ball" that our
great, great grandmothers made; and, by the way, perhaps there is no flour
for which we are more grateful in the preparation of infant food than the
flour ball which is prepared as follows: A pound of flour is tied tightly in a
cheesecloth and is put into a kettle of boiling water which continues to boil
for five or six hours, at the end of which time the cheesecloth is removed
and the hard ball, possibly the size of an orange, is placed on a pie pan and
allowed slowly to dry out in a low temperatured oven. At the end of two or
three hours, the ball, having sufficiently dried, has formed itself into a thick
outer peel which is removed, while the heart which is very hard and
thoroughly dry, is now grated on a clean grater, and this flour has perhaps
helped more specialists to serve more sick babies than any other form of
starch known. It is used just as any other flour is used—wet up into a paste,
made into a gruel, which is boiled for twenty minutes before it is added to
the milk.
Whey is sometimes used in the preparation of sick babies' food and is
prepared as follows:
To a pint of fresh lukewarm cow's milk are added two teaspoons of essence
of pepsin, liquid rennet or a junket tablet. It is stirred for a moment, then
allowed to stand until firmly coagulated, which is then broken up and the
whey strained off through a muslin.
The heavy proteins remain in the curd, and the protein that goes through
with the whey is chiefly the lactalbumin.

CHAPTER XIX

THE FEEDING PROBLEM

A friend of ours who presides over a court of domestic relations in a large
city, recently told us that he believed much trouble was caused in families—
many divorces, occasioned, and many desertions provoked—because
improperly fed babies were cross and irritable and so completely occupied
the time of the mother, who, herself, knew nothing about mothercraft or the
art of infant feeding. Consequently, the home was neglected and unhappy,
quarreling abounded and failure, utter failure, resulted. The children were
constantly cross, and so much of the mother's time was consumed in caring
for these irritable, half-fed babies, that the home was disheveled, the meals
never ready, the husband's home-coming was a dreaded occurrence, and he,
endeavoring to seek rest and relaxation, usually sought for it in the
poolroom or the saloon, with the usual climax which never fails to bring the
time-honored results of debauch—despair and desertion.
In the beginning of this book we paid our respects to the present-day
educational system which does not provide an adequate compulsory course
in which all women could be given at least a working knowledge of home
making and the care and feeding of the babies; so that statement need not be
repeated in this chapter. But we wish to add, in passing, that ignorance is
the basis and the foundation of more unhappy homes, broken promises,
panicky divorces, and shattered hopes, as well as of more deaths during the
first year of infancy, than any other cause. And in speaking of its
relationship to babycraft, we believe that ignorance concerning normal
stools, how many times a day the bowels should move; how much a baby's
stomach holds; how often he should be fed, etc.—I say it is ignorance of
these essential details that lies at the bottom of many problems which come
up during the first year, particularly the "feeding problem."

INFANT WELFARE

In the city of Chicago at the time of this writing, the Infant Welfare
Association maintains over twenty separate stations where meetings are
held for mothers, where lectures are delivered on the care and feeding of
babies. Babies are brought to these stations week in and week out; they are
weighed and measured and, if bottle-fed, nurses are sent to the homes to
teach the mother how properly to modify the milk in accordance with the
physician's orders. The health authorities of our city also maintain several
such stations where mothers and babies may have this efficient help. A
corps of nurses are employed to carry out the instructions and to follow up
the mothers and the babies in their homes, and thus the death rate has been
greatly reduced, not only in our city but in all such cities where baby
stations have been instituted. In a certain ward in Philadelphia the death rate
was reduced forty-four per cent in one year after the baby stations were
established.

CHOOSING A FORMULA

There are three classes of infants who require weak-milk mixtures to begin
with: namely, the baby who has been previously nursed and whose mother's
milk has utterly failed; the baby just weaned; and the infant whose power to
digest is low. If these children were six months old, and the formula best
suited to them is unknown, we must begin with a formula suited to a two-
or three-month-old child and quickly work up to the six-month formula,
which may often be accomplished within two or three days.

THE BOTTLE-FED BABY

When a baby is getting on well with his food, he should show the following
characteristics: He should have a good appetite; should have no vomiting or
gas; he should cry but little; and he should sleep quietly and restfully. His
bowels should move once or twice in twenty-four hours. His stool should be
a pasty homogeneous mass. He should possess a clear skin and good color.
He should show some gain each week—from four to eight ounces—and he
should also show mental development.
As long as a baby appears happy and gains from four to eight ounces a
week and seems comfortable and well satisfied, the feeding mixture should

not be changed or increased.

MAKE CHANGES GRADUALLY

In our experience with the artificial feeding of infants, we have come to
look upon the practice of gradually changing the food formula as the most
important element in successful baby feeding.
We recall one mother in the suburbs who came to us with her baby who had
been feeding on a certain proprietary food. She declared that it "just
couldn't take cow's milk." She admitted "it was not doing well," and so she
would like to have help. The baby was old enough, had it been normal, to
have been taking whole milk for some time. We recall our having the
mother prepare the proprietary food just as she had been used to preparing
it, and each day we had her throw away one-half ounce and put in one-half
ounce of whole milk, this mixture she fed the baby for two days.
The next time, we had her take out one ounce of the mixture and put in one
ounce of whole milk, which we fed the baby for three successive days; and
then one and one-half ounces were substituted which was fed to the baby
for four days; and thus we carefully, slowly, and gradually withdrew the
proprietary food and substituted fresh, certified cow's milk. It took us a
month to complete the change, but we are glad to add that it was done
without in the least disturbing the child.
Now, had the change been made abruptly—in a day or two, or three days—
the baby would probably have been completely upset, while both the
mother and the doctor would have been greatly discouraged. Many mothers
and even some physicians have jumped from one baby food to another baby
food; they have tried this and they have tried that, until the poor child,
having been the victim of a number of such dietetic experiments, finally
succumbed.
We cannot urge too strongly the fact that, as a rule, whenever a change is
made from one food to another, it should be done gradually, unless it be the
change of a single element such as that of a very high per cent of cream
found in top milk mixtures, when it seems to be a troublesome element in
the milk. No bad effects will follow the quick change to skimmed milk with

added sugar, starches, etc; but in changing from a proprietary food to a milk
mixture, the change should always be made gradually, the quantity of the
new food being increased gradually. Milk should be increased by quarter
(1/4) ounce additions, and it should not be increased more than one ounce
in one week; while the mixture should not be increased as long as the baby
is gaining satisfactorily. A wise mother and an experienced physician can
usually see at a glance when a child is doing well—by the color and
consistency of the stools, the child's appetite, his sleep, and his general
disposition.

COMMON MISTAKES IN FORMULAS

First and foremost, we believe a great mistake is often made in using too
heavy cream mixtures; babies as a rule do not stand the use of too high a
percentage of cream. Formulas that call for whole milk should contain four
per cent fat or cream; and while babies often gain rapidly on the higher
percentage of cream found in a rich Jersey milk, nevertheless, sooner or
later serious disturbances of digestion usually occur. Herd milk is, therefore,
better for the babies because in the "whole milk" of the herd of Holsteins
we have only about four per cent fat.
Another common mistake is too heavy feeding at the time of an attack of
indigestion; even the usual feeding may be too heavy during this time of
indisposition. It is not at all uncommon for us to dilute baby's food to one-
third its strength at the time of an acute illness.
Still another trouble maker is dirt—dirt on the dish-towel, dirt on the nipple,
dirt in the milk, dirt on the mother's hands. Dirt is an ever present evil and
an endless trouble maker, as evidenced by stool disturbances, indigestion,
fretful days, and sleepless nights. A dirty refrigerator is another factor which
has been responsible for much illness and distress.
Indigestion is often brought on because a nurse, caretaker, or possibly the
mother, not wishing to go down to the refrigerator in the middle of the
night, brings up the food early in the evening and allows it to become warm
—to remain in a thermos bottle—and we are sure that had they been able to
see the enormous multiplication of germs because of this warm

temperature, they would never have given occasion for such an increase in
bacteria just to save themselves a trifle of inconvenience.
Still another common mistake is to use one formula too long; a feeding
mixture which was good for four or possibly six weeks, must be changed as
the child grows older and his requirements become greater. Let the weight,
stools, general disposition and sleep of the child be your guides, and with
these in mind errors in feeding can be quickly detected and minor mistakes
speedily rectified.

SYMPTOMS OF DISSATISFACTION

Some of the pointed questions which are put to a young mother who brings
her child into the office of the baby specialist, are the following:
Does the baby seem satisfied after his feeding?
Does he suck his fist?
How much does he gain each week in weight?
Does he sleep well?
Does the baby vomit?
What do his bowel movements look like?
Will you please send a stool to the office?
With the intelligent answers to these questions—after knowing the birth
weight and the age of the child and its general nervous disposition—the
physician can formulate some conclusion as to the babe's general condition
and can usually find a feeding formula that will make him grow.
Vomiting, restlessness, sleeplessness and the condition of the bowels, are
the telltales which indicate whether or not the food is being assimilated; and
the stools may vary all the way from hard bullet-like lumps to a green
diarrhea.
Babies do not thrive well in large institutions where the food is so often
made up in a wholesale manner, for the simple reason that the food
elements are not suited to the need of each individual baby. Some infants
are unable to digest raw milk, and for them sterilized or boiled milk should
be tried; others require a fat-free mixture such as skimmed milk, while still

others may need buttermilk for a short time. Babies require individual care,
particularly in their food, and the good or bad results are plainly shown in
the stools, weight, sleep, etc.

FLATULENCE

Flatulence is an excessive formation of gas in the stomach and bowels
leading to distension of the abdomen and the belching of gas, and often the
bringing up of a sour, pungent, watery fluid.
Flatulence is seen in infants suffering from intestinal indigestion and the
food is nearly always at fault. This condition is the result of the faulty
digestion of the sugar and starches—particularly the starch—which should
be immediately reduced. In such conditions the addition of a slight amount
of some alkaline (such as soda, magnesia or lime water) to the food often
produces good results. Great patience must be exercised with a child that
suffers from flatulence, for immediate improvement can hardly be expected;
time is required for the restoration of good digestion.

VOMITING

Vomiting is perhaps more often the result of over feeding or too frequent
feeding than anything else. A healthy, breast-fed baby may now and then
regurgitate a bit, but it simply spills over because it is too full. We do not
refer to this as vomiting, we refer to the belching up or vomiting of very
sour or acrid milk which leaves a sour odor on the clothing. This can all
usually be rectified by lengthening the intervals from two to three hours and
preventing bolting of food by getting a nipple whose hole is not so large.
Too much cream in the food will also sometimes cause vomiting.
Too frequent feeding at night is another cause of vomiting. When the
stomach is full, the failure to lay the baby down quietly, as is so often seen
in those homes where bouncing and jolting are practiced, may also result in
vomiting.
Vomiting may be the first sign of many acute illnesses such as scarlet fever,
measles, pneumonia, whooping cough, etc.

The treatment for acute vomiting is simple. All foods should be withheld—
nothing but plain, sweetened water should be administered, while it is often
advisable to give a dose of castor oil. A physician should be called at once if
the vomiting continues, and not until the vomiting has entirely ceased for a
number of hours and water is easily retained, should food be given, and
even then it should be begun on very weak mixtures.

OVER-FEEDING

The size of the child's stomach should be the guide to the quantity of food
given, and attention is called to the table given in a previous chapter. All
food taken in excess of his needs lies in his stomach and intestines only to
ferment and cause wind and colic. The symptoms of over-feeding are
restlessness, sleeplessness, stationary weight (or loss in weight), and
oftentimes these very symptoms are interpreted by the mother as sufficient
evidence that the baby needs more food; and so the reader can see the
terrible havoc which is soon wrought where such ignorance reigns.

WEIGHT

The weighing time should immediately follow a bowel movement and just
before a feeding time; then, and only then, we have the real weight of baby,
as a retained bowel movement may often add from four to five ounces to
the child's weight. There should be a careful record of each weighing, for
there may develop a great difference if different members of the family
endeavor to keep the weight in their minds. The normal baby should gain
four to eight ounces a week up to six months, and from then on the weekly
gain is from two to four ounces; in other words, by six months the baby
should double his birth weight and at the end of a year his weight should be
three times the birth weight. A stationary or diminishing weight demands
careful attention; a good doctor should be called at once. Likewise, a very
rapid increase in weight is not to be desired, as we do not want a fat baby,
but we do desire a well-proportioned and alert baby, and, as someone has
said, it is better to have little or no gain during the excessive heat than to
upset the digestion by over-feeding, designed to keep the baby gaining.

In weighing, usually the outside garments are removed, leaving on a shirt,
band, diaper, and stockings with the necessary pins; the little fellow thus
protected is placed into the weighing basket and at each successive
weighing, these same clothes or others just like them are always included in
the weight, and it should be so reported to the physician.

THE STOOLS

In the chapter "Baby's Early Care," the first stools were described in detail,
and there we learned that the dark, tarry, meconium stools are quickly
changed within a week to the normal canary-yellow stool, having the odor
of sour milk.
The bottle-fed babies' stools differ somewhat in appearance; they are
thicker and a lighter color, but should always be homogeneous if the food is
well digested. They do not have nearly the number of bowel movements
each day that the breast-fed baby does. If a bottle-fed baby's bowels move
once a day and he seems perfectly well otherwise, we are satisfied. And
curds (white lumps), or mucus (sedimentary, slimy phlegm), indicate that
the food is not well digested.

BOTTLE FEEDING AND CONSTIPATION

A bottle baby may be constipated because the proteins are too high, the fat
too high, the food of an insufficient quantity or quality, or the milk have
been boiled, while weak babies really may lack the muscular power to
produce a bowel movement. With the help of your physician endeavor to
arrive at the cause of the constipation, and, if the baby is two or three
months old, from one to two teaspoons of unsweetened prune juice may be
administered. Milk of magnesia may be added to the food (leaving out the
lime water), or a gluten suppository may be used.
The change from milk sugar to malt sugar has helped many infants; while
the giving of orange juice (after six months) is very beneficial in many
cases. A small amount of sweet oil may be injected into the rectum which
will lubricate the hard lumps and thus favor comfortable evacuation. The
periodicity of the bowel movement (at definite times each day) is a matter

of great importance. Immediately after a meal, if the child is old enough, he
should be placed on the toilet chair. A bit of cotton, well anointed with
vaseline and inserted into the rectum just before meals, will often aid in
producing a bowel movement shortly after the meal has been taken.
Abdominal massage should be administered in all instances of constipation,
beginning with light movements and gradually increasing, with well-oiled
hands.

DIARRHOEA

Diarrhoea usually accompanies acute intestinal indigestion and is so often
associated with the common disorders of infancy that we refer the reader to
the chapter "Common Disorders of Infancy." Dark stools should always be
saved for the physician to observe, as they frequently contain blood. Stools
full of air bubbles with pungent sour odor show fermentation; in which
cases the starches should be reduced, if not entirely taken away from the
food mixtures. Green stools mean putrefaction from filth-germs; a thorough
cleansing of the bowel should be immediately followed by a reduction in
the strength of the food and the boiling of the milk.

REGULATION OF THE STOOLS

At a certain time each day the napkin should be removed and the child
should be held out over a small jar. It is surprising to note how quickly and
readily the little fellow cooperates. Diaper experiences may be limited to
much less than a year if the mother has patience enough and the baby has
the normal intelligence to enter into this regulation regime. We recall one
caretaker who complained bitterly because the child under her care
constantly wet his diaper; so the caretaker was instructed to keep a daily
schedule of the baby's actions for five days; and, to her surprise, she
discovered that the baby urinated about the same time each day. A regularity
was also noted concerning the bowel movements.
The variations in the time of the urinations were only fifteen or twenty
minutes, so nearly did the kidneys act at the same time each day. The
caretaker was instructed to remove the diaper and hold the baby out at the

earliest occurrence on the daily schedule, and, to the astonishment of the
entire family, no further accidents occurred, and the child soon acquired the
habit of letting them understand when he was about to wet his diaper.
Bowel movements may be regulated more easily than the urination. After
the child is about a year old, very few accidents should occur.

MIXED FEEDING

In many instances, and particularly if the infant is under six months of age,
and where he has had to have additional feeding from the bottle—under
such circumstances the breast milk may be continued as "partial feeding," at
least until the baby has reached his ninth or tenth month, at which time it
may be wholly discontinued.
At each nursing time the baby empties both breasts, and the amount he
draws may readily be estimated by carefully weighing him before and after
each nursing. By referring to the directions in a previous chapter, the
quantity of food needed for his size and age may be determined; while the
deficit is made up from a bottle of milk containing properly modified cow's
milk.
If the mother's health admits, or if the breasts continue to secrete a partial
meal for the babe, mixed feeding should be continued until after the ninth
or tenth month, when it can gradually be reduced from four or five times
each day to once or twice a day, until it is finally omitted altogether. In the
meantime, the baby is gradually getting stronger food and at eleven or
twelve months the little fellow is able to subsist and thrive upon whole
milk.

INFANT FEEDING PUZZLES

It is very difficult to explain how some babies thrive on some certain food
while others grow thin and speedily go into a decline on the same régime.
The hereditary tendencies and predispositions undoubtedly have a great
deal to do with such puzzling cases.

Again, sometimes a slight variation in technic or some other trifling error in
connection with the preparation of the baby's food, may be more or less
responsible for the variation in the results obtained. No two mothers will
prepare food exactly alike even when both are following the same printed
directions and these slight discrepancies are enough to upset some
delicately balanced baby.
On the other hand, some babies are born with such strong digestive powers
and such a powerful constitution that they are easily able to survive almost
any and all blunders as regards artificial feeding, while at the same time
they also manifest the ability to surmount a score of other obstacles which
the combined ignorance and carelessness of their parents or caretakers
unknowingly place in the pathway of early life which these little folks must
tread.
The fact that so many babies do so well on such unscientific feeding only
serves to demonstrate the old law of "the survival of the fittest"—they are
born in the world with an enormous endowment of "survival qualities"—
and in many cases the little fellows thrive and grow no matter how
atrociously they are fed.
There may be other factors in the explanation of why some babies do so
well on such poor care, but heredity is the chief explanation, while
adaptation is the other. If the little fellows can survive for a few weeks or a
few months, the human machine possesses marvelous powers of adaptation,
and we find here the explanation why many a neglected baby pulls through.

INFANT FOODS

Rickets and scurvy have so often followed the prolonged use of the so-
called "infant foods" which have flooded the market for the past decade,
that intelligent physicians unanimously agree that they are injurious and
quite unfit for continued use in the feeding of infants. If they are prescribed
to replace milk during an acute illness, or at other times when the fats and
proteins should be withheld for a short period, both the physician and the
mother should be in the possession of definite and exact knowledge as to
just what they do and do not contain. To provide such knowledge, we

present the analysis (Holt) of some of the more commonly used infant
foods.
1. The Milk Foods. Nestle's Food is perhaps the most widely known. The
others closely resembling it in composition are the Anglo-Swiss, the
Franco-Swiss, the American-Swiss, and Gerber's Food. These foods are
essentially sweetened, condensed milk evaporated to dryness, with the
addition of some form of flour which has been dextrinized; they all contain
a large proportion of unchanged starch.
2. The Liebig or Malted Foods. Mellin's Food may be taken as a type of the
class. Others which resemble it more or less closely are Liebig's, Horlick's
Food, Hawley's Food, malted milk, and cereal milk. Mellin's food is
composed principally (eighty per cent) of soluble carbohydrates. They are
derived from malted wheat and barley flour, and are composed chiefly of a
mixture of dextrins, dextrose, and maltose.
3. The Farinaceous Foods. These are Imperial Granum, Ridge's Food,
Hubbell's Prepared Wheat, and Robinson's Patent Barley. The first consists
of wheat flour previously prepared by baking, by which a small proportion
of the starch—from one to six per cent—has been converted into sugar.
In chemical composition these four foods are very similar to each other,
consisting mainly of unchanged starch which forms from seventy-five to
eighty per cent of their solid constituents.
4. Miscellaneous Foods. Under this head may be mentioned Carnrick's
Soluble Food and Eskay's Food.
The composition of the foods mentioned is given in the accompanying
table.
COMPOSITION OF INFANT FOODS
Malted
Nestle's Mellin's Eskay's Ridge's Imperial Carnick's
Ingredients Milk
Food Food Food Food Granum Food
(Horlick's)
Per cent Per cent Per cent Per cent Per cent Per cent Per cent
Fat 5.50 0.24 1.16 8.78 1.11 1.04 7.45
Proteins 14.34 11.50 5.82 16.35 11.81 14.00 10.25
Cane Sugar 25.00 ..... ..... ..... ..... ..... .....

}
Dextrose ..... ..... ..... 0.52 0.42 .....
53.46[1]
Lactose (milk 6.57 .....
}
..... ..... .....
sugar) 49.15[2]

Maltose } 60.80 ..... ..... ..... .....
27.36
Dextrins 19.20 14.35 18.80 1.28 1.38 .....
Carbohydrates 58.93 80.00 67.81 67.95 1.80 1.80 27.08
(soluble)
Starch 15.39 ..... 21.21 ..... 76.21 73.54 37.37
Inorganic Salts 2.03 3.59 1.30 3.86 0.49 0.39 4.42
Water 3.81 4.73 2.70 3.06 8.58 9.23 3.42

1 Chiefly Lactose. 2 Largely Maltose.

CHAPTER XX

BABY'S BATH AND TOILET

From earliest girlhood, women have loved their dolls, and one of the
greatest joys connected with the adored experience was the make-believe
bath and the dressing of the make-believe baby; so now, when we are the
happy possessors of real live dolls, we should go about the task with the
same lightheartedness of a score of years ago when we hugged, kissed,
bathed, and dressed our dolls. There is one big advantage now, the doll
won't break; but, we sigh as we stop to think, we can't stick pins into it as
we all did into the sawdust bodies of our dolls those years and years ago.

THE FIRST WEEK

In the chapter on "Baby's Early Care," this subject was fully discussed and
we only wish to repeat, in passing, that before baby's bath or toilet is
undertaken the hands of the mother, nurse, or caretaker must be
scrupulously clean. And while the first day's bath usually consists of sweet
oil, albolene, or benzoated lard, if the new baby happens to come during the
very warm days of July or August and the oil seems to irritate the soft
downy skin, as it often does during those hot days, a simple sponge bath
may be substituted. The cord dressing remains as the doctor left it, and if
there be any interference, let it be subject to his orders.
The cord usually drops off, and the abdomen is entirely healed by the
seventh to the tenth day, after which time baby is daily sponged for another
week. And now we will describe in detail the simplest, easiest manner of
administering an oil bath or a sponge bath.

GIVING THE BATH

A large pillow or a folded soft comfort is placed on a table in a warm room
—temperature not below 75 F. On baby's tray near by, and within reaching
distance, are the boracic acid solution in a small cup, a medicine dropper,

the warm saucer of oil, the toothpick applicators (made by twisting cotton
about one end, making sure the sharp end of the pick is well protected), a
glass jar of small cotton balls made from sterile absorbent cotton, the castile
soap, talcum powder, needle and thread. A vessel of warm water, several
old, soft, warmed towels and the clean garments required, complete the
layout.
Into the warm, soft blanket on the pillow or comfort we place the partially
undressed baby, for the binder, diaper, and socks are not removed until the
head-and-face toilet is completed.
The top of the head, behind the ears, the folds of the neck, and the armpits
are now gently but thoroughly rubbed with oil, which is then all rubbed off
with a soft linen towel. The eyes next receive two or three drops of the
boracic acid solution, put in by the aid of the medicine dropper, while, with
a separate piece of cotton, the surplus solution is wiped off each eye,
rubbing from the nose outward.
Then with the applicator made by wrapping cotton about the end of a
toothpick, oil is put into each nostril, all the time exercising the utmost care
not to harm the tender mucous membrane. The ears are also carefully
cleansed with a squeezed-out dip of boracic acid on the applicator.
Unless there is an inflammation present in the mouth, and the physician in
attendance has ordered mouth swabbing, do not touch it; for much harm is
done the mucous membrane of the baby's mouth by the forceful manner in
which much of the swabbing is done. The face and head are then washed
with warm water; very little soap is needed and, when used, must be most
thoroughly rinsed off.

THE SECOND WEEK

And now during the second week, we proceed to sponge the baby's body;
the hands are washed with soap and rinsed, and, only those who have
performed this feat know just how tightly they hold shut their little fists.
These hands must be relaxed, and all the lint, dirt, and perspiration be
thoroughly washed away. The arms, shoulders, chest, and back are then
sponged. All the time the nurse or caretaker is standing while carrying out

this most pleasant task. At any time she may quickly cover the babe and
stop for this or that with no inconvenience to herself or the child.
After the thorough drying of baby's upper body, a bit of talcum is put under
the arms, in the folds of neck, etc., and the shirt is slipped on. Next the
band, diaper, and stockings are removed and after first oiling the groin and
the folds of the thighs and the buttocks, the same sponging, drying, and
powdering is done here as on the upper body.
The band is now applied, and sewed on. The diaper, stockings, booties, and
—if a winter baby—the skirt and outing flannel gown (for babies should
wear only night dresses for the first two or three weeks) are now slipped
over the feet and drawn upward, and baby is ready for nursing or for his
nap.

TEMPERATURE OF BATHS

First few weeks, 100 F.; early infancy, 98 F.; after six months, 97 F., cooling
down to 90 F.
A wooden bath thermometer may be purchased for twenty-five cents and it
should be in every home where babies are bathed. In the absence of a
thermometer do not depend upon the hand to determine temperature. Thrust
the bared elbow into the water and if it is just comfortable—neither hot or
cool—it is probably about the correct temperature for baby. Do not shock
the baby by dashes of cold water, for, while it may amuse an onlooker, it
unnecessarily frightens your child, and, subconsciously, he learns to dread
his bath.

THE BATHING PLACE

If the bathroom is warm—temperature 75 F.—that is the most logical place
for the bath, provided baby has his own tub. Place a couple of strong slats
several inches wide across the big tub, six inches apart, and on this place
the baby's tub. Of course, care must be exercised to prevent slipping by
means of properly fitted cleats on the under surface of the slats. The mother
should always stand to bathe her baby and the small tub should be placed at

such a height that she neither has to stoop nor bend. Thus the bathing of the
baby becomes a pleasure instead of a "job" or an "irksome task."
If the bathroom is not warm then the kitchen table or a small table pulled up
near the stove is a place par excellence for the dip.
Many boils seen on young baby's tender skin have been traced to the
careless use of the family tub to bathe the baby in. Not until the child is two
or three years of age, when his skin has become more toughened, should he
be allowed to use the family tub.

FREQUENCY OF BATHS

To begin with, we never bathe either a baby or an adult immediately after a
full meal. From one hour to one and one half hours should intervene.
The frequency of baths depends somewhat upon the season of the year, the
vitality of the child, and the warmth of the home.
We have seen many infants who were bathed too often. The vitality
expended upon the necessary reaction following a tub bath was too much
for the little fellow; the daily bath was stopped and a semi-weekly bath
substituted, much to the gain of the child. Of course in this instance the
hands, face, and buttocks received a daily sponging.
The oil bath may be administered daily. In robust children the tub bath may
be a daily affair; while in pale, anemic little folks, the tub bath is perhaps
better given twice a week. In hot summer days a sponge bath may be given
many times a day.

BEST HOUR FOR BATHING

Again this depends upon several factors; the warmth of the house or
apartment, the vitality of the child, and the kind of bath to be administered.
An oil bath may be given any time—often it may be administered entirely
under the bed clothes, only care must be taken to keep oil from the blankets.

Many of our mothers prefer to give the tub bath at five o'clock in the
afternoon, when the house is thoroughly warm, and the child is thereby
prepared for the long night's sleep. Before dressing in the morning an oil
bath or rub may be given in such cases.
If the forenoon is selected as the time for bathing the child, then an hour
just before the mid forenoon meal is the best. In either event, be regular
about it—do it at the same time every day. Let the caretaker attend to her
many duties, and, as far as possible, mothers, bathe your baby yourself. The
folds of the skin, the creases in the neck, the clenched fists, must all receive
particular care, and no one in all the world will ever care as you—the
mother—cares.

SOAP AND WATER

Select a soap free from irritants and excess of alkalis. There are few kinds
that equal the old-fashioned, white castile soap our grandmothers used.
Very hard water which makes the skin rough and sore may be improved by
boiling, but if possible substitute rain water for it. A flannel bag tied over
the faucet and changed each day will help to clarify muddy water, provided
the stream flows gently through it.

ROUTINE OF THE TUB BATH

Just as we directed the nurse or caretaker to stand while the oil rub or
sponge bath was given, so we admonish the mother to stand while the tub
bath is given. First, get everything in readiness for the bath as directed for
the oil bath, and then the baby's tub setting on the securely cleated slats
placed across the top of the family tub may be filled with water by means of
a hose attached to the faucet. The temperature should be 100 F. when baby
is dipped in to be rinsed.

Fig. 13. Supporting the Baby for the Bath.

The head and face toilet are identical with that described before, and with
the baby undressed and wrapped in a warm towel placed inside the warm
blanket on the pillow or comfort as before mentioned, we proceed with a
good lather of castile soap and water to lather the baby's body all over—
under the arms, the neck, chest, groins, thighs, buttocks, legs, feet, and

between the toes, while the genitals also receive their share of attention. The
foreskin of the boy baby is gently pushed back and cleansed thoroughly;
while the vulva of the little girl baby, having first been swabbed with
boracic acid, is now gently lathered and cleansed. Now grasp the ankles and
legs with the right hand and support the upper back and neck and shoulders
with the left and gently lower the baby into the water in a semi-reclining
position (See Fig. 13). The water should cover the shoulders. Keep a good
firm supporting left hand under the head, neck, and shoulders, and with the
right, rinse all soap from the body.
After this is thoroughly done, lift the baby out onto a fresh warm towel
inside the warm blanket on the pillow, and remain standing, while you
gently pat (never rub) the baby dry. All the little folds, creases, and places
between fingers and toes, are carefully patted dry, and where any two skin
surfaces rub together put on a bit of talcum.
The dressing takes place in the manner already described—first the shirt,
then the band (sewed on), the diaper, stockings, skirt, and gown.
Please note that the soap bath is contra-indicated (should not be given) in
case of eczema.

BABY'S DAILY RUB

This soap bath should be administered for cleanliness only, and should be
given twice a week. If a tub bath is to be given on other days, after the
routine head and face toilet, the baby is simply dipped into the water and
the soft skin gently rubbed.
If the sponge or tub bath is given in the afternoon just before the long sleep
at night, then the oil rub should take place before the mid-forenoon meal;
and likewise, if the sponge or tub bath is given during the mid forenoon,
then the oil rub or dry hand rub is given before the going-to-bed time. The
rub should be a daily procedure for the first two years. Nothing rougher
than the soft palm of the hand should be rubbed on baby's soft skin.

USE AND ABUSE OF TALCUM

Babies have come to my clinic with cakes of talcum under their arms, and
particularly between their thighs and in the crease of the buttocks. Here the
well-meaning but thoughtless mother had reasoned, "a little is good; more is
better" which is not always the case.
Talcum is not used to replace careful drying, and it should never be found in
quantities on the baby's skin any more than you would expect to find
quantities of face powder caked in the creases of the neck or behind the ears
of an adult. The skin is first cleaned, then patted entirely dry, and, as a
finishing touch, a bit of talcum is put on by means of a puff.

TONIC AND MEDICATED BATHS

Tonic baths are usually given to older children when they are able to enter
into the sport and frolic of a cool bath. Baths are called tonic because they
call forth from the body a reaction—a sort of circulatory rebound. This
rebound or reaction brings the blood to the skin, increases the circulation,
and tones up the nerves. The room should be properly warmed and, if
necessary, some form of exercise be continued after the bath to prevent the
chill that sometimes follows a poorly administered bath.
In the case of the anemic child, after six months of age, the mother's hand
dipped in cold water may briskly rub the chest and back until it glows or
becomes red. The child should enjoy this bath. Never frighten a child by
throwing cold water on it or by giving it a too sudden cold plunge; great
harm may be permanently done by these efforts to "toughen the baby."
The simple medicated baths may be administered according to the
following directions:
Salt. Use half a teacup of common salt or sea salt to each gallon of water.
The salt should first be dissolved in a cup of warm water to prevent the
sharp particles from pricking the skin. The doctor sometimes orders a salt
bath.
Starch. Add a cup of ordinary, cooked laundry starch for every gallon of
water in the bath.

Soda. A soda bath requires two tablespoons of ordinary baking soda to a
gallon of water, dissolving it in a little water before adding it to the bath.
Bran. Make a cotton bag of cheesecloth or other thin material, six inches
square. Fill loosely with bran. Soak the bag in the bath water, squeezing it
frequently until the water becomes milky.
Starch, soda, and bran baths are often used in place of the ordinary soap and
water bath when the skin is inflamed, as in cases of chafing or prickly heat.

FEAR OF BATHS

Force and harshness are not likely to cause baby to overcome very much of
the fear of a tub bath. Patience, perseverance, and purposeful diversion of
mind will bring sure results.
In the case of a very young baby, have a helper stretch a towel across the
filled baby tub, lay the baby in it, with its head well supported, and then
gently lower the towel into the water, keeping the head out. (Most anyone
would fear an all-over ducking, if he had ever been completely ducked into
water by a careless or mischievous friend).
In the case of older children, celluloid ducks, fish, or boats may float about
on the water, and the entire bath be forgotten by the little fellow's
enjoyment of "his boats."

OUT OF DOOR BATHING

Although a baby under two years should never be given a sea bath, a word
of caution about sea bathing for young children may not be amiss. The
cruelty with which well-meaning parents treat young, tender children by
forcibly dragging them into the surf, a practice which may be seen at any
seaside resort in the summer, can have no justification. The fright and shock
that a sensitive child is thus subjected to is more than sufficient to undo any
conceivable good resulting from the plunge. On the other hand, a child who
is allowed to play on the warm sand and becomes accustomed to the water
slowly and naturally will soon learn to take delight in the buffeting of the
smaller waves, but he should not be permitted to remain more than a minute

or two in the water, and should be thoroughly dried, dressed immediately,
and not left to run about the beach in wet clothing.

MILK CRUST

Any roughness on the scalp must receive immediate attention. This
roughness, or milk crust, is entirely avoidable; it is the result of
accumulated oil and dirt. When it has formed a complete crust or cake, it
may quickly become eczematous and require a physician's advice; however,
in the beginning, at the first sight of brown patches or roughness, oil the
scalp thoroughly at night with vaseline or cold cream, which should be
gently rubbed off in the morning.
This vaseline or cold cream should be applied repeatedly, several nights in
succession, followed by the morning's gentle rubbing and daily washing of
the head. Often the washing with water must be entirely avoided; only
sweet oil or vaseline being used in those cases where the crusting seems to
be persistent.

THE EYES, EARS, AND NOSE

At birth the eyes are particularly cared for. First, the mucus is gently
swabbed off the closed lids from the nose side outward, and then follows
the application of one drop of twenty per cent argyrol or two per cent silver
nitrate, either of which thoroughly disinfects the eye and prevents the
growth or development of any bacteria that may have gotten into the child's
eye during the descent of the head through the birth canal. The neglect of
this procedure may sometimes result in lifelong blindness.
Under no circumstances should "a mere cold in the eyes" be neglected; it
may result in blindness. Call your physician at once, and if he is not at
hand, wash out the eye thoroughly every hour with warmed ten per cent
boracic acid solution, by means of a medicine dropper, using a separate
piece of cotton for each eye, for if the slightest bit of discharge be carried
from one eye to the other an inflammation will quickly appear.

From birth, especially during the first week, baby's eyes are very sensitive
to light; hence they must be carefully protected. Babies should be so placed
during their outings, sleep, or naps, that they do not directly gaze at either
the sunlight or sky. The lining of the hood of the carriage should be green,
instead of white, as much eye strain is thus prevented.
The daily care of the normal, well eye has been already described, and
while it need not be reiterated, we may say, in passing, that if the eyelid be
at all inclined to be sticky or adherent, never use force, but instead, gently
swab with boracic acid. As a preventive of this condition, a little vaseline
from the tube may be rubbed on the edges of the lids at night.
In the toilet of the ears, never attempt to introduce anything beyond the
external ear, which may be carefully cleansed with a soft cloth. It is often
found necessary to apply oil to the creases behind the ears before the daily
bath. There should be no irritation, redness, or roughness present, all such
conditions being readily prevented by the use of oil or vaseline before the
bath.
With the sharp point removed, make a cotton applicator out of a toothpick,
and gently (with no force, whatever) introduce vaseline or oil into the nose.
This should be a part of baby's daily toilet. Any stoppage of mucus or
snuffiness in the nose should be reported at once to baby's physician. Young
babies often have adenoids.

CARE OF THE MOUTH

Leave the well mouth alone until the teeth appear, and then keep the teeth
very clean (allowing no particles of milk to accumulate at their bases) with
a soft bit of cotton and gentle rubbing. When a child attains the age of two,
he should have his own toothbrush; previous to this time all food particles
should be removed from between the teeth with waxed silk floss. All decay
should be promptly attended to by a competent dentist.
Thrush and ulcers are often caused, not prevented, by the frequent wiping
out of baby's tender mouth. The treatment of thrush and other mouth
infections will be considered in a later chapter, "The Common Disorders of
Infancy."

THE CARE OF THE GENITAL ORGANS

Before the bath, the baby girl's genitals are carefully swabbed between all
the folds with boracic acid solution. The foreskin of the boy baby should be
pushed well back and washed gently with water. If the foreskin of the male
child be long, tight, or adherent, circumcision is advised. See our chapter,
"Teaching Truth."
The genitals of both the boy and girl should be kept scrupulously clean
every day, with as little handling as possible, and, upon the appearance of
the least swelling, discharge, or even redness, the physician's attention
should be at once called to it. In a later chapter, the subject of irregularities
of sex habits will be taken up.

CARE OF THE BUTTOCKS

Often, because of irritating bowel movements, the buttocks become
reddened, chafed, and sometimes raw in places. Some poor little babies are
sometimes roughly rubbed—scoured on the buttocks—much like the
kitchen sink, many times a day, and it is not surprising that they become
reddened, chafed, and very much inflamed.
The buttocks require a gentle swabbing and thoroughgoing "patting dry"
after each soiling or wetting of the diaper, but no soap is required in this
region but once a day, and even then it should be used sparingly.
When the buttocks are inflamed, after a good cleansing with water and a
thorough drying, vaseline or zinc ointment should be applied on a piece of
sterile cotton, and this application should be repeated after each changing of
the diaper. Wet diapers should be removed at once, for the acidity of the
urine causes more chafing. A dusting powder composed of starch two parts,
and boracic acid one part, may be dusted on after a cleansing with oil.
Great care should be exercised in the thorough daily rinsing of the diapers
as well as in the tri-weekly boil in the laundry. White soap only should be
used in their cleansings; no washing sodas or other powders should be used.

OTHER SPECIAL CARE

Under the arms and in the creases of the neck the skin sometimes becomes
irritated because of neglect. To prevent such chafing the following program
should be carefully carried out:

1. Not too much soap—and no strong soap.
2. Careful rinsing of the skin area.
3. Avoid harsh rubbing, but thoroughly dry.
4. The use of talcum powder in all folds of the skin.

With a fine camel's hair brush the hair should receive its brushing after the
cleansing of the scalp. Combs are for just one purpose and that is to part the
hair. The brush should be used to do all the smoothing.
While the frequent trimming of the hair has no marked effect upon its
growth, yet the comfort the little girls enjoy, especially during the warm-
weather months, should not be denied them.
And certainly the boy should become a boy when he puts on trousers and
not be made the laughing stock of his mirthful companions just because his
"beautiful long curls are much admired by the mother and his aunts."
The finger nails should be trimmed round with the scissors, while all
hangnails are properly cared for every day. Toe nails should be cut straight
across and the corners never rounded off. Many ingrowing nails may be
thus avoided.

CHAPTER XXI

BABY'S CLOTHING

The Eden story suggests that in the beginning of our racial experience
artificial clothing was unnecessary; but after a time, in that selfsame garden,
proper clothing became an important problem and has remained so ever
since. Everybody seems to agree, however, that baby's clothing in particular
should at least be comfortable. It may give the child great discomfort
because it may be too warm, or it may not be warm enough, or it may be
too tight, and so, in the discussion of baby's clothing in this chapter, we are
going to keep in mind these two things—comfort and heat.

GENERAL SUGGESTIONS

The choice of material demands some thought and attention. As a rule,
baby's clothing materials should be light in weight, good moisture
absorbers, and at the same time able to retain the body heat. Most layettes
have the common fault of being prematurely outgrown; and so it is well to
allow for ample growth in making baby's first clothes. Since the principal
object of clothing is to insure a uniform body temperature, it is important
that the mother be constantly on her guard to keep the baby cool enough in
the summer and warm enough in the winter.
The mothers of various races and nations have their own ideas concerning
the clothing of their babies. One mother will wrap her baby in cotton, which
is held in place by means of a roller bandage, and as you visit this home
during the first week of baby's life, you will be handed a little mummy-
shaped creature—straight as a little poker—all wrapped up in cotton and a
roller bandage. The surprising feature is that the baby does not seem to
complain.
In another district of the city we find the baby dressed in starched clothes,
ribbon sashes, bright ribbon bows on its arms and around its neck. At first
glance you wonder if the little child is not many years older and is about to

make a visit to a county fair, but on inquiry we find that he has only been
prepared for the event of circumcision on the eighth day.
And if you go into the forest of primeval days you will find another mother
bandaging her baby to a board, head and all, and he seems to live and thrive
in his little woven nest strapped on the back of his Indian mother.
Other babies in the warmer portions of the earth have almost less than
nothing on, and are left to be swung by the breezes in little baskets tied to
the boughs of trees; being taken up only when it is time to feed.

BABY'S LAYETTE

In preparing an outfit for the newcomer it is wise to provide for the
necessities only, because of the fact that since the baby grows very fast the
layette will soon have to be discarded; it is always possible to get more
clothing after the baby is here and started on his little career. We offer the
following list of essentials for the new born baby:

Slips 8 to 10
Skirts (flannel) 3
Shirts 3
Light-weight wool wrappers 2
Abdominal bands 3 to 5
Diapers (first size) 2 doz.
Diapers (first size) 2 doz.
Stockings, pairs 3
Booties, pairs 3
Nightgowns 7
Handling blankets 2
Silkaline puffs 2
Baby blankets, pair 1
Hair or cotton mattress 1

Basinet 1

BANDS AND SHIRTS

The binder should be made of an unhemmed strip of flannel six inches wide
and twenty inches long, so that it goes around the abdomen once with a
small overlap. This binder should be sewed on instead of being pinned, and
serves the purpose of holding the dressings of the cord in place. It is usually
worn from four to six weeks, when it is replaced by a silk and wool barrel-
shaped band with shoulder straps and tabs at the bottom, both front and
back, to which may be pinned the diaper. This band is worn through the first
three or four years to protect the abdomen from drafts and chilling, thus
guarding against those intestinal disturbances which are caused by sudden
weather changes.
There is great danger of having the bellyband too tight, and, in the early
weeks, it is often the cause of great discomfort—often interfering with the
normal expansion of the stomach at meal time.
No matter what the season, the new-born baby should be clothed in a light-
weight silk and wool shirt, preferably the second size. After the first month,
if the weather is exceedingly warm, this woolen shirt may be displaced by a
thin silk or lisle shirt. In buying the second-size shirts always secure the
stretchers at the same time, for in the laundering they soon shrink so that
they are very uncomfortable for the young babe.

DIAPERS

There are a number of materials on the market from which comfortable
diapers may be made for the baby. The cotton stockinet (ready-made shaped
diaper) is excellent, fitting smoothly at the waist, while it is large and baggy
at the seat, thus permitting not only a comfortable feeling but the free use of
the hips, without the bulkiness of the ordinary diaper.
The large square of cheesecloth is easily laundered, and if an inside pad is
used makes a very acceptable diaper.

The stork diapers are made of materials resembling turkish toweling and are
used to some extent. This diaper should not be confused with the stork
rubber diaper which will be spoken of later.
Birdseye cotton is popular and extensively used. It absorbs quickly, and is
much lighter in weight than linen. The first- and third-size widths should be
purchased as a part of the layette, and the number of diapers needed
depends upon the opportunities to wash them out, for diapers are never used
but once without washing; they should always be quickly rinsed and dried
in the sunshine if possible. So if there are good laundry privileges, and daily
washing is possible, the mother can get along with fewer diapers, but no
less than four dozen should be provided.
The diaper pad will be found convenient and serviceable in the early days
when the skin of the child is so very tender. This pad should be pieces of
clean old linen or small pads of absorbent cotton.

CHANGING THE DIAPER

During the mother's waking hours, the diaper should be changed as soon as
it is soiled or wet. If the child cries during the night it should be changed
immediately, but the mother should not feel called upon to lay awake nights
merely to change the baby's napkin when it is soiled. If she places a pad
underneath the baby, which will absorb the urine quickly, he often does not
awaken or become chilled. The pad should be sufficiently thick to ensure
that the nightgown does not get wet.

RUBBER DIAPERS

Rubber sheeting diapers of any description should never be used. Avoid all
patent diapers with a covering or an inner lining of rubber, for, like the
rubber diaper, they not only irritate the child but also retain moisture and
heat, which produce such irritation and itching that the subsequent "habit-
scratching" often lays the foundation for future bad practices. It is far better
for the mother to carry about with her, whenever it is necessary to take the
baby away from home, a rubber pad which she puts on her lap underneath

the little fellow, thus affording ample protection to herself without in the
least harming the baby.

STOCKINGS AND BOOTIES

During the winter months merino stockings are required, while during the
summer months a thin wool or silk stocking is sufficient; on the extremely
hot days thin cotton hose may be worn. During infancy, the stockings
should be fastened to the diaper with safety pins, while on the second-year
child, hose supporters attached to the waist are found very convenient.
A friend told me the other day of a mother who told her the following story:
"Do you know, I don't have any trouble any more about my baby keeping
up his socks for I have fixed it so they won't come off any more. Every time
I looked at his feet he had kicked off his socks and they were no good to
him at all, so I took little chunks of brown laundry soap, moistened them
and rubbed his legs, as well as the inside of his socks and I never, never
have any more trouble with them coming off."
It does not seem possible in this enlightened age that a mother could be so
ignorant as to keep the socks up with brown soap, but the friend assured me
it was a true story, and while it may shock some of my readers as it did me,
I must add, in passing to another subject, that the use of round garters on
little babies and young children is just about as shocking.
During the fall, winter, and spring, booties are worn on top of the stockings.
These booties should be crocheted or knitted out of the heavy Germantown
yarn, and there should be enough of them so that the child may have a clean
pair on every day.

SKIRTS AND PETTICOATS

The flannel petticoat is made with yokes instead of bands, and during the
fall, winter, and spring these yokes are made of flannel like the skirt and
should have long sleeves of the same material. The yokes should be made
large enough so that they may be used during the entire first year (the plait
in the front can easily be taken out when the baby is six months old so that

it may be used much longer than if the yoke is made without a plait). For
the hot summer months, the yokes should be a thin cotton material without
sleeves; and, if the baby is housed in an over-heated apartment, this fact
should be borne in mind and the winter skirt should be made accordingly.
We have found, however, that the baby who is amply protected and
uniformly dressed, does not require the outer bundlings that the poorly
dressed child requires. Part wool and cotton materials are very comfortable
in the overheated city apartments. White skirts are not necessary for small
babies. They only add extra weight and it is always foolish to put anything
on a small baby simply for looks.

NIGHTGOWNS, WRAPPERS, AND SLIPS

The nightgowns should be made of soft cotton flannel or stockinet. The
latter is really the better, and can be purchased in sizes up to two years; it is
absorbent, easily laundered, and may be conveniently drawn up at the
bottom by means of a drawstring.
At least seven nightgowns are needed. A fresh nightgown should be used
each day and each night during the first four or five weeks of baby's life;
while as he gets older (two or three years), the night drawers with feet in
them are used to advantage.
The wrappers are usually made of challis, nun's veiling, cashmere, or other
light woolen materials which can be readily washed. They are very
serviceable to wear over the baby's thin slips and on cool nights they may
be used over the nightdress. They should be simply made, containing no
heavy seams, and at the neck there should be the simplest kind of a soft
band that will in no way produce friction or in any other way irritate the
baby's skin.
Slips are usually made of some very soft material such as nainsook, batiste,
pearline, or sheer lawn cloth. Twenty-seven inches is the length that will be
found both comfortable and convenient. All laces, ruffles, and heavy bands
which will scratch or irritate should be avoided as eczema is often caused
by such mistakes.

SLEEPING BAG

The sleeping bag is of inestimable value, affording extra and secure
covering for the child, and peace of mind for the mother. In the early weeks
it should be made of light flannel, but as the child gets older the sleeping
blanket is made according to illustration (See Fig. 7) by merely folding a
blanket in such a manner that the child cannot possibly uncover himself.
The mother can sleep undisturbed, knowing that the baby is always safely
protected by at least one warm blanket cover.

COMMON FAULTS WITH MOST LAYETTES

As a usual thing the first clothes are made too small. The sleeves are too
short as well as too small around. There is nothing more uncomfortable than
a tight sleeve. Everyone of our readers knows that, and we recall one poor
little fellow who kept up a fretful cry until we took the scissors and cut the
tightly stretched sleeve up to and including the arm hole. He then relaxed
and went to sleep. Sleeves should be made two inches longer than they are
needed at first, and it is a very simple matter to pin them up or turn them
back at the wrist. They should be loose and roomy.
The yokes of the dresses usually are too tight before the slips are discarded.
Heavy seams and raw seams irritate and often make ugly impressions on
the baby's skin.
Usually the first layette is profusely embroidered, and, while it is beautiful
to look at, the mother feels when she sees it outgrown so quickly that a lot
of vital energy was wasted on garments that mattered so little as long as
baby was comfortable. Baby is dear and sweet enough without the fuss and
furbelows of such elaborate garments.
Heavy materials are sometimes used where lighter ones would serve better.

ERRORS IN CLOTHING

A soiled garment should never be put back on the baby. Dirt draws flies,
and flies are breeders of disease. Sour-smelling garments should be changed
at once. They are likely to make the baby sick and interfere with his

appetite if left on indefinitely. The care of the diaper has already been
mentioned.
The main symptom of too much clothing is sweating, and when the baby
sweats something must come off. If he has perspired so much that his
clothes are moist, the clothing should be changed and the skin well dried
with talcum powder. The feet and hands should be kept warm, but the little
head should always be kept cool. When the baby is crying and getting his
daily exercise, remove some of the covering, loosen his diaper, and let him
kick and wave his arms in perfect freedom.
When the baby's feet and hands are cool he is not warm enough. Cotton
underskirts cannot be used in the dead of winter on little babies. They do
not hold the body heat as woolen garments do. The baby's feet should
always be warm and this is particularly necessary in poorly nourished
children. The outer wrapper of woolen material should be added to such
baby's clothing. It is a safe rule to follow that if baby's hands are warm and
he is not sweating, he is "just about right."

SHORT CLOTHES

At the age from four to six months, baby's clothes are shortened. This
should not take place at the beginning of winter if it can be avoided. If the
first layette has consisted of only the necessary garments, they are nearly
worn out by the time the short clothes are due; of those that do remain, the
sleeves should be lengthened, the arm holes enlarged, and all the little
waists let out. Creeping garments and bibs are now added to baby's outfit,
as well as leggings and other necessities for outdoor wear. Remember that
all garments must be loose—then baby is happy.
About the same number of garments are found necessary for the short
clothes as were required at first; except that a large number of creeping
rompers should be added. These creeping rompers should not be made of
dark materials that do not show the soil. We desire the dirt to be seen that
we may keep the baby clean, and if the creeping romper is made of a firm,
white material it may be boiled in the laundry, thus affording ample and
thorough cleansing.

We attributed a sick spell of one baby to the dark-blue calico creeping
romper which he wore day in and day out because it "did not show" the soil.
White ones are much to be preferred, not only for looks but chiefly for
sanitary reasons.

CAPS AND WRAPS

The cap should be made of a material that will protect from drafts and cold
air, but not of such heavy materials as will cause too much sweating. There
are a number of outside wraps that can be purchased ready-made and which
are comfortable, convenient, and warm. They should be long enough not
only to cover the baby's feet well, but to pin up over the feet, thus giving
good protection from winds and drafts.
During the summer months nainsook caps or other thin materials are to be
preferred to the heavy crocheted caps that are sometimes worn by babies.
No starch should be used in the caps or strings, and there should be no
ruffles to scratch the delicate skin of the baby. In all these outer garments,
as well as the under garments, the irritation of the skin must be constantly
borne in mind, as eczema is often produced in this manner.

THE FIRST SHOES

The first shoe that is usually worn during the creeping days is a soft kid
shoe without hard soles. It is important that this soft shoe be worn to protect
the child's foot from chilling drafts while creeping about.
As the baby nears one year of age the hard-sole shoe is secured which must
be wide, plenty long and comfortable in every respect, and without heels.
Rubbers and overshoes may be worn on damp and cold days. Moccasins
and slippers do not give sufficient support to the ankles, so, when the baby
begins to walk, the shoes should be high and of sufficient support to the
tender ankles.

PLAY SUITS

As the baby grows up into the child, the tiny clothes are laid aside and the
boy is given substantial garments that in no way remind him of girls'
clothing. A child's feelings should be respected in this manner, and while it
often adds joy to the mother's heart to see her boy "a baby still," remember
that he is not only chagrined but is nervously upset by these "sissy clothes."
A child three or four years of age should still wear the woolen binder
supported from the shoulders, over which is the union suit, stockings, and
the buttoned waist from which hang the hose supporters. The most
comfortable and easily laundered garment we know of for the small lad is
the "romper," which should be made of washable materials that may be
readily boiled. For cool days a Buster Brown coat of the same material,
with patent-leather belt, may be slipped on over this washable romper—
which completes the boyish outfit.
We recall the pleasant days with our own little fellow when he was between
the ages of two and one-half and five years. We were often compelled to be
away from home—on the train, in the hotel—and when traveling we used a
black, smooth silk material which was made up into rompers with low neck
and short sleeves. There were three such rompers, and two Buster Brown
coats with wide, black, patent-leather belts which completed the traveling
outfit. During the warm days on the train the coat was folded carefully and
laid aside. In the early morning and in the cool of the evening the coat was
put on, and he always looked neat and clean. At night, before undressing
him, the entire front of the romper was cleansed with a soapy washcloth,
rinsed, and rubbed dry with a towel, and, after carefully spreading to avoid
wrinkles, it was hung over the foot of the bed. The coats were sponged or
pressed once or twice a week, and this simple outfit served its purpose so
well that it was repeated three different summers.
The little girl as she leaves her babyhood days should be put into garments
that do not necessitate the constant admonition, "Keep your dress down,
dear." We like to see knickerbockers, the exact color of the dress, made for
every outfit, in which the little girl may kick, lie down, jump, dance, climb
—do anything she pleases—unmindful of the fact that her "dress is not
down." The same undergarments are used for the little girl as were
mentioned for the little boy.

WINTER GARMENTS

Always bear in mind the over-heating of the child with heavy garments
indoors, and the danger of skin chilling and drafts on going out to play in
this over-heated condition. Let the children dress comfortably cool in the
house, and as they go out to play add rubber boots or leggings and rubbers,
sweaters, caps with ear laps or the stockinet cap. Allow them the utmost
freedom in clothes, and always encourage romping in the cool frosty air.

CLOTHING RULES

Do not overload the baby with clothing.
Dress according to the temperature of the day and not the season of the
year.
Avoid starched garments.
Avoid tight bellybands or old-fashioned pinning blankets.
Change all clothes night and morning.
Use woolen shirts and bands.
See that hands and feet are always warm.
Protect the abdomen night and day with the band.
Use the sleeping bag on cold nights.
Baby should sleep in loose stockings at night.
Avoid chilling the child.
Use hot water bags if necessary.

CHAPTER XXII

FRESH AIR, OUTINGS, AND SLEEP

Fresh air is just as important and necessary for the baby as for the adult.
Neither baby, youth, nor adult can receive the full benefit of his food—in
fact it can not be burned up without the oxygen—without an abundance of
fresh air. During the early weeks of life, the air baby breathes must be
warm; nevertheless, it must be warmed fresh air, for baby requires fresh air
just as much as he needs pure food.

INDOOR AIRING

The delicate child often requires more fresh air than does the normal baby.
Both appetite and sleep are improved by fresh air. The digestion is better,
the cheeks become pink, and all the signs of health are seen in the child
who is privileged to breathe fresh air.
During the early days, say after the third week, baby should be well
wrapped up with blanket and hood, tucked snugly in his basinet or carriage,
while the windows are opened wide and the little fellow is permitted to
enjoy a good airing. Even in the winter months the windows may be raised
in this way for a few minutes each day. These "airings" may be for ten
minutes at first, and, as the child grows older, they may be gradually
increased to four or five hours daily. The carriage or basket should stand
near the window, but not in a direct draft.

OUTDOOR LIFE

In summer, a baby one week old may be taken out of doors for a few
minutes each day; in the spring and fall, when baby is one month old, it
may go out for an airing; while, during the winter months, the airing had
better be taken indoors until he is about two months old, and even at that
age he should go out only on pleasant days and should always be well
protected from the wind.

A young baby may enjoy the fresh air in his carriage or crib on the porch,
on the roof under suitable awnings, in the yard, under the trees, and even on
the fire escape. In fact, at proper age and in season, he may spend most of
his time out of doors in the fresh air, if he has proper protection from the
sun, wind, and insects.

BEST HOURS FOR AIRING

During the balmy days of summer and early autumn, baby may spend most
of the time outdoors between seven in the morning and sunset. During the
cooler days of winter and the cool and windy days of spring, the best hours
for the airing are to be found between eleven in the morning and three in the
afternoon.
At six weeks, perhaps an hour a day in the fresh air is sufficient; while at
six months, four to six hours a day are a necessity, and from then on—the
more the better.
Now we realize that the mother of the farm household does not always have
as much time to take the baby out for his airings as many of our city
mothers; but we suggest to this busy mother that the baby be rolled out on
the porch or in the yard, within her sight and hearing, and allowed to enjoy
the fresh air while the mother continues her work.
It is virtually a crime to try to keep baby in the kitchen, hour after hour,
while the busy mother is engaged at her tasks. A hammock, a crib on
casters, or a carriage, is just the coziest place in the world for baby—out on
the porch.

THE COUNTRY BABY

The average city baby really gets more fresh air than ninety per cent of the
country babies. Our city apartments are usually steam heated, and our
windows are open in the winter nearly as much as in the summer. The
country home is often only partially heated by two or three stoves. The
windows are closed in summer to keep out the dust, heat, and flies, in the

winter to shut out the cold, and so the baby who lives in such a home has
little chance to get fresh air.
The city mother is constantly talked to about the benefits of fresh air. The
daily paper brings its health column to her, her pastor talks of it on Sunday,
and—best of all—the older children come home from school and reiterate
the doctrine of fresh air that is constantly being preached to them at school.
Screen the windows, rural mother, and oil the roads in front of your
residence, and then keep your windows open. Remember that baby's health
is of more value than the meadow lot or even a fortune later on in life. Plan
for a new heating plant, if necessary, so that the home can be both warmed
and ventilated during the winter.

WHEN NOT TO TAKE BABY OUT

If a sheltered corner of the porch is within the reach of the mother, we can
hardly think of a time when the baby cannot be taken out. It may rain, the
wind may blow, it may snow or even hail, but baby lies in his snug little bed
with a hot water bottle or a warmed soapstone at his feet. As long as the
finger tips are warm, we may know he is warm all over, and a long nap is
thus enjoyed in the cool fresh air. When the sheltered corner of the porch is
lacking, we wish to caution the mother concerning the following weather
conditions:
1. When the weather is excessively hot, take him out only in the early
morning and late in the afternoon.
2. In extremely cold, below zero, weather, let his airing be indoors.
3. Sharp and cold winds may do much mischief to baby's ears, as well as
blow much mischief-making dust into his nose and eyes. In the case of dust
or sand storms, baby remains in the house.
4. All little people enjoy the rain, and only when the raincoat, rubbers, and
umbrella are missing should they be robbed of the "rainy-day fun". In the
case of baby's outing on rainy days, ample roof protection is the only factor
to be considered; if it is adequate, then take him out; if it is lacking, let the
airing be done indoors.

WINTER OUTINGS

The very young baby is taken out for a fifteen-minute airing during the
noon hour when he is two months old; before this time he receives his
airing indoors. The interval is gradually lengthened until most of the time
between eleven and three is spent out of doors. The reddened cheeks, the
increased appetite, all tell the story of the invigorating benefits of cool,
fresh air. Most babies dislike heavy veils, and they may be avoided by a
fold of the blanket arranged as a protection shield from the wind.
The wind shield, procurable wherever baby carriages are sold, should be a
part of the outdoor equipment, as it greatly helps in the protection of the
baby.
The wind should never blow in his face; neither should he lie, unprotected,
asleep or awake to gaze up into the sunshine or the sky—or even at a white
lining of the hood of his carriage. The lining should be a shade of green,
preferably dark green. And while it may be necessary during the summer to
suspend a netting over the carriage to protect from flies, mosquitoes, etc., it
should never lie on his face.

OPEN WINDOWS

Many of our readers recall with sadness of heart a little hunchback child or
a life-long invalid confined to a bed or wheel chair because some careless
but well-meaning caretaker or mother left an open window unguarded; and
—in an unlooked for moment—baby crawled too near, leaned out too far,
and fell to the ground. The little fellow was picked up crippled for life; and
so while it is very essential to baby's health to have open windows,
admitting fresh air, they should be amply guarded. Screens afford protection
if well fastened, and in their absence a slat three inches wide and one inch
thick may be securely fastened across the opening, thus preventing all such
tragedies with their life-long regrets.

SLEEP

If any of our readers have seen a new-born baby immediately after he has
been washed, dressed, and comfortably warmed, they have observed that he
usually goes to sleep at once, and that he generally sleeps from four to six
hours. Babies, especially new-born babies, need just four things: warmth,
food, water, and sleep.
And while the babies sleep they are not to be disturbed by the fond mother's
caresses and cuddling—feeling of the tiny hands, smoothing out the soft
cheek, or stroking his silky hair—for all such mothers are truly sowing for
future trouble. Let baby absolutely alone while sleeping, and let this rule be
maintained even if some important guest must be disappointed. If such
cannot wait till baby wakens, then he must be content with the mental
picture drawn from the mother's vivid description of baby—his first smile,
his first tooth, his first recognition of the light, etc. The wise mother cat
never disturbs her sleeping kittens.

SLEEP REQUIREMENTS

Sleeping, eating, and growing occupy the whole time of young babies. Until
they are two months old they need from eighteen to twenty hours sleep out
of each twenty-four; and not less than sixteen hours up to the end of the first
year.
At six months, baby should sleep right through the night from six in the
evening until six in the morning, with a ten o'clock feed, which should be
given quietly, in a darkened room, the babe being immediately returned to
his bed.
At two or three years of age, twelve to fourteen hours of sleep is required;
while at four to five years, eleven to twelve hours are needed; when they
attain the age of thirteen years they should still have ten hours of unbroken
sleep each night.
As a general rule, children should sleep alone; even in the case of two
brothers or two sisters, separate beds are far better than a double bed for
both hygienic and moral reasons.

Baby should have a separate bed. The temptation to nurse him on the least
provocation, as well as the danger of overlying, are reasons enough for such
an arrangement.

PUTTING BABY TO SLEEP

At five-thirty in the afternoon, baby should be undressed, rubbed or bathed,
made perfectly comfortable, and fed; then, my mother reader, he should be
laid down in his little bed and allowed to go to sleep, without any coaxing,
singing, rocking, or even holding his hand. Babies will do this very thing
and continue to do it if you never begin to rock, jolt, bounce, or sing to
them; and, mind you, if you do sing to them or rock them, or even sit near
without doing anything but "just hold their tiny hands," there will come a
time when you greatly desire to do something else—you have many urgent
duties awaiting you—and baby not being old enough to understand the
circumstances, begins to wail out his feeling of neglect and abuse. It is
nothing short of wicked thus to spoil a child.
We have seen so many beautiful babies go to sleep by themselves without
any patting, dangling, or rocking, that we encourage and urge every mother
to begin right, for if the little one never knows anything about rocking and
pattings he will never miss them; and even if the baby is spoiled through
extra attention which sickness often makes necessary, then at the first
observance of the tendency on the part of the child to insist on the rocking,
or the presence of a light in the sleeping-room, or the craving for a pacifier,
we most strongly urge the mothers to stick to the heroic work of "letting
him cry it out."
The notion that the household must move about on tiptoes is not only
unnecessary but perfectly ridiculous. From the very hour of his birth, let the
child become accustomed to the ordinary noises of the home, and if this
plan is early started he will prove a blessing and a ray of sunshine to the
family and not an autocrat to whom all must bow and bend the knee.

BEDTIME AND SLEEPING POSITION

Bedtime is regulated somewhat by the hour of rising in the morning.
Usually, up to two years, baby is put to bed from five to six p. m. Regularity
is urged in maintaining the bedtime hour.
The seven o'clock bedtime hour is later established and continued until the
young child attains school age, when retiring at the curfew hour of eight
o'clock gives our boy or girl from ten to eleven hours of sleep, which is
essential to proper growth, calm nerves, and an unruffled temper.
The first few days finds our little fellow sleeping nine-tenths of his time.
Let him lie on his right side, for this favors the complete closure of the fetal
heart valve, the foramen ovale.
Whether baby lies on his stomach, his side, or with the hands over his head
is of little or no consequence. His position should be changed first from one
side to the other until he is old enough to turn himself.

WAKING UP AT NIGHT

Before baby is three months old, he should receive nourishment during the
night at nine and twelve, and again at six in the morning. After four or five
months a healthy child should not be fed between the hours of ten p. m. and
six a. m. At this age, many children sleep right through from six p. m. to six
a. m. without food.

After five months, if a healthy baby awakens between ten p. m. and six a. m.
warm water may be given from a bottle; he soon forgets about this and the
night's sleep becomes unbroken. There are many other reasons than the
need of food that cause the wakefulness of the child; and since the baby
should, after a few months, sleep undisturbed and peacefully, if he is
wakeful and restless—crying out in a peevish whine—and then quiets down
for a few moments only to cry out again, you may suspect one of a half-
dozen different things. Let us, therefore, summarize the things which may
disturb baby's sleep:
1. Lack of Fresh Air. Babies cannot sleep peacefully in a hot, stuffy room, or
in a room filled with the fumes of an oil lamp turned low. A crying fretful
baby often quiets down as if by magic, providing he is not hungry and the

diaper is dry, when taken into a cool room with fresh air. After the first two
months the temperature of the sleeping room should be fairly cool and
fresh.
2. Clothes and Bedding. The night clothes may be irritating and causing
perspiration, while the bedding may be wrapped too snugly about the child.
If baby's neck is warm and moist, you may know that he is too warm. If the
diaper is wet it should be changed at once. One of the worst habits a baby
can possibly get into is to become so accustomed to a wet diaper that it does
not annoy him. In cold weather he is changed under the bed clothing
without exposure or chilling. It may be the bedding is cold and, if so, it
should be warmed up by the use of the photophore previously described, or
by means of the flannel-covered hot water bottle.
3. The Food. Too little, too much, or the wrong kind of food, will disturb
baby's sleep. Indigestion is very easily produced in babies who are
improperly fed. For instance, the mother's milk may be lacking in
nourishment and baby may really be hungry; or, as in the case of a bottle-
fed baby, it is usually due to over feeding. Many mothers we have known
who sleep with their babies or who sleep very near them, nurse them every
time they wake up or murmur, and this soon becomes one of the biggest
causes of disturbed sleep.
4. Spoiling. A lighted nursery or bedroom, rocking to sleep, jolting the
carriage over a door sill or up and down, the habit of picking baby up the
moment he cries, late rompings—any and all of these may disturb sleep, as
well as unsettle the tender nervous system of the child, thus laying the
foundation for future nervousness, neurasthenia, and possibly hysteria. This
is particularly true in the case of the children who have nervous parents.
5. Reflex Causes. Wakefulness is sometimes due to reflex nervous causes
such as the need for circumcision, or the presence of adenoids, enlarged
tonsils or worms. Does baby have to breathe through his mouth? Then you
may suspect adenoids or other conditions which should be removed.
6. Chronic Disorders. The presence of scurvy or syphilis causes the child to
cry out sharply as if in acute pain, while in older children tuberculosis of the
spine or hip is attended by a sharp, painful crying out during sleep.
Malnutrition or anemia are also conditions which greatly disturb sleep.

7. Soothing Syrups. Untold trouble, both physical and nervous, is bound to
follow the giving of soothing syrups. These medicines soothe by knocking
the nerves senseless and never by removing the cause. They contain
morphin, opium, cocain, heroin, and other drugs which deaden pain, and are
most dangerous to give baby.

DAILY NAPS

The morning nap from the sixth month on should be from two to three
hours long, out on the porch, well protected; while the afternoon nap may
be from one to one and a half hours long with an interval of two or three
hours before bedtime. The child should be wakened at regular intervals for
feedings during the day—every three hours until he is six months old, and
then every four hours. These naps should be taken in a cool place—on the
porch, on the roof, in the yard, under a tree, or on the protected fire escape.
If the nap is to be taken indoors, then lower the windows from the top and
darken the room. All children should take daily naps until they are five or
six years old.

CHAPTER XXIII

BABY HYGIENE

Possibly if all our babies could grow up in a mild, warm climate, out of
doors, where they were cared for by mothers who had nothing else to do but
enjoy nature in a garden, their babies unhampered by clothes and other
conventionalities inflicted upon us by our present standards of living—well,
if that were our environment, probably this chapter on baby hygiene would
not need to be written. But realizing that variable climatic conditions, the
indoor life, and the necessary bundling up with clothes, all tend to increase
the ever-present danger of infection from thickly settled peoples and their
domestic pets—these facts, together with the further fact that modern social
conditions make it necessary for some mothers to toil long hours—all these
influences, I say, considered separately or combined, make it imperative for
us to give thoroughgoing consideration to the essentials of baby hygiene.
The subjects of fresh air, sleep, bathing, etc., have been duly discussed in
previous chapters.

WATER DRINKING

As soon as the newborn baby has been washed and dressed, before he is put
to sleep, he is given two teaspoons of warm, boiled water in a sterile bottle
with a clean nipple. This is repeated every two hours when he is awake,
until he is old enough to ask for water himself. This water should contain no
sugar, or anything else—just clean, boiled water. It is better to give this
water from a bottle; for in case of enforced weaning, this practice of taking
his water from a bottle, will have made him acquainted with that method of
feeding.

URINATION

The baby may pass very little urine during the first day or two of his life,
but if the warm, boiled water is administered regularly, the urine will soon

become more abundant.
As the child nears two years of age, if put to bed at six p. m. he should be
taken up at ten or eleven to urinate.
In older children, bed wetting is often corrected by serving the last meal not
later than four p. m. and not allowing any liquids after that hour.
The physician should be consulted in all instances where the habit of bed
wetting extends beyond three years. The subject will be treated more fully
in a later chapter.

EXERCISE

A baby pen, lifted up from the floor, well protected at the sides, and covered
with mosquito bar—if exposed to flies or mosquitoes—affords splendid
opportunity for exercise. Here the little fellow may lay on a well-padded
mattress and kick, move his arms, and otherwise roll about to his own
satisfaction. It should not be in the direct sunshine, but rather in a protected,
somewhat shady place, yet where the air is pure and fresh.
Much exercise is obtained from the daily cry. Here, the arms, legs, hands
and feet, as well as the body, are all exercised until the baby is pink. A good
rebound of blood is flowing through the well-warmed skin, while the baby
is greatly benefited by such daily exercise.
Later on, "creeping" is urged, but not forced. With regard to standing—he
will pull himself up on his feet just as soon as nature qualifies him, and so
he needs no urging or coaxing in this matter. Older children should be
encouraged in active romping, games, etc., rather than to spend the entire
day in the more sedentary amusements, puzzle pictures, etc.
It is a most abnormal situation when a three-, or four-year-old child is
content to sit quietly all day. There is usually something seriously wrong
with a child who never soils his rompers, who never makes a noise, and
who does not seem to enjoy normal play and fun.
Let the little folks early learn that the home is theirs to enjoy and that their
little friends are welcome; and thus you may be spared such a reproof as

one little lad of four unknowingly gave his mamma. His little friend was
approaching the stairs of the play room, when the thoughtless mother
carelessly and impatiently remarked: "Oh, are you going to bring Ned
upstairs? you'll make so much noise." The little host met his friend at the
top with the words: "They don't want boys in the house, we'd better go
outdoors." The mother "woke up" and arranged a little "party" upstairs for
the two husky, healthy—and noisy—boys.
During the creeping days remember that the floor is the coolest part of the
room, and in the absence of the creeping pen, which is "built up" two feet
above the floor, extra clothing should be put upon the child while on the
floor. During the damp days of early spring and the cool days of late fall, as
well as on the bleak days of winter, baby is better off if he is kept off the
floor. It is a fine plan to put a number of table boards on top of the springs
of the baby's bed; in this way a sort of pen is produced which is high above
the cold floor and the baby is content to spend much of his time in this little
pen, happy with his playthings.

KISSING THE BABY

We most strongly protest against the haphazard, promiscuous kissing of
babies. Many forms of disease, such as tuberculosis, syphilis, diphtheria,
influenza, common colds, etc., may be carried to the child in this way.
The baby, notwithstanding his attractiveness, his beauty, and his grace,
should not be overfondled. Kissing the hand is not much better than the
mouth, for the hand quickly finds its way to the mouth. If it be necessary to
kiss a baby, then let the kissing be done on the back of the neck or on top of
his head, but never on the face or hand.

SUCKLING HABITS

There came into the office one day a woman forty or more years of age,
whose mouth was markedly disfigured, and on my inquiring as to the
probable cause she said: "Doctor, it is the result of sucking my thumb when
I was a mere child, too young to know better, and every time I look into the
glass, which I assure you is only when I am compelled to, I curse my

parents for not breaking me of that habit." The indulgent parents were hated
and despised for neglecting their duty, because of the disfigurement which
resulted from this unrestrained habit of early childhood.
Thumb sucking, finger sucking, or pacifier sucking, are all filthy habits, and
should be early discouraged. To aid in overcoming the habit of sucking the
thumb or biting the fingernails, the ends of the fingers and edges of the nails
may be painted with a solution of aloes or quinine. In extreme cases, a
splint may be placed on the anterior bend of the elbow, thus preventing the
possibility of raising the hand to the mouth.
The "sugar teat" of our mother's generation has passed, as has also the
"mumbling" of food for the young child; we no longer give the babies
concentrated sugar, nor do we "chew" our children's food at the table.
Extreme cases of chalk or dirt eating have been noted; such tendencies are
decidedly abnormal, and require medical attention.

KEEP BABY WARM

Much colic and fretfulness may be avoided if baby is kept warm. The finger
tips are a good thermometer, for if they are warm the feet usually are.
"Bundling" is unnecessary, but careful attention should be paid to keeping
the feet and hands warm without making the child sweat; that is an art, and
all mothers should attain it. An extra flannel wrapper and a pair of heavy
wool booties in the winter are good warmth producers. Cotton flannel
petticoats should be replaced by warm woolen ones, and when the baby
begins to get about on his hands and knees a pair of loosely fitting wool
tights, made from discarded woolen underwear are of inestimable comfort
and value. In the effort to avoid draughts and body chilling, ever bear in
mind baby's need of fresh air and the dangers of sweating, for the sudden
cooling of a sweating child is a forerunner of pneumonia, cold catching,
diarrhoea, and other troubles.

BABY'S TEMPERATURE

During early infancy, baby's temperature sometimes varies greatly; for
instance, a rectal temperature may register 97.5 or 100.5 F. while the child
may be in perfectly good health.
The baby's temperature should be taken at the rectum—which should
normally register 99.5 F. This temperature, as stated above, may register
100.5 F., with no other symptoms of illness. In taking rectal temperature the
thermometer should remain in place two minutes.
The groin is the next best place to take the temperature; here the
thermometer should remain five minutes, and the registry is usually a
degree lower than that of the rectum.
The baby's temperature usually is a good guide to the severity of any
illness. In case the temperature runs above 101 F. the physician should
always be notified and his orders carefully followed. Slight causes often
produce a high temperature of 103 to 105 F. for a short time; but such a
temperature of long duration means serious trouble and demands expert
advice and attention. Abnormal temperature will be more fully considered
in that section of this work entitled "Common Disorders of Infancy."

BABY BOUNCING

The common custom of bouncing or trotting baby on the knee is a harmful
one. The young and growing nervous system of the child is decidedly
injured by this constant jolting and jiggling, to say nothing of the "spoiling"
effects of this practice. There is a vast difference between the sensitive
nervous system of the infant, with its liability to shock and disturbances,
and that of the settled and developed nervous system of an adult. The
strength of the mother or nurse is so great that the jarring not only often
causes indigestion and vomiting in the infant, but sometimes also lays the
foundation for "wrecked nerves" in later life.
The tossing of baby in the air comes in for the same condemnation. Baby is
not "our plaything," and must not be bounced and tossed about like a rubber
ball.

CARRIAGES AND GO-CARTS

The first carriage should be roomy and comfortable. The bed should be
thirty-three inches long and fourteen inches wide, and should be twenty-
eight or thirty inches from the floor. The wheels should be rubber tired. The
cover should be a good sized hood containing a dark lining, and provided
with a wind shield. This dark lining creates a neutral shade for the eyes and
protects them from the glare of the sun and the bright skies.
The bed of the carriage should be soft and warm; and, with the size before
mentioned, there is ample room for the "tucking in" with warm blankets,
which are first spread out on the bed and then the baby placed into the
blanket, after which it is brought up and over him.
The folding go-cart and the small carrying-basket are to be used only in an
emergency. They are convenient in traveling or shopping for the mother
who has no maid or caretaker with whom to leave the baby; but they are not
satisfactory pleasure vehicles, neither should the baby be left to sit fastened
in one of these carts for any great length of time.
The mattress of the carriage should be of hair, while needed warmth may be
secured by the use of a thick, light-weight woolen blanket, placed under the
child and brought up and around him.
A top covering for the carriage must have washing or dry cleaning qualities.
A crocheted afghan, a washable embroidered cover, or a firm silk puff, are
good covers. The one thing to be remembered is that everything about the
carriage soils readily, and if this thought enters into the selection of fabrics,
you will not be disappointed when cleaning time comes.
The carriage pillow should be of down, except in the very hot months, when
hair is preferable. Simple, easily laundered slips may be made from two
men's-size handkerchiefs.

BOW LEGS

Particularly in boys and men, bow legs are not only awkward but are a
noticeable deformity; even the little folks notice them and often remark
about it, as did one child who sat profoundly eyeing a very important visitor
who stood before the cheerfully lighted grate warming himself. The little

fellow suddenly exclaimed, "Oh, Mister, look out! You're warping." Such a
painful experience might have been saved this distinguished gentleman had
his mother or caretaker not urged his standing too soon; and at the same
time had fed him on the proper food, so as to avoid "rickets." The
ossification or hardening of the bones of the legs continues all through
childhood and is often interfered with by improper feeding during the first
two years of life. Urging the little people to stand too early is to be
discouraged. Nature prepares them for it when the right time comes; which
time varies—thin children standing and walking usually much earlier than
heavy children.

LIFTING THE BABY

A very young baby should be lifted from his bed by grasping the clothing
below the feet with the right hand, while the left hand slips underneath the
back and with spreading fingers supports the neck and head. It is then raised
upon the left arm. During the early months the entire spine must be
supported in this manner (See Fig. 6). In grasping a baby under the arms or
about the waist, undue pressure is made upon the abdomen and chest.
Serious injury often follows the careless lifting of the older child by his
wrists or hands. The throwing or whirling of the older children by the arms
is strongly condemned. Dislocations have followed such careless so-called
fun.

PREVENTION OF FALLS

In the selection of the high chair, care should be given to the possibility of
overturning. Fortunately, baby's bones are only partially ossified, else he
would sustain many fractures in the frequent falls and bumps. When we
pause to consider the thoughtless manner in which many babies are left on
beds and in unguarded chairs, it is not strange that they fall so often.
Open windows must be carefully protected by well-fastened screens or by
slats of wood. Beds afford a good place for a romp or play, but high-backed
chairs should be placed at the side to prevent a fall. A strap across the waist
should be fastened to the sides of the carriage to prevent falling out.
Everything possible should be done to prevent falls. Outdoor hammocks are

exceedingly dangerous for the baby. Never leave a child in one unguarded.
A little caution, a large amount of common sense—the "good use of
brains"—will prevent scars and other lifelong deformities.

THE BABY'S BREASTS

Never allow anyone to manipulate or "break down" a swollen breast in a
girl or boy baby during the first week or two. This swelling occurs often
and should not be interfered with. A hot compress of boracic acid solution
may be applied, after which a piece of sterile gauze should be placed over
the swollen part and held on by a muslin bandage. Secure medical attention
if the swelling does not go down in a day or two.

VISITING

Unless absolutely necessary, babies should not be taken on trains and street
cars; nor should they take long journeys into the country to attend
"reunions." Infections accompany crowds, and baby is far better off at
home, in the quiet of his natural surroundings, than he is in the dust,
closeness, and bustle of illy ventilated cars, streets, shops, movies, or even
at church. Many an infant has been sacrificed by a train journey to "show
him off" to the fond grandparents; scores of babies acquire whooping cough
at the movies; and many a baby has nearly lost his life by catching measles,
scarlet fever, or diphtheria at church; while the only thing accomplished by
the church experiment was the spoiling of the entire service by its fretful,
tired cry—the infant's only means of protest.

THE RUNABOUT BABY

"Runabouts" are the little folks between the age of one and three years, and
they require good care, good feeding, and warm and comfortable dressing.
In general, they need the same fresh air, daily outings, and daily naps of the
younger child. Their hands need washing oftener, and their clothing, which
is usually a play romper, should be either of white or fast colors that it may
be most thoroughly boiled, thus getting a good disinfection. Their eyes,

nose, and ears, as well as the genital organs, all require the most rigid daily
cleanliness.
The "bugbear" second summer need not be feared by the mother who takes
particular care to see that:

1. The drinking water is boiled or distilled.
2. The orange is not overripe.
3. The banana is not underripe or overripe and is not eaten in chunks.
4. The milk is fresh and pasteurized.
5. The baby does not eat candy, ice cream, or other forbidden foods.
6. The baby's bowels move daily.
7. He does not remain dirty.
8. He naps daily.
9. He is protected from dust, flies, flees, and mosquitoes.
10. He does not go visiting, to church, shops, or "movies."

The second summer is no harder than the first, as good clean water, easily
digested foods, and good general hygiene are all a baby needs at this time.
A large army of little folks grow up in spite of the little care they get and the
place in which they live. Did they not possess good vital resistance, sound
nerves, and good digestion, the children of the "slums" and of the "ghetto"
would quickly succumb to their unhygienic surroundings.

TOYS

In selecting toys for the infant, it must be borne in mind that they will be
put to the mouth, and hence they should not be:

1. Toys with sharp points.
2. Small enough to swallow, or to push into the nose.
3. Covered with hair or wool.
4. Glass that is easily broken.
5. Painted toys.
6. Toys that may be taken apart and the small parts swallowed.
7. Paper books that may be chewed or torn.

Bear in mind that babies are easily amused with such simple toys as:

1. A half-dozen clothes pins.
2. An aluminum pan and a spoon.
3. Rubber toys (easily washed).
4. Celluloid dolls, ducks, and other floating toys.
5. Blocks.
6. A large rubber ball.

The older children have wonderfully good times out of doors with a spade,
a cart, and the sandpile. Boys most thoroughly enjoy a track with its engine
and cars, switches, etc. They build sham fortifications, truly works of art,
with their blocks, while the girls are happiest with dolls and household sets.
However, occasionally we meet a mother who has a girl who is really a boy
in her tastes for toys, and so we say to that mother: give the little girl the
desire of her heart; if it's a train instead of a doll, or a toy gun instead of a
doll's trunk, well and good, let her have them. What we want are free and
easy, natural, children. They are much more likely to have good nerves,
clean thoughts, sound digestion, and equalized circulation.

CHAPTER XXIV

GROWTH AND DEVELOPMENT

The newborn baby comes into the world in an absolutely helpless condition
and completely unconscious of his surroundings. He unconsciously
performs certain acts, such as opening his eyes, crying, urination,
movement of the bowels, and even nursing of the breast; but there is
probably no distinct voluntary action connected with any of these acts. All
of his senses at birth are practically dormant, but as the days and weeks go
by, they begin to awaken.

SPECIAL SENSES

The baby cries, but the tears do not actually flow over the lids until he is
three or four months old, and while the baby may fix his eyes upon objects
and distinguish light from darkness, he will not wink nor blink when the
finger is brought close to the eye. Vision is probably not complete until the
beginning of the third month.
Infants are said to be deaf for the first twenty-four to forty-eight hours after
birth, and some authorities hold that they are deaf for several days.
Taste is early developed, as a newborn baby will often repeatedly show a
desire to taste sweet things, while if sour or bitter things are put to the
tongue, it shows its displeasure.

HAIR AND SCALP

The newborn baby usually comes into the world with a good head of hair,
but the end of the first or second week witnesses the falling out of much of
this hair, and falling may continue for even another week or two. The hair is
often worn off on the back of the head because of constant friction upon the
pillow.

Children differ greatly in the growth of hair. Some of them come into the
world with heavy hair, and others lose it quickly and remain nearly bald-
headed until after the first year.
As the second hair grows in, it is usually lighter than it was at birth and
lighter than it will be later in life, as the hair has a tendency to grow darker
as the years go by.
The scalp should receive the care already mentioned. As the hair comes in it
should be shampooed once in two weeks and brushed often, making it
healthy and vigorous.

MISSHAPEN HEADS

It is wise to turn the baby first on one side and then on the other and not
allow him to sleep night after night on one side of his head. The newborn
head may be misshapen by laying the child constantly on one side, and the
ear may be misshapen if it is allowed to curl under or become pressed
forward. Markedly protruding ears may be partially corrected by having the
child wear a well-ventilated cap made for the purpose.

THE SALIVA

Many mothers think that the presence of drooling or the excessive flow of
saliva is associated with teeth cutting. While it may be associated with the
teeth, this is not usually the case; it is more probably due to the beginning
of a new function of secretion. The newborn baby has only enough saliva to
furnish moisture for the mouth, and not until the age of four or five months
does saliva really flow, and since the teeth appear a bit later we often
confuse the institution of a new secretion with the oncoming teeth.

SENSATIONS AND RECOGNITION

The young baby manifests a number of sensations early in its career.
Hunger and satisfaction as well as comfort and discomfort seem to be
recognized by the little fellow. He early learns that the approach of someone
when he cries usually means that he is to be taken up, and he usually ceases

crying as soon as he is taken up. He early manifests a sense of comfort
when he is cuddled; there also is early present a manifestation of the desire
to sleep, and the satisfying pleasure of a drink of water.
At the age of three months he has recognized many things such as the light
or a bright object. He distinctly recognizes his mother and often smiles at
her approach. He recognizes his hands at four months, and now begins to
recognize other members of the household aside from his mother. Even as
early as one month, he may smile at his mother. At two months of age he
will often smile at other members of the family. He laughs out loud or
chuckles during the fourth or fifth month. But, on the whole, he must be
considered as just a little animal whose greatest needs are to have his
appetite and thirst satisfied, his little body clothed, and his little nerves put
to rest—to sleep.

SITTING ALONE

At four months the normal baby will hold up his head; and if he is
supported at the back with a pillow, he will sit erectly—holding his head up
—at six months; while at eight months or not later than nine, the normal
child should sit alone on the floor with no support. Later in the ninth month
he often manifests a desire to bear his weight upon his feet. Care is here
urged that the mother protect the little fellow at this time and not allow him
to rest his weight upon his feet but a moment or two at a time.
He will reach for a ball suspended from the top of his carriage or bed as
early as the fifth month. About this time he discovers his toes while in his
bath. He will handle a rattle at six or seven months, and shows delight in
such toys.

DENTITION

In both the upper and lower jawbones of the newborn infant there are
hidden away in snug little cavities two sets of tiny teeth; the first set, or
milk teeth, and the second set, or permanent teeth. These rudimentary teeth
grow as the baby grows and push their way up or down from the jawbones

until they finally make their appearance through the gums. The milk teeth
appear in a definite way and in five definite groups.
There should be no physical disturbance at the appearance of the teeth,
which is a physiological process, and it is to be deplored that all of the ills
of babyhood are laid upon the teeth with the careless remark: "Oh, its his
teeth!" Many, many illnesses are neglected because our inexperienced
mother has been told that she can expect "anything to happen when the
baby is cutting its teeth." Now, it is true that the babies of many families do
have trouble in cutting their teeth, but the majority of babies cut their teeth
comfortably and the first knowledge anyone has of it is the appearance of
the tooth itself. As the teeth push their way nearer the surface of the gums,
there is a broadening and a hardening of the gums themselves, and it is the
exception rather than the rule that the baby needs any help in cutting his
teeth.
Usually by the time the baby is seven months old it has two central teeth on
the lower jaw (the central incisors), which constitute the first group. The
second group of teeth to appear is the four upper central teeth which are all
through by the time the baby is twelve months old, and are often through at
ten months. Then there is a pause of from one to three months before the
next teeth appear—the four anterior molars. As these four anterior molars
come in, the two lateral incisors appear on the lower jaw, which now gives
us, by the time the baby is fourteen or fifteen months old, four central teeth
upper, four central teeth lower, and the four anterior molars, which make
twelve teeth.
Another pause of two or three months and then we get the four canine,
which fill in the space between the first molars and the front teeth. The
canine on the upper jaw are commonly known as the eye teeth, while the
canine teeth on the lower jaw are spoken of as the stomach teeth. This
brings us to the age of eighteen to twenty-four months, when there is still
another pause of two or three months, after which time the big teeth or the
four posterior molars appear, which completes the first set of twenty teeth—
the milk teeth. When baby is twenty months old the milk teeth are often all
in. The complete set should appear not later than the thirtieth month.

During the life of the milk teeth the child should be taken to the dentist at
least once a year, better once in six months, for all defective teeth must be
properly and promptly cared for. Inexpensive but sanitary fillings should be
placed in all decayed teeth, for the roots of the first teeth are very soft and
infection readily spreads to the jaws and the permanent teeth and serious
trouble often begins thus early.
If dentition is seriously delayed, investigation should be started concerning
the general condition of the child, for this delay often accompanies ill
health.
When the child is six years old, the mother should be watchful, for it is at
this time that the first permanent teeth appear just behind the last molar of
the milk teeth. They do not replace any of the teeth present, and many times
they come through and decay without receiving any attention. It is seldom
necessary to assist these milk teeth as they come through the gum, and
should the gums become highly colored and swollen it is not wise to lance
them, for if the teeth are not ready to come through immediately, the gum
only toughens the more and makes the real cutting still more painful.
This is the time to cut down the baby's food as well as to look for other
digestive disturbances, for the number of stools may increase and vomiting
may occur, and by reducing the quantity and quality of the food and
encouraging abundant water drinking, much trouble may be avoided. Under
no circumstances urge the baby to eat when he refuses his food, when the
gums seem swollen and red during the teething time. You will find that he
will enjoy orange juice, pineapple juice, or prune juice. All of these
digestive symptoms are simply the result of "feeling bad," and if heavy food
of his regular feeding is greatly diminished he will get along much better
than if fed his regular allowance of food.

APPEARANCE OF THE TEETH

The normal child has:
Six teeth at one year.
Twelve teeth at one and one-half years.
Sixteen teeth at two years.

Twenty teeth at two and one-half years.
When the child is six years old the first permanent tooth appears just back
of the last of the milk teeth. By the time he is seven, the four central teeth,
two above and two below, are out and the new ones begin to appear. The
order of their appearances is as follows:

Four first molars 6 years
Four central incisors 7 years
Four lateral incisors 8 years
Four first bicuspids 9 to 10 years
Four second bicuspids 10 to 11 years
Four canines 11 to 13 years
Four second molars 12 to 15 years
Four third molars 17 to 25 years

DENTAL SUGGESTIONS

A better plan than to lance swollen gums is to rub them gently with ice
wrapped in a soft cloth, or to dip the finger in ice water and rub the gums—
this often gives the baby much relief.
Often the baby finds comfort in biting on an ivory ring, but the utmost care
must be used in keeping it clean and avoiding contamination by allowing it
to drop on the floor.
Convulsions are never the symptoms of teething. Consult a physician at
once, as such seizures probably spring from causes other than teething.
Cleansing of the teeth should be carried out systematically every morning
by means of a piece of cotton which has been dipped in a boric-acid
solution or a solution of bicarbonate of soda (common baking soda). A soft
brush may be used for cleansing, and when there are particles of food
between the teeth they should be removed by strands of waxed floss.

Throughout life, frequent visits should be made to the dentist; during early
childhood days he should be on the lookout for symptoms which indicate
deformity—narrow jaws and other conditions which affect the permanent
teeth. During adolescence and adult life the teeth should be examined every
six months and cleansings of the mouth should become a part of the daily
toilet.

THE WEIGHT

During the first year, nothing gives us so much information concerning the
child's general well-being as the weight. Such a record will not only
enlighten the mother concerning the development of the child, but the
grown-up child appreciates the record and preserves it along with the other
archives of babyhood days. Every Sunday morning, when the father is at
home, the baby should be weighed and an accurate record kept. It is
important that the baby be weighed each time in the same garments—shirt,
band, diaper, and stockings—for every ounce must be accounted for.
Until the baby is five or six months old he should gain from four to eight
ounces a week. Anything short of this is not enough and should be reported
to the physician. After six months the gain is about a pound each month.
This varies somewhat; possibly during the tenth and eleventh month the
gain is lessened, but by the close of the first year the baby should have
trebled its birth weight.
Dr. Griffith gives us the following very interesting bit of information
concerning the weight of boys and girls after the first year, and to him also
belongs the credit for the accompanying table showing the growth, height,
and weight of the child up to sixteen years of age.

After the first year we notice that, taking it all together, there is a gradual
increase in the number of pounds and a decrease in the number of inches
added yearly, four inches being gained in both the second and third years,
three inches in the fourth and fifth years, and after this two inches a year.
The gain in weight is four pounds yearly from the age of three to that of
seven years, then five, then six, and then about nine pounds. It sometimes
happens that at about the age of nine in girls and eleven in boys there is
almost a cessation of growth for a short time. Later, at about twelve years,
girls take on a particularly rapid growth, and decidedly exceed boys of the
same age in weight, and sometimes in height also. At fifteen or sixteen
years the rapidity of growth in girls, both in weight and height, will be
greatly diminished, while boys of this age will often begin to develop very
rapidly, and will soon materially exceed the other sex in both respects.
TABLE SHOWING GROWTH IN HEIGHT AND WEIGHT
Age. Height. Weight.
Birth 19 7 lbs. 8 oz.
inches.
1 week 7 " 7½ "

2 7 " 10½ "
weeks
3 8 " 2 "
weeks
1 20½ " 8¾ " } Gained 1 oz. a day;
7 oz. a week
month
2 21 " 10¾ "
months

3 22 " 12¼ "
months Gained ¾ oz. a day;
4 23 " 13¾ " } { 5½ oz. a week
months

5 23½ " 15 "
months
6 24 " 16¼ " }
months Double original weight.
7 24½ " 17¼ " Gained 2/3 oz. a day;
months 42/3 oz. a week
8 25 " 18¼ "
months
9 25½ " 18¾ "
{ Gained ½ in. a month
months
10 26 " 19¾ "
} Gained about 1 lb. a month

months Treble original weight.
11 26½ " 20½ "
months
1 year 27 " 21½ "

2 years 31 " 27 "
3 years 35 " 32 " } { Gained 4 in. a year
4 years 37½ " 36 "
5 years 40 " 40 " } { Double original length.
Gained 3 in. and 4 lbs. a year.

6 years 43 " 44 "
7 years 45 " 48 " } { Gained 2 in. and 4 lbs. a year.
8 years 47 " 53 "
9 years 49 " 58 " } { Gained 2 in. and 5 lbs. a year.
10 51 " 64 "
years
11 53 " 70 " } { Gained 2 in. and 6 lbs. a year.
years

12 55 " 79 "
years }

13 57 " 88 "
years
14 59 " 100 "
years
15 61 " 109 " { Gained 2 inches and about
9 lbs. a year.
years
16 63 " 117 "
years

GENERAL DEVELOPMENT

The accompanying illustration (Fig. 14), taken from Dr. Yale, represents the
developmental changes at one, five, nine, thirteen, seventeen, and twenty-
one years. Each figure is divided into four equal parts, and as we watch the
development from the baby who at one year, as Dr. Yale says, is four heads
high, at the age of twenty-one the legs and the trunk have much outgrown
the growth of the head, so that at this age the head is only two-thirteenths or
less of the whole length of the body. The legs have grown more rapidly and
equal one-half the entire body length. The trunk has not kept pace with the
legs, for as you will see from the diagram the line reaches the navel of the
child in one year, while in the adult it is much lower. The rapid growth of
the legs is accomplished after nine years of age.

Fig. 14. Developmental Changes.

The proportions of the head, chest, and abdomen are exceedingly important
in the growing child. At the end of the first year the head, chest, and
abdomen are about uniform in circumference. The head may measure one-
fourth of an inch more, but the chest and abdomen should both measure
eighteen inches in circumference at this time. Should the head or the
abdomen be two inches larger than the chest; the attention of the physician
should be called to it, for either are indicative of conditions that should be
carefully investigated.

NORMAL BREAST WEANING

As a general rule the normal, healthy, breast-fed baby is given a feeding of a
bottle each day after he is ten months old. These bottles are increased in
number until, by the time the baby is a year old, he is gradually weaned
from the breast. Should the ninth month of baby's life arrive in the hot
summer months we urge the mothers to continue breast feeding, with
possibly the addition of some fruit juices, as noted elsewhere, until early
autumn. Under no circumstances should the baby be weaned and compelled